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A delegation from KPMG has paid a working visit to the
National Health Insurance Authority (NHIA) to explore potential collaboration
aimed at strengthening operations of the Authority and the National Health
Insurance Scheme (NHIS).
The meeting, held on Thursday, August 21, 2025, focused on
strategic areas including how KPMG can support for NHIA’s ongoing
digitalisation drive, which has enabled 100 percent electronic claims
submission, as well as self-registration and renewal of NHIS membership.
Discussions centred on NHIA’s digital progress, system
strengthening, and KPMG’s global expertise in healthcare advisory, financing,
and digital transformation.
The KPMG team, led by Global Head of Healthcare, Dr. Anna
van Poucke, was received by NHIA Deputy Chief Executive in charge of
Operations, Dr. Senanu Kwesi Djokoto, who represented NHIA Chief Executive, Dr.
Victor Asare Bampoe.
Dr. Djokoto welcomed the partnership, noting KPMG’s global
reputation.
He traced the Authority’s mandate to its establishment in
2003 under Act 650, later revised by Act 852 of 2012, with a mission of
protecting Ghanaians from the financial burden of healthcare. “Our mandate is clear: to provide financial protection
against the debilitating cost of healthcare,” he said, stressing the focus on
vulnerable groups.
Highlighting Ghana’s health insurance progress, he said,
“Among emerging low-income countries, we may be about the best.
In Africa, Rwanda has about 90 percent coverage, and Ghana
is currently doing about 56 percent. We are number two on the continent.”
He added that while 95 percent of disease conditions are
covered, gaps remain, particularly in addressing non-communicable diseases.
Dr. Djokoto commended President John Dramani Mahama’s Free
Primary Health Care initiative, designed to expand access to preventive and
promotive services.
He also pointed to the Ghana Medical Trust Fund as part of
efforts to address rising complications from non-communicable diseases.
The Deputy CEO stressed the importance of partnerships to
enhance efficiency and sustainability.
He noted reforms such as the uncapping of the National
Health Insurance Fund and improved fund releases, which have boosted liquidity
and ensured early provider payments.
“This year, providers are being paid early, and it grants us
the opportunity to work on collaborations for the benefit of the scheme,” he
said.
Looking forward, NHIA aims to increase coverage from 56
percent to 80 percent, with a long-term goal of universal health coverage. He
cautioned against financial leakages, describing them as a major threat to
sustainability.
“Every social health insurance has some amount of leakage.
But when it is unusually high, it affects sustainability. We are putting in
plans to block the leakage and will collaborate with you on that,” he added.
KPMG
Dr. Van Poucke noted that while KPMG is best known for
auditing, it has become one of the largest providers of healthcare advisory
services globally, with 5,000 professionals across 70 countries, including more
than 200 clinicians.
She said healthcare advisory now accounts for two-thirds of
KPMG’s global health work, generating $1.8 billion annually.
She highlighted KPMG’s footprint across Africa, citing work
in Ghana, Nigeria, Kenya, Uganda, Tanzania, Ethiopia, Rwanda, and South Africa.
Areas of focus include universal health coverage, digital transformation,
AI-driven fraud detection, and health financing reforms.
Emphasising the importance of tailoring solutions to local
realities, she said KPMG partners with funders such as the World Bank, Gates
Foundation, Gavi, and the Global Fund.
Dr. van Poucke praised Ghana’s reforms and noted that
emerging markets have the chance to “leapfrog legacy systems” through digital,
data, and AI solutions.
Other Contributions
NHIA’s directorates also shared perspectives on the
partnership.
Dr. Ruby Aileen Mensah Annan, Director, Strategic Health
Purchasing, spoke about NHIA’s role in managing the benefits package, national
formulary, costing, and tariff setting to ensure value for money, and welcomed
KPMG’s advisory support in health economics and transparent tariff
determination.
Mrs. Mariam Musah Alhassan, Ag. Director of Operations,
stressed the need for collaboration in digitalisation, fraud prevention,
private health insurance regulation, and AI-based claims monitoring.
Mr. Suleymana Abass, Acting Director of Research, Policy,
Monitoring and Evaluation, highlighted evidence-driven reforms such as mobile
renewals and e-payment, and revealed that a national survey on Free Primary
Health Care is underway.
Mr. Kaleo-Bioh Vitus Gundona, Acting Director of MIS,
showcased NHIA’s large health IT system linking 16 regional offices and over
4,000 providers.
He explained that all claims are now submitted
electronically, with integration across provider validation, claims, and
payments.
He also announced upcoming innovations including telehealth
services, an e-pharmacy platform, and AI-powered fraud detection.
Adding to this, Mr. Omane-Adjekum William, Acting Director
of PHIS, emphasised the importance of deploying AI to regulate and monitor
private insurance providers and to enhance national data for inclusive
decision-making.
The visit concluded with both parties' expressing optimism
about the future of collaboration, especially in harnessing technology and
global expertise to advance Ghana’s universal health coverage agenda.
Report by Doreen Andoh
Pictures by Isaac Hagan & Ebenezer Danso
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