Healthcare costs in Ghana are financed by both the public and private sectors, with the country firmly committed to achieving Universal Health Coverage. Currently, 58.2% of the population is enrolled in the National Health Insurance Scheme (NHIS)—the second-highest coverage rate in Africa.
However despite this achievement, patients are still facing significant financial burden for their health, with Out of Pocket (OOP) expenditures covering over a third of Ghana’s total healthcare spend. A cancer diagnosis can be financially catastrophic for many patients and their families across the care continuum of diagnosis, through to treatment.
To address some of these challenges, C/Can conducted an assessment to identify the insurance coverage gaps and challenges faced by NHIS and healthcare providers for breast and cervical cancer care. These cancers account for 30% of the total cancer burden in Ghana, making the risk of financial toxicity for these patients a national concern.
This study is crucial given the rising cases of breast and cervical cancer in Ghana and the significant economic burden these diseases impose on households. The financial strain is often so severe that it pushes families into poverty due to catastrophic health expenditures. While the National Health Insurance Scheme (NHIS) offers coverage for breast and cervical cancer, it is essential to assess the comprehensiveness of this coverage and how effectively it is implemented at the healthcare facility level, ensuring it benefits the patients it is intended for. This study is timely, as it presents an opportunity to identify the gaps between NHIS policy and its actual implementation. The findings could provide valuable empirical evidence to guide stakeholders in improving access to care and expanding coverage for breast and cervical cancer patients, ultimately enhancing their health outcomes.
said Richmond Owusu, Health Economics and Policy Expert, University of Ghana
A qualitative study was developed that involved local healthcare providers, patient navigators, civil society organisations, patient representatives and academia. The assessment looked at the extent of coverage included under the benefit package of the NHIS for breast and cervical cancer care, and any operational inefficiencies which led to patients incurring additional expenses.
Key findings include:
- Benefit packages covered under the NHIS are very comprehensive for breast and cervical cancer, with the exception of:
- Routine screening tests (such as pap smear or mammography)
- Psychosocial support, rehabilitative care and prosthesis.
- Health providers are unaware of the coverage provided under the NHIS scheme which creates operational inefficiencies and limited knowledge of which services to claim.
- Patients copay for services on site, which are then not liable for reimbursement.
- Inefficiencies within the system mean that patients are paying partially or in full for diagnostics, treatment and surgery at health facilities, which are then not liable for reimbursement. This is due to:
- Uneven awareness of coverage across providers.
- Some providers believe that reimbursement rates are too low and not cost covering, and resort to levying unofficial copayments.
Based on the assessment, the following recommendations have been presented to the Ministry of Health to address these coverage gaps:
- Increased stakeholder engagement in the development of tariffs to factor in the realities in the cost of healthcare provision.
- Prioritization for both financing coverage and donor funded initiatives in respect of early detection and prevention to ensure timely treatment of patients that yield better outcomes while reducing treatment costs.
- A comprehensive Cancer Policy Update for the NHIS, in line with current practices and realities.
C/Can will continue to support the Ghanian Ministry of Health in addressing these challenges together with the NHIS, with the ultimate goal of reducing out of pocket expenses for breast and cervical cancer patients.
