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

Genesis

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, transparency, reduce corruption and make more effective governance of 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.

Coverage

The Scheme provides equitable access and financial coverage for basic healthcare services targeting about 95 percent 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 post-natal 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.

Benefit Package

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.

Expansion

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 continuous expansion coupled with the then-capped National Health Insurance Levy (NHIL), the Scheme was running a deficit in claims payments.

Membership exponential upsurge

The NHIS achieved a historic 70 percent national population coverage as of the 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.

Funding Sources

Since its inception, the NHIS major source of funding is the earmarked National Health Insurance Levy (NHIL), pegged at 2.5 percent levy on goods and services collected through the Value Added Tax (VAT).

There is 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 the infrequent international donor support. Through contributions mobilized 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.

Expenditure

Approximately 70 percent of the NHIS funds go to credentialed healthcare providers (claims payments), 20 percent for administrative and general expenses, and 10 percent was allocated for the Health Ministry through a “Capped release valve,” that allowed for funding emerging national health development priorities, for instance the global COVID-19 pandemic outbreak. The NHIA funding now supports the Ghana Medical Trust Fund (GMTF).

Earmarked Funds Capping and Realignment

On April 5, 2017, Parliament passed the Earmarked Funds Capping and Realignment Act, 2017 (Act 947) to cap statutory earmarked funds at 25 percent of the tax revenue.

The 25 percent threshold was later reduced to 17.5 percent via the amended 2022 (Act 1088).

The development negatively affected the operations of many statutory institutions, particularly the National Health Insurance Authority (NHIA).

The largest portion of the National Health Insurance Levy (NHIL) and the Social Security and National Insurance Trust (SSNIT) contributions that were diverted into the Consolidated Fund for general budget expenditure, accounted for the delayed and accumulated reimbursements (claims payments) backlog.

The cash flow constraints warranted threats by some of the credentialed healthcare providers to discontinue their services to the NHIS active members, whereas others reverted to the dishonest demand for cash (illegal charges) at the point of need service, reducing public trust in the NHIS.

Consolidating the NHIS Universal Health Coverage (UHC) gains required financial stability. Key stakeholders in the health sector and initiative-taking civil society groups consistently advocated a complete exemption of the National Health Insurance Levy from the Earmarked Funds Capping and Realignment Act, 2017 (Act 947).

The Breakthrough

Assented and commenced on April 2, 2025, the Earmarked Funds Capping and Realignment amendment Act, 2025 expunged the National Health Insurance Levy (NHIL) from the list of statutory funds that were diverted into the Consolidated Fund for general budget expenditure, guaranteeing the allocation of more funds to the NHIA.

Positive Outcomes

The Ministry of Finance regular release of substantial funds to the NHIA Executive Management is increasingly clearing the historic claims arrears backlog, making consistent and prompt claims payments, restoring public confidence in the NHIS, increasing the active population coverage, strengthening the synergy between the NHIA and the credentialed service providers, reducing illegal charges, mitigating the donor funding deficit, partly funding a bigger portion of the Free Primary HealthCare and the Ghana Medical Trust Fund (Mahama Cares) programmes.

Prompt Claims payments

In July 2026, a whopping Ghs1.2 billion was paid to credentialed healthcare service providers across the country.

Aggressive illegal charges combat

Persistent extortions and illegal charges at the credentialed hospitals severely reduced public trust in the NHIS, driving down membership renewals and discouraging new enrolments.

The Executive Management’s aggressive pursuit of combating the persistent illegal charges and fraudulent claims payments led to the suspension of three pharmaceutical companies, namely Deldem Pharma Limited, Paramedical Pharmacy and Desh Chemist. The bold decision was derived from the extensive audit findings of fraud and service abuse, under the Authority’s licensed Service Provider Agreement.

In a related development, the Akim Oda Government Hospital management was sanctioned and compelled to refund GH¢312,413.51. The punitive action followed a clinical and compliance audit report, triggered by a patriotic whistle blower's tip off.

Free Primary Health Care

The uncapped NHIL emboldened the Executive Management to channel enough human and financial resources toward the successful rollout of the well-intentioned Free Primary HealthCare and Ghana Medical Trust Fund (MahamaCares) programmes, seeking to promote and protect the vulnerable populations on health-related conditions.

In August 2026, the NHIA paid over GH¢35 million to healthcare facilities in 107 districts across the country, where the Free Primary Health Care first phase is being implemented.

Ghana Medical Trust Fund Secretariat

On August 13, 2026, the NHIA officially announced releasing thirteen of its members staff on secondment to the Ghana Medical Trust Fund to help the new Secretariat. The two organizations maintain a collaborative partnership in coordinating the government’s well-intentioned healthcare reforms.

Donor funding deficit mitigation

The Donald Trump administration’s sudden suspension and closure of the United States Agency for International Development (USAID) major sponsored programmes in developing countries caused a $78.2 million external donor funding deficit in Ghana’s health sector. It slowed down the NHIA’s staff capacity building and the massive awareness creation campaigns meant to accelerate the Universal Health Coverage.

Fortunately, the timely uncapped National Health Insurance Levy (NHIL), injected billions of additional domestic revenue into Ghana’s healthcare system, expanding the National Health Insurance Authority’s (NHIA) financial capacity to mitigate the negative impact of the external donor funding gaps and meeting vital co-financing obligations including the Global Alliance for Vaccines and Immunisation (GAVI) commitments.

Executive Management’s forward thinking

The Governing Board and Executive Management remain focused on ensuring that providers across the country receive timely and accurate reimbursements for providing quality care to the NHIS active members and by extension, coverage of the Free Primary Health Care programme, prioritizing underserved populations, rural communities, and vulnerable groups.

Uncapping the National Health Insurance Levy (NHIL) was the wisest decision and a major step towards strengthening the NHIS which serves as Ghana’s primary vehicle for attaining Universal Health Coverage (UHC), embedded in the Sustainable Development Goal 3 of ensuring good health and the well-being of all.