The Upper East Regional Directorate of the Ghana Health Service (GHS) says the dreaded ‘cash and carry system’ will become operational once again in the region if the National Health Insurance Authority (NHIA) failed to settle its arrears.
The Regional Director of Health Services, Dr. Koku Awoonor-Williams told The Chronicle on the sidelines of the 2014 Health Sector Performance Review meeting held in Bolgatanga recently that hospitals owed the Regional Medical Store about GHc8 million while the GHS also owed the Central Medical Store about GHc 6million due to the inability of the NHIA to pay service providers for 6 to 9 months now.
He lamented that: “Let me tell you, the services are coming to a halt, because our drug available has dropped from 95% to almost 40%”.
Dr. Awoonor-Williams explained that the GHS expected that for example, if five medicines were prescribed for a client, the client should get at least four of them, but in the present circumstance if six medicines were prescribed for a client, they might get only one. As a result, the director regretted that, the regional medical store did not have drugs.
“And the suppliers will not also give us drugs because we owe them so much and the hospitals don’t also have the money to go out of the facilities in terms of the regional medical store to buy the drugs,” he noted. Dr. Awoonor-Williams further noted that the energy crisis had also compounded the already precarious situation and that hospitals who have stand-by generators were finding it very difficult to raise funds to buy fuel.
“I am very worried because we seem to be going backward in the things we have achieved over the years because of the National Health Insurance. It’s as if the National Health Insurance now basically owns the facilities, so they can dictate the pace.
“They don’t even have the courtesy to come and negotiate with us and give us assurance. It’s that we have to beg them to give us our money that they owe us and for me, that is a worry and I don’t know whether anybody is looking at that aspect of the relationship.
“Somebody must get up one day and take them to court and make sure that they pay, because you can’t owe somebody for nine months. It’s not for the doctor, it’s not for the nurse; it’s for the population where we want to serve,” he said.
He also noticed that it has reached a point where people could no longer buy medicines prescribed for them and so they throw away their prescriptions. When asked if he also thought the scheme was collapsing as some people have suggested, this was his response.
“If the facility owes me 9 months and cannot pay, and you are implementing the National Health Insurance, it is obvious you will say the scheme is collapsing. As to the parameters of determining the collapse, it’s left with the NHIA but to the provider, he thinks that this is a failed system.
“He will think that it’s a failed system because why won’t you pay me for 9 months and I continue to provide services? And for me, I am worried because it looks like the kind of gains and the quality of service that we have, the motivation to provide services is dwindling because the facilities don’t have money to run”.
When asked if he thinks ‘cash and system’ was the way to go – Dr. Awoonor-Willaims responded in the negative because of the high level of poverty in the country. However, he maintained managers of NHIA must sit up and do the right thing that would save the scheme from collapsing.
“I should see the national health insurance coordinator in my office telling me that I owe your facilities, can you give me one month or two months, I will pay, but there is nothing like that. You just have to complain like I am complaining to you now. Who is calling the shot? It’s the NHIA. And they expect us to keep quiet and say that the NHIA is still working? It’s unfortunate”.
But in a response, the Upper East Regional Operations Manager, NHIA, Mr. Kasimu Abudulai, said though the authority was aware it owed the service providers, it was not up to six months. He however fell short of giving details of how long the authority owed service providers. According to him some of them also delayed in submitting their claims. He cited that till date, some facilities had still not submitted their claims.
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