2. Improving Access to Treatment of PLHIV, the Role of the National Health Insurance Scheme
Author: Mr. Kwasi Gyimah Okai, Co-authors: Dr. Angela El-Adas : Dr. Henry Nagai : Mr. Emmanuel Larbi : Mr. Samuel Dery

3. Presentation Outline Background Introduction Issues Descriptions
Results
Lessons learned
Challenges
Next Steps

4. Background ANC Prevalence is 1.6% General adult prevalence 1.47%
Total number of PLHIV – 250,232
Adults (15+ years) – 229,009 (92%)
Children (0–14 years) – 21,223 (8%)
Total new infections in ,356
Adults (15+ years) – 9,467 (83%)
Children (0–14 years) – 1,889 (17%)
Total AIDS Deaths in 2014 – 9,248
Adults (15+ years) – 7,953 (86%)
Children (0–14 years) – 1,295 (14%)
Northern
0.6%
Volta
2.2%
Ashanti
2.8%
Brong Ahafo
2.6%
Western
2.4%
Eastern
3.7%
Upper
West
1.3%
Central
1.4%
Upper East
Greater Accra
3.1%
Legend
0.00 – 1.00
1.00 – 2.00
3.00 – 4.00
2.00 – 3.00
Source: National AIDS/STI Control Programme

5. Introduction
In Ghana, the National Health Insurance Scheme (NHIS) as a Social Protection Strategy program is one aspect used to address the basic needs of vulnerable groups including PLHIV
In 2003, NHIS law was passed and fully implemented in 2005 to make healthcare accessible and affordable to all Ghanaians
ART defaulting among PLHIVs are mostly due to social and economic factors mainly household expenditure and stigma related issues.
PLHIV paid 5 Ghana Cedis for ART related services until 2013
Since its introduction, the National Health Insurance Scheme (NHIS) has had positive impact on the utilization of health care services.

6. Issues
Ghana AIDS Commission (GAC) as part of the National Strategic Plan (NSP ) implementation enrolled PLHIV onto the NHIS for free scheme to help;
Achieve Universal access to Treatment Care and Support Services
Increase coverage of ART Services
Treatment of Opportunistic Infections
Ghana AIDS Commission (GAC) as part of the National Strategic Plan (NSP ) implementation provided free enrollment of PLHIV onto the NHIS to protect PLHIV and their families from financial hardships

7. Descriptions With support from the Global Fund in October 2010, GAC;
Undertook an assessment of health facilities that provide ART services
GAC signed an MOU with the health facilities to carry out enrollment for the PLHIV across the country onto the scheme
Provided funds for insurance premiums for PLHIV
Logistical support to facilities for coordination & communication
Established M&E system
quarterly reporting, on-site data verification and supportive supervision, technical and financial audit and feed back mechanism.
database system developed to store and help analyze data
Health facilities were provided with funds for insurance premiums for PLHIV and logistical support to carry out weekly meetings for smooth implementation of the intervention

8. Results Year 2010 2011 2012 2013 2014 Total PLHIV Enrolled 6,497
24,896
16,507
12,748
15,367
76,015
New
3,294
12,000
5,018
3,030
3,474
26,816
Percent (%)
50.7
48.2
30.4
23.8
22.6
35.28

9. Lessons Learned
Mainstreaming successful interventions in national systems provides equitable access
Single point of multiple services for convenience and increased uptake by PLHIV – NHIS registration and treatment services
The M&E systems put in place facilitated timely feedback, the smooth implementation and quality of intervention.
Logistical support for coordination (weekly meeting at facility level) and communication with PLHIV, contributed to the successful implementation of the program
Reducing the financial barriers of PLHIV helped to improve easy access to treatment care and support service particularly treatment of OI’s
Improved retention in care among PLHIV

10. Challenges
Some ART sites do not meet the requirements for providing services
Some of the facilities are not partners of the National Health Insurance Scheme
Some delays in reporting
Initials delays with issuance of cards- was a deterrent for PLHIV but this has been resolved recently

11. Next Steps
Scale up the intervention to all 267 facilities that provide ART services in the Country; currently 123
Dialogue between NHIA, Quasi government facilities to provide services
Quarterly technical support and supervisory visits would be improved to ensure that facilities are updated on implementation arrangement, reporting guidelines as well as timeliness in submission of reports
Utilize social platforms for better coordination and share best practices across facilities
Strengthen in our early warning systems to include social platforms
Engage in annual stakeholders consultative meetings for health facilities

12. Under the Office of the President Cantonments, Accra – Ghana
THANK YOU
Under the Office of the President
P. O Box CT 5169
Cantonments, Accra – Ghana
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