Accra: Ghana's National Health Insurance Scheme (NHIS) has gained global recognition as the lifeblood of Universal Health Coverage (UHC), especially in sub-Saharan Africa. Established under the National Health Insurance Act 2003, the NHIS aims to provide financial risk protection against the cost of quality healthcare services for all residents in Ghana. The Act was later replaced by the National Health Insurance Act 2012, which established the National Health Insurance Authority (NHIA) to consolidate the gains of the NHIS and enhance its governance.
According to Ghana Web, the NHIS provides equitable access and financial coverage for basic healthcare services targeting about 95 percent of disease conditions recorded in Ghana. The scheme exempts identified vulnerable groups from paying fresh registration fees and annual premiums, including children under 18, pregnant women, the aged, and beneficiaries of various social programs.
The NHIS Benefit Package includes Outpatient Services, Inpatient Services, Oral Health, Eye Care Services, Maternity and antenatal Care, and emergencies requiring urgent intervention. However, certain services such as heart and brain surgery, organ transplantation, and treatments abroad are excluded. The continuous expansion of the Benefit Package, coupled with the then-capped National Health Insurance Levy (NHIL), led to a deficit in claims payments.
The NHIS achieved a historic 70 percent national population coverage by mid-year 2026. The scheme's major source of funding is the National Health Insurance Levy (NHIL), a 2.5 percent levy on goods and services collected through VAT, alongside other contributions and funds. However, the Earmarked Funds Capping and Realignment Act, 2017, which capped statutory earmarked funds, negatively impacted NHIA operations by diverting funds into the Consolidated Fund.
To restore financial stability, stakeholders advocated for the exemption of the NHIL from the Earmarked Funds Capping. This breakthrough came with the amendment of the Act in 2025, guaranteeing more funds for the NHIA. The Ministry of Finance has since been releasing substantial funds to clear claims arrears, restoring public confidence and increasing active population coverage.
In July 2026, Ghs1.2 billion was paid to credentialed healthcare service providers, while aggressive measures were taken to combat illegal charges at hospitals. The NHIA's efforts have led to the suspension of fraudulent pharmaceutical companies and the sanctioning of non-compliant hospitals.
The uncapped NHIL has also supported the rollout of Free Primary Health Care and the Ghana Medical Trust Fund (Mahama Cares) programs. By August 2026, over GHS35 million was paid to healthcare facilities in districts implementing the first phase of Free Primary Health Care.
The NHIA has continued to mitigate donor funding deficits exacerbated by the withdrawal of USAID programs, using domestic revenue to maintain financial capacity and fulfill co-financing obligations. The uncapped NHIL decision is seen as a significant step toward strengthening the NHIS and achieving Universal Health Coverage in Ghana, aligning with Sustainable Development Goal 3.