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The above were the words of Ghana's president John Mahama, when he was reiterating the fact that the National Health Insurance Scheme will continue to thrive following the positive impact in health delivery in the country.

In spite of the sustainability challenges that the scheme is facing, measures must be put in place to ensure that the NHIS is not left for dead.

Established by an Act of Parliament in 2003 (Act 650), the NHIS is an initiative by government to secure financial risk protection against the cost of healthcare services for all in Ghana.

Note, this is not the first time Ghana is implementing health insurance. In 1957 when the country gained independence, a National Health Service (NHS), which was fully financed from state revenue was established. Its aim was to abolish existing user charges in government health facilities.

The NHS system, which did not involve out-of-pocket payments at the point of service, provided services particularly for the poor.

However, the system gradually became financially unstable in the 1970s, following economic stagnation which contributed to budgetary constraints for the scheme.

In effect, the quality of medical services deteriorated as the urban population benefited more to the detriment of the rural poor.

Government then introduced low user fees for hospital services to recover some costs and generate provider performance incentives. But, that did not help as government continued to spend less on health through the 1970s and 1980s leading to shortages of medicines and supplies and deteriorating quality of care.

Thus, when Jerry John Rawlings came into power, he introduced the "cash and carry" system in 1983, where he raised and expanded user fees for public health care services.

But, the highly unpopular cash and carry system posed great financial difficulties to access to health care. So, in order to remove these financial difficulties, the National Health Insurance Scheme (NHIS) came into being to provide a broad range of health care services to Ghanaians through district mutual and private health insurance schemes.

The funding of the scheme is based on a combination of the following models; National Health Insurance Levy which is 2.5 per cent, Value Added Tax, 2.5 per cent of social security contributions and the graduated informal sector premium based on ability to pay.

But, in its first decade of implementation, one may ask, has the scheme been able to achieve its objectives?

There is no denying the fact that there are criticisms about the quality of care that policyholders are given in the various health facilities.

The scheme since its introduction has been hit with a lot of challenges with health service providers threatening on several occasions not to attend to subscribers because they have not been paid their claims.

What is more, from registration challenges to cardholders receiving poor medical treatment and low-quality drugs at the hospitals, one cannot deny the fact that there are hiccups in the system which needs to be addressed.

At some of the 145 district offices of the scheme, the frustration expressed by workers and subscribers points to the fact that all is not well. Sources close to the Adenta district office of the scheme have told Pulse Ghana of the intense pressure exerted on them by would-be beneficiaries when their machines for registration gets frozen. To make matters worse, basic materials such as stationery and internet facilities are often denied them.

Why the system must not be left to collapse

Apparently, the NHIS just like other public organizations is facing some challenges, but the government together with National Health Insurance Authority and the managers of the various schemes have announced measures to sustain the scheme to enable it deliver its mandate.

As the president stated in his 2015 state of the nation address, his government has constituted a technical committee to make proposals that will lead to a fundamental redesign of the National Health Insurance Scheme (NHIS).

He said that with the investment in preventive health, it becomes imperative that investment habits continue to change with regards to diseases such as hypertension, diabetes, high blood pressure, cholesterol and obesity.

Two months later into his address, the National Health Insurance Authority announced an upward price review of between 24% and 27.5%.

According to the National Health Authority, prices of medicines on the NHIS list will go up by 24% while services will increase by 27.7%.

Deputy Director of Communications of the National Health Insurance Authority (NHIA), Selorm Adonoo told Pulse Ghana that the increment is due to concerns from health service providers that cost of health care has increased.

He explained that "when the tariffs are raised, it doesn't mean that consumers are going to pay. It means NHIA is going to pay the hospitals more."

Furthermore, the magnitude of expansion that NHIS has undergone within a short period is very phenomenal.

According to President Mahama, the number of outpatients had risen from 597,000 in 2005 to 26 million in 2014.

“In 2005, total outpatient utilisation of the health insurance was 597,000. In 2014, outpatient utilisation rose to 29.6 million visits. From 597,000 to 29.6 million visits in 2014, you can see the phenomenal increase in utilisation,” explained the president.“Apart from that claims payments in 2005 amounted to less than GHS8million, if you want to be precise; about GHS7.6 million for the whole of 2005. In 2014, claims payment amounted to GHS1.07 billion," the president added.

Also, as part of contribution of the NHIS towards Ghana’s quest to meet the Millennium Development Goals, Child mortality is still being looked at under the NHIS as all persons under 18 years have free access to health insurance. The Scheme also has a free maternal health care policy introduced in July 2008 for pregnant women.

And certainly, the fact that would-be beneficiaries of the scheme wake up at dawn to queue at the various offices of the Scheme in order to grab the new biometric identification cards further goes to explain how valuable the NHIS is to the people.

For the poor and vulnerable, a collapse of the scheme means they will be totally cut off from accessing quality free healthcare services.

In effect, considering the history of health insurance since independence, and the sake of the largely poor who form the majority of subscribers,  it is instructive for government, party leaders, health service providers and other stakeholders to work tirelessly to ensure that the NHIS does not die.