In the 2016 NPP manifesto, on page VI, Nana Addo, in outlining his vision for Ghana, lamented the sorry state of the NHIS. He wrote, “I see the pain of the mother of the sick child, who has to walk miles on the dusty road to the clinic to get medicine, only to be turned away because the clinic will not accept her NHIS card and she has no money to pay.” On page 118 of the same 2016 manifesto, Nana Addo specifically outlined his plan to revive the supposedly collapsed NHIS by promising to:
- Increase budgetary allocation to the National Health Insurance Scheme (NHIS).
- Directly and strictly allocate all funds raised through the National Health Insurance Authority (NHIA) Levy into the National Health Insurance Fund (NHIF), focusing on activities related to quality patient treatment, medication, and care.
THE DELIVERY
While in opposition, Nana Addo was certain that the main challenge of the NHIS was low funding. Unfortunately, after just a year in office, he further reduced funding to the already underfunded NHIA through the Earmarked Funds Capping and Realignment Act of 2017. This act stipulates that funds for statutory bodies like the NHIF should not exceed 25% of total tax revenue. To make matters worse, the capping was further reduced to 17.5% as of 2023 through Amendment Act 947.
The NPP government’s rationale for capping the NHIF was to create fiscal space for government policy, which the finance minister described as making room for “policy manoeuvrability.” However, we painfully discovered that the NHIF was capped to provide extra cash to the government for reckless spending, such as financing a historically bloated government with 110 ministers and 998 presidential staffers—the largest government in Ghana’s history.
The consequence of depriving our healthcare system of the necessary funds from the NHIF is the current sorry state of the NHIS. Hospitals can no longer pay for utilities and medications. Now, the ordeal of the “mother of the sick child” that Nana Addo described in his vision for Ghana is even worse. She now has to afford medicines at higher costs with meagre pay.
WHAT IS THE CURRENT ECONOMIC SITUATION OF “THE MOTHER OF THE SICK CHILD” VIS-À-VIS THE COST OF MEDICINES?
On pages 6 and 7 of the NPP 2016 manifesto, Nana Addo described John Mahama’s minimum wage record as abysmal, pegging Ghana’s minimum wage to the dollar. To quote explicitly, “In dollar terms, under the NDC, the minimum wage declined from $2.12 to $2.02 by 2016 (i.e. by 4.6%). Between 2012 and 2016, the minimum wage in dollar terms declined by 23.6%.” Using the same dollar terms, the current minimum wage is $1.15, a decline of 57%. The “mother of the sick child” is now earning far less and is in a worse financial position to afford medicines in the open market.
According to the Ghana Center for Democratic Development (CDD), 70% of pharmaceutical products are imported, and even the 30% produced locally rely on 83.5% of imported materials for manufacturing, making prices of medicines susceptible to foreign exchange fluctuations. Therefore, medicine prices are indexed to the dollar for pharmaceutical companies to stay in business. While medicine prices are skyrocketing due to the weak cedi, the situation is compounded by the Nana/Bawumia administration’s decision to cap the NHIF, depriving the NHIA of the funds needed to regularly adjust the prices of medicine tariffs upward. As a result, many hospitals have refused to provide services to NHIS cardholders, forcing the “mother of the sick child” to make out-of-pocket medicine purchases in an inflation-prone market.
In 2016, $1 was equal to 4 cedis. Today, $1 equals 15.70 cedis, a depreciation of 392.50%. Since pharmaceutical product prices are indexed to the dollar, medicines have seen a 392.50% price hike during the seven years of Nana Addo/Bawumia’s presidency. Simply put, if the “mother of the sick child” was paying 3 cedis for paracetamol in 2016, she is now paying 11.78 cedis. This means that the incompetence of Nana Addo/Bawumia has caused the troubled mother to lose 8.78 cedis every time she visits the pharmacy to buy paracetamol for her sick child.
IS THERE ANY HOPE FOR “THE MOTHER OF THE SICK CHILD”?
Nana Addo had a vision and a plan to increase healthcare financing, but after gaining the vote of “the mother of the sick child,” he did the opposite. We can say that Nana Addo understood the ordeal of the troubled mother, though he scammed her. Bawumia, on the other hand, in his 2024 manifesto, has no plan to improve health financing or revive the collapsed NHIS. Thus, there is no hope for “the mother of the sick child.” With Korle-Bu Renal Unit unable to provide critical services like dialysis due to a debt of 2 million cedis, and many other tertiary health centres lacking basic equipment to deliver quality healthcare, health financing is evidently a major challenge in the sector. However, Bawumia’s vision for Ghana is silent on addressing this funding gap.
In contrast, John Mahama plans to de-collateralize the National Health Insurance Levy and ensure that the total revenue (100%) from the NHIS levy is reserved for healthcare funding. Additionally, he intends to create a Ghana Medical Care Trust Fund for patients with kidney failure, heart disease, and cancers. He also plans to legislate the allocation of a percentage from established and new extractive fields, as well as from the National Insurance Commission’s motor insurance premium to the NHIF. To tackle the inflation-prone $616 million pharmaceutical market, Mahama will provide support to pharmaceutical companies to expand production, reducing reliance on medicine imports and mitigating the impact of exchange rate fluctuations on medicine prices. A Mahama presidency promises “the mother of the sick child” not only a robust NHIS but also relatively stable medicine prices in the market.
Written by: Dr. Crispin Wienaa
