The debate about the most appropriate way of financing healthcare delivery has been an issue since the colonial era. After the attainment of Independence, successive governments have tried in different ways to find better, sustainable and more acceptable ways to finance health care service delivery in Ghana.

Hence, the enactment and subsequent passage of the National Health Insurance Act 2003 (Act 650) and subsequent Legislative Instrument (L.I. 1809) of 2004, which introduced the National Health Insurance Scheme (NHIS), focused on removing financial barriers to the utilization of healthcare among Ghanaians. This was to enable subscribers get access to quality healthcare at minimum cost and was a most welcomed intervention in the healthcare delivery strategy.

As part of the National Health Insurance Authority?s (NHIA) efforts at expanding access to quality and affordable healthcare to all subscribers under the scheme, the NHIA enrolled private healthcare facilities to serve as accredited healthcare service providers under the scheme. This initiative allowed members of the Ghana Registered Midwives Association (GRMA) to join the scheme to ensure that their services were available to NHIS subscribers.

Unfortunately, the inability of the NHIA to strictly adhere to provisions in section 71(1) of the National Health Insurance Act 2003 (Act 650), which states that ?Tariffs payable to healthcare providers shall be paid within four weeks by schemes to the healthcare providers directly? is adversely affecting the business viability of members of GRMA who are accredited as service providers under the scheme.

The current practice where claim payments by the NHIS is always in arrears, in certain cases in excess of 6 months, presents a formidable challenge to the delivery of quality midwifery services by GRMA members to subscribers of the NHIS.

This undue delay in the payment of claims to NHIS service providers and members of the GRMA will adversely affect Ghana?s efforts at attaining her targets under goals 4 and 5 of the Millennium Development Goals (MDG) on maternal and infant mortality rates especially in most remote and rural inaccessible areas. These are areas where more often than not midwifes are the only healthcare service providers in the entire community.

What makes the inability of the NHIA to comply with section 71(1) of Act 650 even more precarious on the business viability of GRMA members is the fact that a vast majority of members of the association are retired midwives who have established maternity homes from their own scarce resources to enable them render quality midwifery and other essential primary healthcare services to the public.
Most of these healthcare facilities operate with minimal funds as against our overheads and recurrent expenditure.
The Government?s service contract with the scheme expects GRMA members to pre-finance all their services to NHIS subscribers (except those under capitation pilot) and then file claims at the end of the month for reimbursement from the scheme.

Most GRMA members obtain their supplies on credit or as loans from financial institutions to enable them to render their services to NHIS members; therefore any delay by the scheme to reimburse claims jeopardizes the already precarious financial situation members find themselves in. This also compromises on the quality of healthcare offered by GRMA members to NHIS subscribers to the detriment of quality healthcare delivery as a whole in the country.

It is against this backdrop that the GRMA is, under the Business Sector Advocacy Challenge (BUSAC) Fund, advocating for broader consultation and dialogue between the NHIA and all stakeholders to identify sustainable cost containment and funding measures that will facilitate compliance with 71(1) of Act 650 to improve the cashflow situation of GRMA members who are accredited as service providers under the NHIS.

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