Ghana’s National Health Insurance Scheme (NHIS) has gained global recognition as the lifeblood of Universal Health Coverage (UHC), especially in sub-Saharan Africa.

🇬🇭 Here's What Happened

The NHIS was established under the National Health Insurance Act 2003 (Act 650), aimed at providing financial risk protection against the cost of quality healthcare services for all residents in Ghana and people in the country on long visits.

The Act 2003 (Act 650) was replaced by Act 2012 (Act 852), which established the National Health Insurance Authority (NHIA), mandated to consolidate the National Health Insurance Scheme (NHIS) gains, remove administrative bottlenecks, enhance accountability and transparency, reduce corruption and make governance more effective than the previous semi-autonomous District Mutual Health Insurance Schemes (DMHIS).

Section 27(1) of the National Health Insurance Act, 2012 (Act 852) explicitly states that every resident in Ghana is legally required to be a member of the NHIS and may join a licensed private health insurance Scheme. While membership is mandatory by law, its strict enforcement in the informal employment sector remains voluntary.

📌 Key Details

The Scheme provides equitable access and financial coverage for basic healthcare services targeting about 95 per cent of disease conditions recorded in Ghana. Identified vulnerable groups are exempted from paying fresh registration fees and annual premiums. They include children under 18, pregnant women (for maternal, antenatal, and postnatal care), the aged 70 and above, the extremely poor (indigents), beneficiaries of the Livelihood Empowerment Against Poverty Programme (LEAP), Students under the Ghana School Feeding Programme, psychiatric hospital patients, Prison inmates, Social Security and National Insurance Trust (SSNIT) contributors and pensioners.

It covers Outpatient Services, Inpatient Services, Oral Health, Eye Care Services, Maternity and antenatal Care, and emergencies that require urgent intervention. The Benefit Package excludes heart and brain surgery, VIP ward accommodation, organ transplantation, diagnosis and treatment abroad, mortuary services, HIV antiretroviral medicines, cosmetic surgeries and medicines that are not on the NHIS approved medicines list.

By the approval of the Ministry of Health, the NHIA successive Executive Management and Governing Boards expanded the Benefit Package to include critical services mental health treatment, Depression Disorder, Bipolar Disorder, Anxiety Disorder and Schizophrenia Disorder, four childhood cancers, (Acute Lymphoblastic Leukaemia, Burkitt Lymphoma, Retinoblastoma, and Wilms tumour), dialysis treatment, family planning, and specific medications to reduce out-of-pocket costs and drive UHC. Due to the Benefit Package's continuous expansion coupled with the then capped National Health Insurance Levy (NHIL), the Scheme was running a deficit in claims payments.

The NHIS achieved a historic 70 per cent national population coverage, as of mid-year 2026. The significant milestone was attributed to the community-focused campaigns and digital innovations, specifically, the market storm, campus connect, sensitisation on illegal charges combat, festive pulse, free maternal healthcare, faith and wellness, mobile renewal short code *929#, MyNHIS App and the One Time Attendance Code (OTAC) digital solution, piloted in the Western North and Ahafo Regions.

Since its inception, the NHIS's major source of funding is the earmarked National Health Insurance Levy (NHIL), pegged at a 2.5 per cent levy on goods and services collected through the Value Added Tax (VAT). There are an additional 2.5 percentage points of Social Security and National Insurance Trust (SSNIT) monthly contributions and returns on the National Health Insurance Fund (NHIF) investments.

Other sources are the Road Accident Fund, Internally Generated Funds (IGF) and infrequent international donor support. Through contributions mobilised by the National Insurance Commission (NIC), a percentage of vehicle owners' insurance cover is allocated to the NHIA. The Internally Generated Funds (IGF) are the NHIS premium and registration fees, healthcare facilities credentialing and renewal fees, licensing fees from private health insurance companies and other regulated entities, and the Authority’s investment returns.

📰 Source: Joy Online Ghana