The Tragedy of Small Decisions – NHIS in Ghana

I believe one of the good things to have happened to Ghana was the introduction of the National Health Insurance Schemes (NHIS). The evidence is clear; no nation has ever lifted itself out of abject poverty without a strong health care system. In fact this is intuitive – you need a healthy work force as well as a healthy citizenry to pursue a sustained development program. The NHIS is therefore a welcome policy in that it has the potential to offer much needed health services to the people of Ghana as well as raise the much needed funds to sustain the health sector. In fact if managed well, this policy has the potential to reverse the brain drain in the health sector. As the evidence points out, Ghana has been losing a lot of health professional to the western countries. Most of these health professionals are leaving Ghana because they are tired of the system. Salaries are low and equipments are outdated and inadequate. An insurance scheme has the potential to provide the necessary resources needed to pay realistic salaries to medical professionals as well as provide some of the cross cutting equipment and technology needed in the medical field.

However the proposal for only a one time premium payment for the NHIS is a sure way to bankrupt the scheme and make it irrelevant within a very short period. It seems the politicians are playing politics with this one too to secure votes. But this is one area that we just have to tell the people the truth. For once let us think about mother Ghana and do the right thing. It is obvious that no government no matter how rich will be able to provide FREE health care service. The Scandinavian and the British systems are the closest to a free health care service and in spite of all their riches, the scheme is fast threatening to bankrupt their economies. This is a matter of basic human behavior – any valuable thing that is free is over subscribed. That is why almost all insurance policies have a co pay – some negative incentive to prevent over use and abuse of medical insurance policies.

At present, Mr. Eric Ametor-Quarmyne, a Deputy Director at the NHIS says government currently finances 97% of the funds for the scheme while individual premiums make up only 3%. Now, that is really messed up. I don’t know why anybody should be happy about this. I get it, nobody likes to pay money, especially to the government. However, Government of Ghana cannot continue to be responsible for 93% or even 70% of the funds needed to run the NHIS scheme. Government of Ghana cannot sustainable finance the NHIS scheme at this level and at the same time deal with all the other critical issues of national importance. We have to know that the cost of medical care is not going to be static and as cost goes up so will the amount of money the government needs to pay to keep the scheme viable. Maybe the NHIS will only be providing funds for only malaria and diarrhea treatment. I don’t know why we think we have to depend on the government for everything. How can we enter the 21^st century medical treatment and technology era if we are to depend on unreliable government contribution to our health care?  We don’t want a scheme that will only treat small medical problems, but a program that will come through when we need it most to treat our life threatening conditions. Today, an average organ transplant cost $59,000 (GHC 82,000) per patient. Do we think the government will have the funds to be paying for these treatments on a regular basis? Nobody should tell me that organ transplant and other such medical treatments will be only isolated cases in Ghana. Gone were the days when we referred to chronic illnesses like diabetes, hypertension, renal failure, cancer and heart failure as the WHITEMAN’S diseases. Today, these diseases are very prevalent or fast becoming prevalent in Ghana. These diseases are usually associated with affluent countries. Although we are not that affluent, globalization has made a lot of the western lifestyles that make people prone to these diseases available in Ghana. It is now very common to find people in Ghana moving from their air conditioned homes to their air conditioned cars to their air conditioned offices. They are no longer walking in the sun and sweating, no exercise and yet they still eat all the fattened chicken, beef, unhealthy canned food and drink all the finest alcohol money can buy. Like the proverbial Fanti man, we are all now digging our graves with our mouths. If we want to live long and healthy lives, not only must we change our lifestyles we must also be ready to pay our share into the NHIS to make it more viable.

My brothers and sisters, I was amazed when I read about current technology on tissue allograft. I am sure a lot of you will be wondering what tissue allograft is. I am no medical doctor, but tissue allograft make it possible to transplant bones, heart valves, blood vessels, skin and tendons from the body of one person to another. Usually a person may donate his body after death or his next of kin may donate his body after death to harvest these body parts to benefit living persons who for medical reasons may need these parts. Can the government alone pay for all this? Of course not. But is it politically expedient to promise the people that all they need is a onetime payment to the NHIS system and the government will take care of the rest. The average person is instantly happy with such a proposal not knowing that his potential health care will be limited by what money the government can ‘afford’ to pay into the scheme. Yet when government officials are sick they are taken abroad to enjoy all the wonderful medical technologies at the expense of the tax payer. As if the life of a politician is worth more than that of an ordinary citizen. This is what I refer to as the Tragedy of Small Decisions. When people pandering to the politics of the four year cycle fail to make decisions that will benefit society in the long run.

The people of Ghana deserve to have access to the best medical technologies available in the world and it is obvious that a government financed NHIS system will not provide this. Let us therefore reject the onetime payment nonsense and embrace a fair recurrent payment system that will not be too burdensome on the people. This is my contribution.

