NHIA seeks legal reforms to support free primary healthcare
The Deputy Chief Executive Officer of the National Health Insurance Authority (NHIA), Dr Kwesi Djokoto, has called for amendments to the National Health Insurance Act, 2012 (Act 852), to align it with the government’s Free Primary Healthcare (FPHC) programme and the introduction of population-based payment systems.
Speaking before Parliament’s Health Committee, Dr Djokoto said the current law needed to be revised to support the new healthcare arrangements and strengthen efforts to address claims leakage, fraud and illegal out-of-pocket payments.
He explained that the NHIA was pursuing tariff adjustments and deploying artificial intelligence (AI) and other digital tools to improve claims verification, identify fraudulent activities and address gaps between service tariffs and the funding available to the National Health Insurance Scheme.
Dr Djokoto also highlighted measures to curb unauthorised charges imposed on patients, including illegal co-payments.
He said the authority was implementing a tariff review and establishing an anti-fraud and illegal payments directory to help prevent and detect such practices, as well as impose sanctions to deter offenders.
He urged the committee to support the proposed legal reforms, strengthen penalties for fraud and illegal co-payments, and prioritise capital budget allocations for 2027.
Dr Djokoto further noted that the NHIA had established digital systems to improve its operations, including an electronic claims platform designed to enhance efficiency and speed up reimbursements.
He said claims processing was fully electronic, with a turnaround time of 20 days, adding that the authority was making monthly payments and using digital interventions to improve service delivery.
President John Dramani Mahama launched the Free Primary Healthcare initiative on April 15, 2026, to provide essential first-contact medical services to the public at no cost at the point of use.
The programme is expected to operate through Community-based Health Planning and Services (CHPS) compounds, health centres, polyclinics, public health units, health posts, community pharmacies and mobile or container-based health kiosks in busy areas such as markets and lorry parks.
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