TheHealthReport25: Health and wellness in Ghana: A Comprehensive overview with a focus on health insurance

Introduction

In Ghana, the health and wellness landscape are increasingly becoming a priority for individuals, communities, and the government. With a growing population and shifts in lifestyle, there are rising concerns around both preventive health and access to quality healthcare services.

The importance of health insurance in Ghana cannot be overstated, particularly as the country strives to improve healthcare outcomes, reduce the burden of out-of-pocket payments, and promote universal health coverage (UHC).

The health and wellness value chain in Ghana

The value chain in Ghana’s health and wellness ecosystem can be divided into several key areas, each playing an essential role in ensuring the overall well-being of the population. From preventive care to rehabilitation, the Ghanaian healthcare system offers a mix of services supported by both public and private sectors.

1. Prevention and wellness in Ghana

Preventive healthcare in Ghana is heavily influenced by public health campaigns and community health services. Despite the challenges faced with infrastructure and resources, efforts to educate the public on healthy lifestyles are prevalent. The National Health Insurance Scheme (NHIS) covers preventive services like immunizations and antenatal care. However, only 40% of rural residents are enrolled, compared to 65% in urban areas (Ghana Statistical Service, 2021).

• Healthy lifestyle promotion: Non-communicable diseases (NCDs) like diabetes, hypertension, and cardiovascular conditions are on the rise in Ghana due to changing diets and increasingly sedentary lifestyles. Public health initiatives, such as the “Healthy Living, Healthy Life” campaign, encourage citizens to exercise regularly, eat balanced diets rich in fruits and vegetables, and reduce sugar and salt intake. These campaigns are largely government-led but also supported by NGOs and international organizations.
• Vaccination programs: Ghana has made notable strides in preventive care, especially in areas like immunization. The Expanded Programme on Immunization (EPI) ensures that infants and children receive vaccines against diseases such as measles, polio, and hepatitis. Successful mass vaccination campaigns, such as those for the eradication of guinea worm and measles, underscore the importance of prevention in national health planning.

2. Primary Healthcare (PHC) services in Ghana

Primary healthcare is the first point of contact for most Ghanaians when seeking medical attention. The country has established various health facilities, from Community-based Health Planning and Services (CHPS) compounds to district hospitals.

• CHPS compounds: These are decentralized health posts that serve as the backbone of Ghana’s primary healthcare. They provide preventive services, maternal care, family planning, and treatment of common ailments. CHPS compounds play a significant role in rural areas, where access to healthcare facilities is limited. For example, in the Upper East and Northern regions, CHPS centers offer immunizations, basic medical services, and health education, thus contributing to overall wellness in these communities.
• Health screening: Ghana’s Ministry of Health often collaborates with corporate bodies and NGOs to organize health screening exercises for the public. These screenings, focused on detecting hypertension, diabetes, and cholesterol levels, are typically free and are held at churches, mosques, or marketplaces.

3. Secondary and tertiary care in Ghana

For those requiring specialized medical care, Ghana’s secondary and tertiary facilities offer more comprehensive services. However, these services are often concentrated in urban centers.

• Specialist hospitals: Teaching hospitals, such as Korle Bu Teaching Hospital in Accra and Komfo Anokye Teaching Hospital in Kumasi, provide specialist services such as oncology, cardiology, and surgery. The increasing cases of cancer in Ghana have made oncology care crucial, with organizations like Breast Care International leading initiatives to raise awareness about early detection of breast cancer. Late-stage cancer diagnoses contribute to a 60% mortality rate (Ghana Health Service, 2022).
• Private healthcare providers: The private healthcare sector plays a crucial role in providing secondary and tertiary care, often catering to the middle and upper-income segments of the population. Facilities like Trust Hospital in Accra are known for providing advanced diagnostic services, surgeries, and maternal care. However, the cost of these services is often beyond the reach of the average Ghanaian without insurance.

4. Rehabilitation and long-term care in Ghana

The role of rehabilitation is becoming more prominent as the country grapples with the burden of NCDs and injuries resulting from road accidents.

• Physical therapy and rehabilitation centers: Korle Bu Teaching Hospital runs a physiotherapy unit that caters to patients recovering from strokes, accidents, or surgeries. Additionally, several NGOs such as the Orthopedic Training Centre, offer rehabilitation services for individuals with physical disabilities.
• Chronic disease management: Diabetes and hypertension are among the most prevalent chronic diseases in Ghana. The Ghana Diabetes Association and Ghana Heart Foundation are leading the charge in educating Ghanaians on managing these conditions through continuous care, including proper medication, diet, and exercise. Ghana has over 2.4 million diabetics, yet only 30% adhere to treatment due to cost (Ghana Diabetes Association, 2023).

