IFPRI Discussion Paper 01309 
                         December 2013 
            The National Health Insurance Scheme in Ghana 
              Implementation Challenges and Proposed Solutions 
                      Gissele Gajate-Garrido 
                        Rebecca Owusua 
                Development Strategy and Governance Division 
                              
                   INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE 
                   The International Food Policy Research Institute (IFPRI), established in 1975, provides evidence-based 
                   policy solutions to sustainably end hunger and malnutrition and reduce poverty. The Institute conducts 
                   research, communicates results, optimizes partnerships, and builds capacity to ensure sustainable food 
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                   IFPRI collaborates with partners around the world, including development implementers, public 
                   institutions, the private sector, and farmers’ organizations, to ensure that local, national, regional, and 
                   global food policies are based on evidence. IFPRI is a member of the CGIAR Consortium.
                                                                                                                           
                   AUTHORS 
                   Gissele Gajate-Garrido(g.gajategarrido@cgiar.org) is a research fellow in the Development Strategy 
                   and Governance Division of the International Food Policy Research Institute (IFPRI), Washington, DC. 
                   Rebecca Owusua was a research officer in the Development Strategy and Governance Division of IFPRI, 
                   Accra, Ghana, when she wrote this work. 
                   Notices 
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                   IFPRI. 
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                                                       Contents 
               Abstract                                                                                v 
               Acknowledgments                                                                        vi 
               Abbreviations and Acronyms                                                            vii 
               1.  Introduction                                                                        1 
               2.  Ghana’s National Health Insurance Scheme                                            3 
               3.  Data Collection                                                                     7 
               4.  Results                                                                             8 
               5.  Discussion and Conclusions                                                        27 
               Appendix:  Supplementary Information and Tables                                       31 
               References                                                                            33 
                                                            iii 
                   
                                                                     Tables 
                  4.1 Percentage of District Mutual Health Insurance Schemes (DMHIS) facing scheme-related barriers  
                      that affect children’s access to healthcare, 2008                                                        9 
                  4.2 Percentage of District Mutual Health Insurance Schemes facing parental and district barriers that 
                      affect children’s access to healthcare, 2008                                                             9 
                  4.3 Percentage of District Mutual Health Insurance Schemes s facing internal challenges, 2008               10 
                  4.4 Percentage of District Mutual Health Insurance Schemes facing external challenges, 2008                 12 
                  4.5 Percentage of District Mutual Health Insurance Schemes applying management solutions to deal  
                      with internal challenges                                                                                13 
                  4.6 Percentage of District Mutual Health Insurance Schemes applying management solutions to deal  
                      external challenges                                                                                     14 
                  4.7 Percentage of District Mutual Health Insurance Schemes noting internal actions that can be taken  
                      to improve the scheme                                                                                   16 
                  4.8 Percentage of District Mutual Health Insurance Schemes noting external actions that can be taken  
                      to improve the scheme                                                                                   17 
                  4.9 Percentage of District Mutual Health Insurance Schemes in each region that demanded the  
                      following requirements to determine indigent status                                                     24 
                  A.1 District Mutual Health Insurance Schemes and facilities accredited by region, 2008                      32 
                  A.2 NHIS membership by region, 2008                                                                         32 
                                                                    Figures 
                  4.1 Evolution of annual premiums for nonexempt adults (in GC¢)                                              18 
                  4.2 Evolution of renewal fees for nonexempt adults (in GC¢)                                                 19 
                  4.3 Evolution of renewal fees for children (in GC¢)                                                         19 
                  4.4 Evolution of card processing fees for nonexempt adults (in GC¢)                                         20 
                  4.5 Evolution of card processing feesfor children (in GC¢)                                                  20 
                  4.6 Evolution of waiting periods for nonexempt adults when registering                                      21 
                  4.7 Evolution of waiting period for children when registering                                               21 
                  4.8 Rule to be able to register children for free in the NHIS, 2011                                         22 
                  4.9 Total number of exceptions for children to benefit from the NHIS without parents being registered, 
                      2011                                                                                                    23 
                  Figure 4.10 Total number of requirements to be assessed as indigent, 2011                                   27 
                                                                        iv