Healthcare Costs Push Ghanaian Families Into Poverty
Hospital bills especially for the treatment of non-communicable diseases continue to bankrupt many families in Ghana. Isaac, 49, a single father, has had to sell his plot of land at Kasoa, another in his hometown, his car and emptied his life savings in order to keep his son, Ransford, alive one week at a time.
“Ransford Asiamah is currently on admission at the Cape Coast Hospital battling with kidney failure (unfortunately, both kidneys). He is on dialysis in the interim. The family needs US$ 25,000 to cover the kidney transplants in India. We call on corporate Ghana, philanthropists and all individuals to help save his life.”
The newspaper announcement continues with instruction on how to donate to support 28-year-old Ransford Asiamah’s operation.
Desperate families appealing to the benevolence of the public to cover health costs is commonplace in Ghana’s media sphere. For many, the media is the last resort because the family is near bankruptcy and other social safety nets such as the church have not been able to raise the money.
“Since he became sick about six to seven months ago, things have been so tough for me. Because, this kidney problem is very very (sic) expensive – medicines, lab tests, even the dialysis. He has to go on dialysis three times a week and every week we have to spend about 1000 cedis and at times we have to pay for [two pints of] blood…[I have to pay about 300 cedis for that]. So it is not easy” says Isaac Asiamah, Ransford’s father and also his primary caregiver.
Isaac, 49, a single father of three, has had to sell his plot of land at Kasoa, another in his hometown, his car and emptied his life savings in order to keep his son alive one week at a time. Isaac is also saddled with getting 30,000 dollars (including flights and other expenses) for a kidney transplant which doctors have recommended to be done in India. In India, Isaac will also be required to donate one of his kidneys. A crowdfunding campaign has so far received just about 10 percent of the 30,000 dollar target.
What is Universal Health Coverage?
“Universal Health Coverage (UHC) is ensuring that all people have access to the health services that they need…without falling into financial hardship when they do”, says Dr Owen Kaluwa, the country director of the World Health Organisation (WHO). It encompass the whole range of health services including health prevention, promotion, treatment, rehabilitation and palliative care, Dr Kaluwa adds.
According to the WHO, while “UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis”…“robust financing structures are key.” Even more central, Dr Kaluwa says is “strengthening health systems so that those health systems are able to deliver the services that is required. We continue to also emphasis a primary health care system that will also help to make sure universal health coverage is attained and in doing that no one is left behind in the spirit of the SDGs.”
Goal Three of the Sustainable Development Goals has a target to achieve universal health coverage and there is a target to ensure that one billion people have universal health coverage around the world by 2023, the midpoint between 2015 when the goals were agreed and 2030 when they are expected to have been realised.
This year, the WHO has dedicated the theme of the World Health Day observance (also the 70th anniversary of the WHO) to advocacy for UHC. Although noble, the ideal of UHC is clearly yet to be realised by many including the Asiamahs. According to the global health body, “at least half of the world’s population still do not have full coverage of essential health services [and] about 100 million people are still being pushed into “extreme poverty” (living on $ 1.90 or less a day) because they have to pay for health care.”
National Health Insurance Scheme (NHIS)
In 2004, Ghana’s government introduce the National Health Insurance Scheme (NHIS), a pro-poor policy to reduce the financial burden of people when they access health care. The scheme has been credited for playing a crucial role in the reduction maternal and infant mortality and deaths attributed to endemic diseases such as malaria. It has been lauded as a model to be followed on the continent of Africa replacing the so called “cash and carry” system. According to the National Health Insurance Authority, it has 11 million subscribers (less than half the total population) [2014 pdf p.5] and it covers 95 percent of the disease conditions.
However, this does not mean all services are covered or are covered fully – out of pocket payments are still expected. The system is riddled with fraud and administrative inefficiencies. Between 2011 and 2013, 11 million cedis (nearly 8 million dollars) was uncovered.
Many private hospitals have threatened on numerous occasions and actually gone ahead to withdraw their services from NHIS-card bearing patients because of the habitual delays in the payment of insurance claims by the government.
Again, as the disease burden in Ghana has moved dramatically towards non-communicable diseases, such as kidney failure, the state’s assistance has not followed in that direction.
A 2008 election campaign promise of ‘one time premium’ by former president John Atta Mills never materialised and 10 years on there does not appear to be the political will to increase premiums as this might not be a popular decision. Again, Ghana has consistently failed to reach the target it signed up to in 2001 in Abuja to designate 15 percent of its budget to health, only managing to reach about half of that threshold in the 2018 budget.
At a press conference on Wednesday April 11 to launch Ghana’s observance of World Health Day, the minister of health, Kwaku Agyemang Manu admitted there is still a long way to go.
“Many poor people find it difficult to pay even the registration fees as well as the premiums. Although the scheme is designed to cater for the very poor of the society, it has difficulties in determining the socioeconomic status of its applicants and [we have been] adopting strategies of even hiring consultants to be able to pick people that we can put on the indigence list…Fixing flat rates rather than income-related premiums also burdens poorer members excessively.”
He adds: “For Ghana to move towards universal health coverage, the country needs to find more money to invest into the NHIS as the relative contributions of premiums is quite poor. Tax-based funding is the obvious source.”
“It is very tough”
Non-communicable diseases are expensive to treat and while the NHIS cover some services for diseases such as cervical cancer and diabetes, the greater proportion of the financial burden is offloaded to families like the Asiamahs.
“What I already have is what I have been selling. I have sold my car, I have sold my plot, even the plot I have in my hometown, I have even sold it, all because of this kidney failure”, a frustrated Isaac Asiamah says.
While preaching the adoption of healthy lifestyles, Agyemang Manu said the government is “going to look at the benefit package we have with health insurance…We may have to expand [the package] but that will depend on how quickly we can mobilise some extra resources to invest into the system…
Some of them are very expensive to treat and with the type of meagre premiums we are paying and the resources that are coming into the health insurance, it is very difficult for us to [cover] 100 percent of the disease burden and their associated costs with it. We are working on it and we are committed that getting on, we will see how best we can look at this situation.”
But for Isaac Asiamah, help cannot come fast enough. He says if the health insurance was able to cover even the cost of dialysis, it would have saved his a lot of money which could have been used for the trip to India.
“I would be the happiest person. Because the dialysis, the dialysis…is not easy…For you to pay for dialysis at the same time looking for money for transplant it is very tough.”
Editor’s note: To donate to Ransford’s transplant and dialysis treatment, call Isaac Asiamah on +233 24 436 0097 or give through the GoFundMe campaign.
April 16: *An earlier version of this story said Isaac Asiamah was Ransford’s brother. This has been corrected to reflect Isaac’s status as his father instead.