Health insurance in Ghana

Health insurance is pivotal in Ghana’s healthcare system, playing a significant role in improving access to healthcare services and reducing out-of-pocket expenditure. Two major types of health insurance dominate the market: the National Health Insurance Scheme (NHIS) and Private Health Insurance (PHI).

1. The National Health Insurance Scheme (NHIS)

The NHIS was introduced in 2003 as a key government initiative aimed at achieving Universal Health Care UCH. It has significantly increased access to healthcare for many Ghanaians, particularly for those in low-income households.

• How NHIS works: Individuals and households pay premiums based on their income level, and in return, they receive access to a range of services at public and accredited private healthcare facilities. The NHIS covers services such as outpatient consultations, maternal care, surgical procedures, and medications for common conditions like malaria, typhoid, and respiratory infections.
• Challenges: Despite its success, the NHIS faces challenges, including long waiting times, delayed reimbursements to hospitals, and limitations on the range of services covered. For example, cancer treatment and advanced diagnostic tests like MRIs are often not fully covered, pushing patients to seek expensive care outside the system.

2. Private health insurance (PHI)

Ghana’s growing middle class and corporate sector have led to the rise of private health insurance offerings. There are about fifteen (15) health insurance companies in the country who provide tailored insurance packages to Ghanaians—employees, individuals, families, etc.

• Comprehensive coverage: PHI tends to offer more comprehensive coverage than the NHIS, including access to private healthcare facilities, specialist care, and advanced treatments such as cancer therapies and high-cost surgeries. For instance, corporate clients of these health insurance providers often receive coverage that includes dental care, ophthalmology services, and full maternity care at private hospitals.
• Affordability issues: The major drawback of PHI in Ghana is its affordability. Premiums are significantly higher than those of the NHIS, and they are primarily utilized by higher-income groups and employees of large corporations. For instance, while the average annual premium for NHIS is between GHS 25 and GHS 60, private insurance premiums can run into several thousands of cedis per month, depending on the plan.

Health insurance and public education

Educating Ghanaians about the benefits of health insurance is critical to ensuring broader coverage. Many people remain unaware of how insurance works or the benefits it provides. Key areas of focus for public education include:

• The NHIS renewal process: Many Ghanaians lose coverage because they do not renew their NHIS cards annually. Public awareness campaigns focusing on simplifying the renewal process and offering digital solutions are thereby needed. NHIS relies on a 2.5% VAT levy, but delayed reimbursements strain providers. Over 70% of hospitals report NHIS arrears exceeding 6 months (Health Facilities Regulatory Agency (HeFRA), 2023). Only 45% of members renew annually, citing bureaucratic hurdles as reasons (NHIA Annual Report, 2022).
• Explaining coverage: The NHIS covers a basic package of health services, but not all services are included. Efforts must be made to educate policyholders on what is and isn’t covered, helping the Ghanaian understand when they may need additional private coverage.

Challenges of the NHIS

Below are a few of the challenges faced:

• The vast majority of Ghanaians tend to view illness as a spiritual curse, preferring traditional healers over NHIS-covered clinics.
• NHIS educational materials are often in English, excluding 45% of Ghanaians who are not literate (UNESCO, 2022).

Examples from the Ghanaian Market

Several real-life examples illustrate the impact of health insurance in Ghana’s healthcare value chain:

• NHIS impact on maternal care: Maternal care is fully covered under the NHIS, and as a result, many women have been able to access antenatal services and safe deliveries. According to the Ministry of Health, maternal mortality rates have decreased over the years, partly due to the increased number of insured women accessing free maternal care. NHIS reduced maternal mortality by 50% between 2008 and 2017, by covering antenatal care and deliveries.
• Private insurance for specialized care: A corporate executive with private health insurance can undergo a complex heart surgery at a private hospital without spending out-of-pocket, an operation that would have been prohibitively expensive without insurance. The private health insurance policies can cover up to 100% of the medical expenses, including post-surgery rehabilitation.

Conclusion

In Ghana, health and wellness are supported by a diverse value chain, from preventive care to rehabilitation. Health insurance, whether public or private, is a critical component of this value chain, offering financial protection and improved access to healthcare services. While the NHIS has made healthcare more accessible for millions of Ghanaians, challenges remain in areas such as affordability, coverage limitations, and public education. By addressing these challenges and expanding health literacy, the country can move closer to achieving universal health coverage (UHC) and securing long-term well-being for its citizens.

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Michael Osei Dickson is an accomplished insurance professional with over 11 years of extensive experience in the industry. Currently, he serves as the Head of Group Life, Health, and Pensions at KEK Insurance Brokers Limited. His expertise encompasses underwriting, claims management, and marketing, making him a versatile asset in the insurance sector.