Ethiopia Lauds Ghana’s Health Insurance Capitation Model | 8/17/2023

The Ethiopia Health Insurance Agency (EHIA) is using Ghana’s earlier National Health Insurance Scheme (NHIS) Capitation model to enhance health financing there.   

In the year 2012, Ghana introduced capitation payment under the NHIS, which was piloted in the Ashanti and extended to the Volta, Upper East and Upper West regions, with a key objective of controlling outpatient utilization and Claims expenditure.

Under the Capitation system, beneficiaries of the NHIS were made to select and visit only one health facility, referred to as the Preferred Primary-care Provider (PPP), when in need.

Addressing participants at a three-day global dialogue on Primary Health Care (PHC) Financing, held in Adis Abiba, Ethiopia’s Senior Health Financing Officer, with the World Health Organization (WHO), Tesfaye Mesele lauded Ghana’s earlier Capitation model, hence the need to adopt it in improving that of Ethiopia. 

According to him, Ethiopia started piloting Capitation in some communities, hence the adoption of Ghana’s model to perfect theirs.

He said areas that would be explored consist of households mapping, public financing reforms, private sector engagements and capitation rate setting approach.

Leader of Ghana’s delegation, Deputy Director Research, Monitoring and Evaluation, Mr. Collins Akuamoah highlighted health purchasing reforms introduced in Ghana’s health eco-system, some challenges, and possible solutions.

He explained, “Capitation as a provider payment system ensures that all accredited healthcare service providers in the healthcare delivery system are paid in advance, a predetermined fixed rate, to provide a defined package of services for each member of the NHIS for a fixed period. The amount is paid whether or not the enrolled member accesses services within the payment period. Also, there is no limit on the number of times the enrolled member can access healthcare services from the provider. The provider (accredited by NHIA), to whom a member is enrolled is referred to as the Preferred Primary-care Provider (PPP).

A health financing specialist , Nouria Brikci in her presentation indicated that to achieve Universal Health Coverage (UHC), it is imperative to invest in Revenue Mobilization, Pooling and Purchasing.

Other speakers were Pascal Hilbert, who spoke on Financing Facility, Ermias Dessie, health Financing Advisor delt with Primary Health Care financing in Ethiopia and Dr. Munir Amsalu, Senior Advisor, Ministry of Health, Ethiopia recapped PHC strategic purchasing system adopted in the past.

The workshop concluded with a joint action plan developed for the next phase of Primary Healthcare Financing (PHC) and health Financing Reforms in Ethiopia. 

The Ethiopian Health Insurance Agency was established as an autonomous federal government organ through Regulation No. 191/2010 with the objective of implementing health insurance system in the country.

Ethiopia is implementing community-based health insurance which mainly targets peri-urban communities. Ethiopia also have Social Health Insurance (SHI), which comprises the population engaged in the formal sectors of the economy.

With in-depth experience and knowledge in health financing, Ghana is celebrating 20 years existence of the National Health Insurance Scheme (NHIS), which serves as a shinning model for others in Sub-Saharan Africa.

Source:  Hamdiya Amadu Yakubu