Peter Yeboah, MPH, MSc, Executive Director of the Christian Health Association of Ghana shares how CHAG works with the Ministry of Health in Ghana to provide health care and addresses challenges and how the organizations works to overcome them.

1. PeterYeboah, Executive Director-CHAG
13th July 2017, CCIH Conference, Johns Hopkins
University, Baltimore- MD
HEALTH SYSTEMS RESILIENCE
THE ROLE OF CHAG IN THE GHANAIAN HEALTH SYSTEM

2. Outline
1. CHAG; Nature, Mission, Collaborators
2. The CHAG HSS Model: Health Financing for UHC in focus
3. Achievements & Challenges
4. Lessons Learnt

3. Brief Profile of CHAG
• A Network of 25 Christian Denominational Groups with 302
Member Institutions
• With 5.5% Health Infrastructure, CHAG has 35-40% share in
the Health Sector
• Recognized as an Agency/Implementing Partner of the MOH
• Established in 1967, CHAG is 50 years!!!!

4. HSS: Policy & Operational levels
Partnership with Gov’t has been an evolving relationship since 1967
Policy
– Formalized by MoU with MOH(2006) guided by HSS Framework in
the Administrative Instructions
– Rights & Responsibilities: policy implementation, regulatory
compliance: salaries, exemptions, resources allocations, etc.
Operational/Practice
– Collaborative framework with Gov’t/MOH Agencies:
– Ghana Health Service, NHIA, etc

5. HSS
Service Delivery
Health Workforce
Information
Medical Products, Vaccines &
Technology
Financing
Leadership / Governance
Community Participation
Partnership
Research
ACCESS
COVERAGE
QUALITY
SAFETY
Improved Health (Level and Equity)
Responsiveness
Social and Financial Risk Protection
Improved Efficiency
System Building Blocks
Overall Goals / Outcomes
The Nine Building Blocks of A Health System: Aims and Desirable Attributes

6. HSS via Financing Scheme
ISSUE/CRISES INTERVENTION
1980s: User fees (also known as
cash and carry)
Catastrophic health care cost for
families, & barrier to health care.
1990s: Decline of OPD attendance
by 25%
 1990s: CHAG pioneered the NHIS
through a pilot of 40 Community-Based
Health Insurance Schemes(CBHIS)
Design, adoption and implementation
 Ghana’s National Health Insurance
Scheme(NHIS) in 2003, with the
passage of Act 650 (2003) and a
Legislative Instrument (LI1809, 2004)
 Gov’t nationalized the 40 CBHIS to roll
up the NHIS

7. National: NHIS Membership, Utilization & Claims
1.3 million
8.9 million
598 thousand
23.9 million
29 thousand
GH¢ 7.6 million
GH¢ 616 million
1.4 million
Active
Membership
Outpatient
Utilization
Inpatient
Utilization
Claims
Payment
Source: Unaudited Financial Statements
10.5 million
29 million
GH¢ 968 million
1.6 million

8. CHAG: HSS Synergy by NHIS
Service Delivery Human Resource Technology
98% of OPD and 92% of
in-patients are NHIS
Members in CHAG
Facilities
Recruitment &
Retention of
Professional Staff
Pooled Procurement
Programme: 30%
reduction in medicines
cost
CHAG MIs increased
from 192 -305 (59% )
Continuous
Professional
Development Training
Programmes
Tracer drug availability
improved from an average
of 75% to 98% for CHAG
Improved service
delivery
package/benefit
Improved productivity
through supervision

9. CHAG: HSS Synergy by NHIS
Leadership &
Governance
Finance Community Participation
Improved Regulatory
compliance
NHIS reimbursement
90% IGF
Increased NHIS Clients’
enrolment
Accreditation &
Credentialing
requirement
28% increase in tariffs
Enhanced Patients rights
through choice of
Providers and
competition for Clients
Performance
accountability:
Claims processing
Clinical audit
User fees reduced to the
barest minimum.
Social accountability

10. Is Ghana’s NHIS the best????
• Chronic delays in reimbursement with 11 months arrears to
Service Providers
• Effects: Indebtedness crippling Providers, Suppliers not paid,
effects on medicines & consumables, secret user fees, and
• General loss of confidence in the health system

11. State of NHIS

12. State of NHIS

13. State of NHIS

14. Partnership with Government for Sustainability
Policy Review of NHIS - CHAG served on Presidential
Committee in 2015-2016:
– Sustainability
– Equity
– Efficiency
– Accountability and Public Satisfaction
CHAG’s position affirmed:
“PHC at public and CHAG facilities will be guaranteed at
100% with no user fees on health services for all the
population (i.e. automatic coverage).”

15. CHAG calls for Solutions
http://www.graphic.
com.gh/news/gener
al-news/govt-urged-
to-initiate-national-
dialogue-on-
nhis.html
Ghanaian Daily Graphic issued Thursday, May 9th 2017

16. Challenges
• Dual Identity: Collaborator & Critic
– Threats, boycotts & withdrawal of service
seemingly betrays public trust, Christian values, &
non-strike tradition
– Active involvement with Gov’t could stifle
independent positions
• Changes in Politicians & Policies
• Risk of assimilation and loss of identity

17. WITH MINISTER OF HEALTH, 2016

18. With New Minister, 2017

19. With CEO, NHIA, 2017

20. Lessons Learnt
• Hardware & Software
– Formalized framework for engagement with Stakeholders
– Requires nuances in policy analysis, lobbying, advocacy &
activism, negotiations, media communications, artful
confrontations with political actors, technocrats and bureaucrats
• Building Leverages
– Technical skills in health insurance; policy options
– Stakeholder approach in operational matters
– Buffers & Resilience: deadlock between Labour & Government:
CHAG becomes a “saviour”
– Supportive criticism with plausible solutions/options
– Build and leverage Trust

21. Take Home Message
 The SDG 17 highlights partnerships for UHC
 HSS initiatives are indispensable for sustainable
UHC
 FBOs have better prospects & potentials in LMIC
to champion HSS:
– Advocacy & Accountability mechanisms
– Mobilization & reach
– Sustainability of quality health systems