Ghana’s National Health Insurance Scheme (NHIS) has an ambitious goal: to achieve universal health coverage. However, the National Health Insurance Authority (NHIA) realized that its membership had plateaued at about 40 per cent of the population a few years ago and has remained unchanged to date. In addition, the NHIS, like many national health schemes, faces financial challenges, with a limited ability to raise additional funding through taxation or other revenue sources. All money flowing through the NHIA for claims or operations must therefore be wisely spent.

However, positive change is afoot with the NHIA receiving support from the ILO’s Impact Insurance Facility . This unit enables the insurance sector, governments, and their partners to realise the full impact of insurance to reduce households’ vulnerability, promote stronger enterprises and facilitate better public policies.

During a project scoping mission, the unit identified that one of the major operational bottlenecks was enrolment and renewal of NHIS membership, which had to be done in person at one of the NHIA’s offices.

Queues often snake around buildings with some people even resorting to sleeping overnight outside of these facilities to avoid queuing in the midday heat. NHIA staff are often overwhelmed, and the long waiting times discourage many people from joining or renewing their membership.

For both members and the NHIS alike, this manual, time-intensive and costly process was causing considerable damage. An innovative, digital solution was needed.

The NHIS is therefore piloting a system that allows customers to use simple cell-phones or smart-phones to renew their membership. The ILO’s Impact Insurance Facility provided initial funding, conceptualisation of possible technological solutions, technical assistance and project management support to get the programme running.

Low cost intervention, huge impact

Presenting the NHIA at the ILO in Geneva recently, Deputy Chief Executive in charge of Operations, Dr Lydia Dsane-Selby, said that the project has the potential to cut costs by being more operationally efficient and can significantly reduce what she called the “leakage” of cash. If scaled nationally, the savings, she believes, could reduce NHIA’s deficit in a meaningful way and move the needle with respect to the scheme’s footprint in Ghana.

“I am pleasantly surprised,” Dr Dsane-Selby said, “I didn’t think that within six months and with 30,000 US dollars we’d have something that is potentially a game-changer for the NHIS. It’s low cost and high-impact – it’s amazing.”

Craig Churchill, who leads the ILO’s Impact Insurance team, says he too is highly impressed by the success of the project. “I think what’s exciting is how something that started with the aim of reducing the lines for registration at the district office, turned into something much more significant in terms of reducing costs, increasing income and addressing the issue of fraud.”

“The ILO’s Impact Insurance Facility is celebrating its ten-year anniversary in 2018. Our involvement in the Ghana social security project is a good example of the diversity of our interventions, including public policy projects, and how a comparatively small amount of financial support can bear huge results,” concluded Churchill.