NHIA embarks on evaluation exercise (Spread)

THE National Health Insurance Authority (NHIA) has begun an exercise to evaluate all its 4,251 accredited service providers to ensure quality, safe, effective and acceptable health care services.
For a start, a total of 40 health professionals engaged by the authority have gathered data on 603 health facilities, which include CHPS compounds, maternity homes, clinics, hospitals, laboratories and pharmacies for study.
The exercise has become necessary due to the fact that provisional accreditation given to many of the service providers when the National Health Insurance Scheme (NHIS) was introduced were based on certification by existing regulatory bodies such as the Medical Dental Council (MDC), the Ghana Private Medical Practitioners Association, the Pharmaceutical Society of Ghana (PSG) and the Registered Midwives Association.
A visit by the Daily Graphic to some of the accredited facilities in the western part of Accra, notably Mallam, Gbawe, Awoshie, Santa Maria and Kwashieman, revealed that all was not well.
The problems ranged from absence of medical doctors and midwives, as well as inadequate number of nurses and other health workers through dirty bedding in emergency wards to unclean environment which could worsen one's health condition.
To determine which of the facilities could continue to provide services under the NHIS, the evaluation team is using a new set of standard guidelines developed by the authority to ensure best practices under the scheme.
The acting Chief Executive Officer (CEO) of the NHIA, Mr Sylvester A. Mensah, told the Daily Graphic that the rationale behind the evaluation was that the authority should get the best of services for the clients of the NHIS.
He said as a regulatory body, the law (Act 650) allowed the NHIA to undertake that exercise, which, he said, began about a month ago.
Section 2 of the National Health Insurance Act (Act 650 of 2003) states that for the purposes of achieving its objectives, the authority has the responsibility to (a) register, license and regulate health insurance schemes; (b) supervise the operations of health insurance schemes; (c) grant accreditation to health care providers and monitor their performance and (d) ensure that health care services rendered to beneficiaries of the schemes by accredited health care providers are of good quality, among others.
Under the NHIS, health facilities are to be accredited to ensure that they are in the position to provide health services to people and also to promote the provision and delivery of quality, safe, effective and acceptable health care services to people living in Ghana.
The Media Relations Officer of the NHIA, Mr Akwasi Acquah, explained that the evaluation exercise, which began about a month ago, was expected to cover all the 4,251 service providers throughout the country.
Mr Acquah said 1,551 of the facilities were privately owned and 2,700 owned by the state, quasi-government as well as the Christian Health Association of Ghana (CHAG).
Throwing more light on the issue, the Provider Relations Manager of the NHIA, Mrs Vivian Addo-Cobbiah, said the evaluation exercise would cover all the 4,251 health providers.
She pointed out that there were new sets of standard guidelines which the service providers were expected to follow and mentioned some of the areas to be looked at as: range of service, staffing, environment and infrastructure, as well as basic equipment.
The rest were organisation and management, safety and quality management, out-patient care, in-patient care, maternity care, specialised care, diagnostic services and pharmaceutical services.
She explained that the time had come for all the facilities to be properly evaluated because initially provisional accreditation was given to some of the service providers based on recommendations from bodies other than the NHIA.
She observed that initial reports received from the evaluation team had revealed that some of the facilities were doing excellent job while others were far below standard.
She said although the exercise had not been completed, there was an indication that some of the facilities would be asked to stop providing services since the NHIA could not entrust the health of Ghanaians into the hands of unprofessional people.
Mrs Addo-Cobbiah pointed out that there were plans to introduce a grading system for the various facilities at the various levels to encourage them to perform better.
She said the NHIA had plans to intensify its monitoring system to enable the facilities to improve on service delivery.
The accreditation manual provided by the NHIS states that, “To achieve the above objectives and enhance acceptability, the Accreditation Programme shall deliberately and diligently apply the principles of neutrality, transparency, fairness, firmness, equity, reliability, credibility and accountability”.