Inclusion of family planning in NHIS benefits package will save lives

Findings from a Family Planning (FP) Pilot study in Ghana, has shown that its inclusion on the National Health Insurance Scheme (NHIS) benefits package, will save more lives, cost, and improve uptake of contraceptive methods among women.

Dr Stephen Duku, the Project Manager of the Pilot study on the Inclusion of FP services on the NHIS benefits package, at the dissemination workshop in Accra on Thursday, said, the research led to an increase in uptake of Long Active Reversible Contraceptives (LARCs) and a decrease in Short Active Reversible Contraceptives (SARCs) uptake.

Again, the combination of all three interventions made up of Cost Removal, LARCs Training and Demand Generation, were found to be significantly associated with increased uptake of both LARCs and SARCs by insured women.

However, the findings showed that Out -of-Pocket Cost removal alone may not lead to expected increase in LARCs uptake by the insured, but it must be completed with a sustainable demand generation and LARCs training.

Dr Duku said the study was conducted by the Ghana Health Service (GHS) in seven districts, to identify the key process learning from the FP pilot, by understanding what people wanted to know about the various contraceptives, to generate evidence on cost as a barrier to uptake, identify and generate evidence on other barriers, and generate evidence on the cost implications to the NHIS on the effective inclusion of FP on the benefit package.

He said it was estimated that the health impact on the insured was that it could avert 228 maternal deaths, 1,248 child mortalities and 37,725 unsafe abortions, therefore with FP on the NHIS benefit package, the government was assured that for everyone dollar invested, four more dollars would be saved through the uptake of the various contraceptive interventions.

This key outcome, he said, should inform policy makers on investment decisions by considering FP as a gain rather that a national liability.

Dr Duku said among the key recommendations made by the researchers were that FP to be included on the NHIS benefit package nationwide in phased implementation and that only clinical FP methods should be included on the NHIS benefit package.

It also said LARCs capacity building and demand generation should be incorporated in the nationwide in the nationwide roll-out, while insisting that commodities should be procured by government at the national level and distributed through the GHS channels, he said.

He said other recommendations were that FP should not be capitated on the NHIA, but a case-based tariff should be used to reimburse providers, and the demand that current payment arrangement for FP commodity retention fees between facilities and District Health Management Teams be maintained.

Dr Duku said additional proposals were made that retention fees payment should only be made when NHIA reimburses facilities for FP services, while current arrangements for accessing FP at the facilities should be maintained with NHIS identity number recorded in register for insured clients.

The study requested that the decision to include FP on the NHIS benefit package should consider all recommendations mentioned and ensure that the nationwide roll-out of FP on the NHIS benefit package involved all stakeholders for effective and sustainable implementation, he said.

Dr Asenso Boadi, a Director, GHS, said the two-year pilot project was carried out in the Upper East-(Bolgatanga and Bawku West), Ashanti (Obuasi Municipality), Volta (Adaklu) and Central (Ekumfi, Mfantseman), and in three control districts involving Upper Denkyira East and West, as well as in Mamprusi West.

The workshop brought together stakeholders including; traditional leaders, policy makers, officials from the GHS, National Health Insurance Authority as well as some development partners.

Ms Anne Coolen, the Country Director, Marie Stopes Ghana, said different barriers were identified to affect FP one of which was cost, saying if women were allowed to choose a contraceptive method, they would prefer LARCs.

Prof. Augustine Ankomah, the Country Director, Population Council, an International Organisation, noted that if FP was put on the NHIS, people could freely walk to health facilities for access to save life and ensure quality health.