There is an odd fear and fascination with Malaria in Canada. To many, it’s an “exotic” and deadly disease. It’s shrouded in misinformation and myth. Travelling to a high risk zone, I fecklessly stocked up on mosquito spray and prophylaxes.
After only two weeks in Ghana, I developed a hellish fever. In a haze, I wandered a few blocks to a small hospital. I was too zoned out to figure out my travel health insurance, so I walked past the line for “insured” patients and joined the much longer line for the “uninsured.” I was diagnosed within a couple hours, immediately treated, and, within 24 hours, felt significantly better.
For me, and anyone else who has easy access to proper treatment, Malaria really isn’t that big of a deal. Amazingly, however, Malaria continues to kill more Ghanaians than any other disease.
The idea for the National Health Insurance Scheme (NHIS) first surfaced as a campaign promise in the 2000, in order to improve access to basic health care services and eliminate the widespread “out-of-pocket” payment for health services. The idea became law in August of 2003, and, in December 2004, the NHIS was established.
Since then, the NHIS has always been on the political radar. In 2009, President Atta Mills and the National Democratic Congress vowed to improve the struggling system, striving to make publically funded basic health care universally available.
The idea is that Ghanaians contribute to a fund so that they are financially supported when they need medical care. Formal workers pay a percentage of their income to the system and informal workers- about 80 per cent of the Ghanaian workforce- pay a flat rate to the NHIS. In return, they qualify to have their basic medical expenses covered by NHIS. In practice, however, things are quite different.
“The concept is good, but the reality isn’t. It doesn’t really help many people,” one Ghanaian friend told me.
In 2008, there were only 1,500 health care facilities to service the entire Ghanaian population of 24 million people. According to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report, these facilities are not evenly distributed and the average Ghanaian lives about 16km from a health care centre.
Plagued by chronic funding and personnel shortages, the NHIS doesn’t cover the very people it was designed to serve.
On May 2007, the NHIS covered under half of its targeted people. That’s only 19-65 per cent of the population, depending on the region, said the same ACCORD report.
OXFAM estimates the numbers to be even lower – around 18 per cent. The same 2011 report maintains that most people covered are rich, not the poor who the system was designed to protect from the high user fees.
Whatever the numbers may be, the reality is that most health care spending Ghana continues to be “out-of-pocket.” In 2005, out-of-pocket expenditures amounted for over 65 per cent of all spending on health care, according to the ACCORD report.
The “out-of-pocket” expenditures are not cheap. For my visit, I paid one cedi for my file, eight for my consulting fee, 15 for the blood test, and 10 for the treatment. For me, the total cost was 34 cedis, about $18 USD. The minimum wage in Ghana is only 4.48 cedis per day, about $2.66.
Due to the high cost associated with health care, and the failure of the NHIS to offset this cost, many Ghanaians seek traditional treatments or self medicate. That means people aren’t going to get the same quick, effective malaria treatment I was privileged to: the reason why a curable disease is, sadly, the disease that claims the highest number of victims in the country.