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Submitted by Cheryl Cashin on

Thank you, Patricio, I enjoyed reading this post, which nicely highlights a very important step for Ghana’s NHIS. Health reform in general, but provider payment reform in particular, requires time and patience to take root, as well as simultaneous strengthening of supporting institutions and structures. Provider income is at stake with provider payment reform, and there will always be push back. In a democracy with a vibrant free press as in Ghana, this push back can be highly public and at times political.

Some commentators declared the initial pilot of capitation in Ghana’s NHIS a “failure” because of the strong negative reaction of some providers and the subsequent compromises that had to be made in the capitation model to get the pilot off the ground. But the NHIA and MOH held steady in the knowledge that, to the extent that time and other constraints allowed, they had done the diagnostics, invested time in a good design, engaged stakeholders at every stage, and now are making refinements based on the pilot experience. There is growing consensus that there could be benefits for all sides—some guaranteed income and reduced administrative burden for providers, more responsive and flexible services for patients, and a way for the NHIA to manage a part of its expenditures. All of these are critical for the NHIS to be sustained and to thrive, which is a common goal shared across stakeholder groups in Ghana.

The important lesson, I think, is that it is too tempting to rush to judge policy innovations as “successes” or “failures.” The next phase of capitation implementation will bring its own challenges and imperfections. The real success in Ghana has been the process and how the NHIA, MOH and all stakeholders have been willing to do the work together to learn from experience and constantly adapt and improve.