European Soccer in Ghana

For purposes of full disclosure – I am not a sports fanatic, but I think I watch and follow my fair share of sports. At least I try my best to watch and follow most of the international tournament involving the Ghana national team.
Ghana generally has always been a soccer nation and most people will do the unthinkable during football matches. I can recall many cases where people have carried their television sets in their cars looking for where to plug it to watch an ‘important’ match because of power outages in their house. But I am still astounded about the craze for European soccer in Ghana lately. That is all people talk about, drink and eat. To me, as a policy junky, everything comes down to how my country can benefit from a phenomenon.
The way I see it, our appetite for foreign goods has been so insatiable that it has extended to foreign sports. As with demand for foreign products, the foreign entities make all the money and we make nothing (except of course whatever value we derive from the consumption of those goods as individuals). Local TV stations are buying the right to show European matches in Ghana. European teams’ paraphernalia and memorabilia are being sold and worn all over Ghana. I get it, with globalization you cannot help with the demand and consumption of foreign products. Those who provide quality goods anywhere in the world are rewarded. But there is a serious economic consequence that befalls ones economy as demand for foreign products far outstrip exports. Just look around the world and you see the negative consequences of trade imbalance everywhere – from the western world all the way to the doorstep of the poorest developing country. For goodness sake let us also be patriotic; let us be proud of what we produce at home. If you don’t like what we have, try to contribute for change. Let us also promote our own sports – go to stadium and patronize the souvenirs of your local team. The churches should also stop preaching that going to the stadium is a sin because it amount to fraternizing with the ungodly – what happens when we go to work). Let pay our local stars well and give them incentives to invest their money in our economy instead of taking it abroad.
Assuming we are so addicted to European soccer that we can’t stop consumption without some serious withdrawal symptoms. Then at least let us think about ways our country can also benefit from European soccer instead of sending all our money to them. I love the Dubai guys (UAE) – I don’t think any country in the Middle East has bought into globalization the way Dubai has. Unlike other countries who are always complaining about the negatives of globalization, Dubai has strategized and thought about how to profit from globalization instead of blindly sitting down for others to dictate what they should do. In the sports arena, these guys are not only consuming the very fine and well organized sports around the world, they have actually strategized to benefit from the most exotic sports you can think about. Can you imagine that they have created an indoor skiing area comparable to the slopes of the world famous ski resorts in Colorado? I hope u get the enormity of this project. They have created snow in the middle of the desert – literally. Now their people can spend money in Dubai and enjoy Colorado without actually going to Colorado to spend money. You will be surprised the number of people who travel from all around the world to Dubai to enjoy Colorado (skiing) including even Coloradoans. That is what I call proactively embracing globalization. They have some of the best golf courses in the world and they have invested in breeding million dollar horses for racing. Everyone knows America is, among other things, famous for its amusement parks and roller coaster rides. They are famously found in Florida, Georgia, California and Nevada. This week, Dubai unveiled the world’s biggest indoor amusement park and the world’s fastest roller coaster ride. The message – don’t go to America; come to Dubai for the best amusement parks and the best roller coaster rides. You should have seen the queues when it was opened – hundreds and hundreds of people. The interesting part was that most of the people in the queue were foreigners.
It is not only Dubai that is trying to make money off of the traditionally western dominated world of competitive sports. Cricket historically has been the first love of the English people. They have dominated the organizing and the economics side of the game for a long time. Then enters the Indians and now everything is fast changing. Cricket was introduced to India during the colonial era, but most importantly the Indians have strategically placed themselves to receive some of the billions of dollars in the cricket industry. Like the Dubai people, they also realized that they don’t have to just love cricket and watch as other people made all the money. They can also fight for a piece of the pie and today the cricket industry in India is a billion dollar industry with countries such as Pakistan, Bangladesh, South Africa, England all paying for the rights of Indian cricket matches.
Instead of just patronizing European soccer and helping those guys make money, maybe we can think about negotiating to get some of our beloved European teams to play at least one match in Ghana. Can you imagine the money we will make by having thousands of fans in Ghana for an European match? All the hotels in Accra will be full, local restaurants will probably have to buy all the tomatoes in Makola to be able to cook for all the fans that will be coming in to eat. Alcohol will be flying off the shelf. Christmas will come early for taxi and trotro drivers, the guys at the art center will be tired of counting their money from the sale of artifacts. The increase in economic activities will mean more tax money for the government. The value of the international media spotlight on Ghana will be priceless.
How about building a world class golf course in the North, preferably near the Mole Game Park for sports globalization. Nobody should tell me it won’t work. If creating snow in the desert can work then anything is possible. As the Dubai people have shown, if you build it they will come. Master, how exotic can it get, playing golf while seeing all these elephants and lions watching you from afar. We can arrange with the PGA or some other golf body to just play one or two tournament a year at our Exotic Ghana Golf course. You have no idea the transformation this will have for the Northern region. The business people will be racing like crazy to build hotels, restaurants and other such facilities. The airport will of course be expanded to accommodate all the big planes coming in as well as house all the numerous private jets. The people in the north will get the much needed jobs they desperately need. Seriously, this is my future business plan – to build a golf course in the North near the game reserve- hope nobody copies my idea before I am able to raise the funds for it. Ok I have patented the idea – wink!