I enjoyed writing the piece on co-payment, although I wrote it with dismay. This one I wanted to write with a smile.
You’ve heard me talk about Free Primary Health Care. You’ve seen the figure, GH¢35.1 million released, 107 districts, first-quarter payment. But numbers are hard to hold in your hands. So let me tell you what that money actually looks like when it arrives somewhere.
Let me tell you about Efua.
Efua
Efua is fifty-eight. She sells dried fish in a small community a good distance from the nearest district hospital, the kind of place where “going to the hospital” is a full day’s undertaking, a cost in transport and lost trading before you even reach a doctor. So, like a lot of people in her community, Efua simply didn’t go. Not for check-ups. Not for the tiredness she’d been feeling. You don’t close the stall and spend a day’s earnings on a journey to be told you’re fine.
She felt well enough, most days. And the days she didn’t, she rested and carried on.
What Efua didn’t know was that her blood pressure had been climbing quietly for years. High blood pressure gives no warning. It doesn’t hurt. It just waits, and then one day it becomes a stroke, or a failed kidney, or a heart that gives out, and by then the cost of care is enormous and the damage is often already done.
Efua was walking toward that day without knowing it. And she would never have found out in time, because nothing in her routine would ever have taken her to a place where someone could check.
Then one morning, the place came to her.
A community health nurse, working out of the CHPS compound that serves Efua’s area, was doing outreach, the ordinary, unglamorous work of going house to house, stall to stall, checking vitals and talking to people who never come in. She wrapped a cuff around Efua’s arm at her own stall, between customers. She looked at the reading. Then she looked at it again.
She sat Efua down. She explained, in plain language, what the number meant. She started her on the path to managing it, the check-ups, the advice, the small changes, early enough that it is a condition to be managed, not a catastrophe to be survived.
Efua is still selling fish today. She still feels well, most days. The difference is that now, someone is watching the thing that could have taken her from her family, and watching it in time.
What actually happened there
Efua isn’t real. But her blood pressure is real, and it is climbing right now in tens of thousands of people across this country who feel perfectly fine and have no reason to visit a facility. That is exactly the person Free Primary Health Care is built to reach.
For most of our history, Ghana’s health system has been built to treat people once they are already sick. You feel unwell, you go to a facility, you are treated. That model saves lives every day, but it has a blind spot the size of a nation. It waits for people to arrive. And the people who need it most are often the ones least able to arrive: those far from facilities, those who cannot afford a day away from work, those who have no symptom yet to send them.
Free Primary Health Care is built to close that gap. It changes the question from “who came to us?” to “who have we reached?”
Funded by the NHIA, it works differently from the NHIS by design. The NHIS reimburses providers service by service, for treatment delivered. Free Primary Health Care instead gives participating districts predictable, upfront funding based on the size of the population they serve, so that a CHPS compound doesn’t have to wait on a claim for each patient before it can plan and deliver care. That structure is what lets a nurse go out to Efua’s stall in the first place. It funds outreach, home visits, school and workplace engagements, and public education. It funds routine screening for conditions like hypertension, diabetes, obesity, mental health and cancers; maternal and child health services such as antenatal care, postnatal care, immunisation and growth monitoring; and health promotion like NCD risk counselling, family planning, safe water and menstrual hygiene. And it funds treatment too, for common conditions like malaria, diarrhoea and respiratory infections, along with basic emergency care, counselling and referral.
That is the point many people miss. Free Primary Health Care is not only about prevention. It is preventive, promotive and curative at once, it keeps you well, teaches you how to stay well, and treats you when you fall ill, all at the primary level.
And critically, at that level, it is free. You do not need an NHIS card for this community-level care, the only thing you need is a valid national ID. Where a condition needs more, a referral to a district, regional or teaching hospital, or advanced care beyond the primary package, that is where a valid NHIS card carries you. This is also why we encourage everyone still uninsured to enrol: so that the moment you need that next level of care, your cover is already in place. Prevention, promotion and treatment at the community level; clinical and hospital care through the NHIS. Two arms of one body, reaching toward the same thing: Universal Health Coverage for every Ghanaian.
That is why yesterday mattered. GH¢35.1 million released as first-quarter payment to the 107 districts now running the programme is not a line in a budget. It is thousands of Efuas who will be reached this quarter by someone who came to them in time.
Who this actually belongs to
I want to be careful here, because this is the part that matters most to me.
It would be easy to present this as an achievement of the NHIA, or of my office. It is not, and I won’t pretend otherwise. This belongs to other people.
It belongs to the community health nurses and CHPS staff who will carry this programme the last mile, into the homes and stalls and schoolyards where the health system has never quite reached. They are the ones who turn a disbursement into a hand on a shoulder and a number on a blood pressure monitor. Nothing happens without them.
It belongs to the staff of the NHIA and every allied institution who did the invisible, meticulous work of turning a policy into money that actually lands in a district account, the planning, the systems, the population data, the payments.
It belongs to the Minister for Health, Hon. Kwabena Mintah Akandoh, whose leadership kept this on the table and moving. And it belongs to the Minister for Finance, Dr. Cassiel Ato Forson, whose backing turned commitment into the funding that makes it real, because a policy without money behind it is only ever a wish.
And it belongs to His Excellency President John Dramani Mahama, whose vision made it a funded reality, including the uncapping of the National Health Insurance Levy that helps pay for it. A commitment is only real when it is financed, and this one now is.
My own role in all of this is simple. It is to serve, to make sure the money moves, the districts are supported, and the promise reaches the person it was made to.
And to the people of the 107 districts
This is for you. So use it.
Have your vitals checked, even when you feel fine, especially when you feel fine, because the conditions that harm us most give no warning. Take your children for their immunisations and growth checks. Listen to the nurses and health workers who serve your community; they came to help you stay well, not only to treat you when you are ill.
Efua’s story ended well because someone reached her in time. Free Primary Health Care exists so that yours can too.
The road to Universal Health Coverage is long. But yesterday, it moved forward, because of you, and the people who serve you.
Story origially writtern by Dr Victor Asare Bampoe
