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THE PROMISE TO THE “THE MOTHER OF THE SICK CHILD”
In the 2016 NPP manifesto, page VI, Nana Addo, in stating 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 stated his plan to revive his claimed collapsed NHIS by promising to;
1. Increase budgetary location to the National Health Insurance Scheme (NHIS).
2. Directly and strictly ceding all funds raised through the National Health Insurance Authority (NHIA) Levy into the National Health Insurance Fund (NHIF), concentrating on activities focusing on quality patient treatment, medication and care.
THE DELIVERY
Nana Addo, in opposition, 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. The act provides that funds for statutory bodies like the NHIF should not exceed 25% of total tax revenue. To add salt to injury, the capping was further reduced to 17.5% as of 2023 through the amendment act 947.
The NPP government’s reason for capping the NHIF was to create fiscal space for government policy, which the finance minister described as making room for “policy manoeuvrability.” But we discovered to our detriment that the NHIF was capped to provide extra cash to the government to embark on reckless spending like financing a historically bloated government of 110 ministers and 998 presidential staffers, obviously the largest government in the history of Ghana.
The consequence of depriving our healthcare system of the needed funds from NHIF is the sorry state of NHIS today. Hospitals can no longer pay for utilities and medicines. Now, the ordeal of the “mother of the sick child” Nana Addo described in his vision for Ghana is worse off. She now has to afford medicines at a higher cost with low pay.
WHAT IS THE CURRENT ECONOMIC SITUATION OF THE “MOTHER OF THE SICK CHILD” VIS-À-VIS COST OF MEDICINES?
On pages 6 and 7 of the NPP 2016 manifesto, Nana Addo described John Mahama’s minimum wage record as abysmal while 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 situation 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 had 83.5% of all materials for local manufacturing also imported, making prices of medicines susceptible to foreign exchange fluctuations. Therefore, for pharmaceutical companies to stay in business, prices of medicine are indexed to the dollar. While medicines prices are skyrocketing due to the weak cedi, the situation was compounded by the Nana/Bawumia administration’s decision to cap the NHIF, depriving the NHIA of the needed funding to regularly review the prices of medicine tariff upwards. This has led many hospitals to decline 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 4 cedis. Today, 1 dollar is 15.70 cedis, a depreciation of 392.50%. Because the prices of pharmaceutical products are indexed to a dollar, medicines saw a 392.50% price hike within the seven years of Nana/Bawumia’s presidency. In simple terms, if the “mother of the sick child” was paying 3 cedis for paracetamol at the pharmacy in 2016, the same person is now paying 11.78 cedis. This means the incompetence of Nana/Bawumia has caused the troubled mother to lose 8.78 cedis anytime she visits the pharmacy to buy paracetamol for her sick child.
IS THERE ANY HOPE FOR THE “MOTHER OF THE SICK CHILD”?
With Nana Addo, he had a vision and a plan to increase healthcare financing, but he did the opposite after gaining the vote of the “mother of the sick child”. We can say 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 and no plan to revive the collapsed NHIS. And definitely, 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 and prompt healthcare, it is obvious that health financing is a major challenge in the health sector. But surprisingly, Bawumia’s vision for Ghana is completely dead silent on his plans to bridge the funding gap in the health system. It is sad to discover the “I have my own vision” touts by Bawumia means he has no vision to provide adequate funding to a critical sector like health.
On the contrary, John Mahama has plans to de-collateralize the National Health Insurance Levy and ensure the total revenue (100%) accrued to the NHIS levy is set aside for funding the health sector. It is also interesting that he intends to create an additional funding source called the Ghana Medical Care Trust Fund for people with kidney failure, heart disease, and cancers. There is also a plan 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 national health insurance fund. To tackle the inflation-prone $616 million pharmaceutical-sized market, John Mahama will provide support to pharmaceutical companies to expand production, thereby reducing the import of medicines and consequently lessening the susceptibility of medicine prices to exchange rate fluctuations. A John Mahama presidency will offer “the mother of the sick child” not only a robust NHIS but also relatively stable medicine prices in the open market.
Written By: DR CRISPIN WIENAA
