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Danish Embassy joins the Health Monitoring Visit

24.11.2015  23:09

The Danish Ambassador, H.E. Tove Degnbol, and First Secretary, Health, Ms. Lena Hothes, participated in the Health Sector’s November Joint Monitoring Visit to Ashanti Region. The Joint Monitoring Visit is an arrangement for colleagues of the Ministry of Health, its agencies as well as Development Partners and other stakeholders to gather information on topical (re-merging and emerging) issues confronting the sector. The Joint Monitoring Visit is organised as a preparation to the Health Sector’s Business Meeting. The information gathered serves as inputs to enhance the discussions at the meeting.

The topic of this round of the Joint Monitoring Visit was primarily the roll out of Capitation in the Upper East, Upper West and Volta Regions and lessons learned from Ashanti. Capitation was introduced in Ashanti Region as a pilot in 2012. The idea is for clients to sign up to one health provider and then pre-pay the providers a fixed rate per registered client (for more on Capitation, please see here).

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The team first met with various partners from regional level all the way to visiting CHPS compounds (Community-based Health Planning and Services) in various districts. Further, we went to the Regional Office of the National Health Insurance Scheme to see the progress in biometric registration of cardholders and were also given the opportunity to visit two district offices.

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Especially on Capitation the team got many and positive findings. At all levels, Capitation was seen as a good payment mechanism and its implementation nationwide was recommended - provided some improvements! Capitation has the possibility to save the nation a lot of money if implemented well, since it reduces facility shopping and introduces positive competition among the health providers to offer quality services in order to keep their clients on board. People will vote with their feet – they will sign up to the health facility with the best services.

Before the introduction of Capitation in Ashanti Region, many clients did not use the same provider each time. This meant that clients could visit different health facilities for the same health condition and thereby ‘over-use’ the system. The introduction of Capitation has limited the clients to one facility, which has made it possible for the health providers to better know their clients due to continuous interaction and increased appreciation of their medical histories.

Further, there was a general agreement that one major advantage of Capitation is the pre-payment that it brings. This keeps the providers with some funds to pay creditors and run the facility while waiting for the health insurance reimbursement (which can be taking several months!).

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Capitation has also made it more attractive for providers to invest in preventive care in order to make their clients healthier - thereby reducing their visits to the facilities. This means that the facilities are making more money, since fewer visits still give the same pre-payment per client registered.

However positive everybody was, several challenges were still mentioned. The pre-payment advantage had recently suffered, since it had been late several times. For example most of the facilities had their September 2015 Capitation paid on 29 September instead of 1st September. The late advance payment has however been recognized and the obstacles identified.

Capitation pre-payment can also in some instances make health facilities ‘upgrade’ their clients’ health problems in order to get more money out of the health insurance agency. Finally, there was a general agreement that there is a constant need to review the pre-payment rates, the registration practices and the Capitation package.

Overall, however, the Joint Monitoring Visit gave a good and positive impression of the future of Capitation in Ghana.

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