EDITORIAL: Well Done NHIA
When public institutions act swiftly, transparently and in the public interest, citizens are reminded that systems can work — and work well. The National Health Insurance Authority (NHIA) has given us such a reminder with its recent clinical and compliance audit of the Akim Oda Government Hospital and the resultant directive that the facility refund GH¢312,413.51 for irregular claims and improper charges to NHIS members.
We applaud NHIA Chief Executive Dr. Victor Asare Bampoe and his team for responding decisively to a whistleblower report and invoking the law — Sections 31(1) and 35(2) of the National Health Insurance Act (Act 852) — to protect scheme members and the public purse. The multidisciplinary audit, conducted by NHIA Quality Assurance, Internal Audit, the Claims Processing Center and an external clinician, is a textbook example of rigorous oversight: independent, evidence-based and timely. That it uncovered discrepancies in medicines dispensed versus billed, inappropriate prescribing and unlawful co-payments demonstrates both the necessity and the effectiveness of such scrutiny.
This action matters for three reasons. First, it restores trust. When patients learn they will not be charged out-of-pocket for services covered by the NHIS, confidence in the scheme — and in public healthcare — grows. Second, it protects scarce public resources. The demand for a substantive refund and stricter validation of subsequent claims shows the NHIA is safeguarding the financial sustainability needed to deliver care for millions. Third, it advances the broader national goal of Universal Health Coverage: removing financial barriers to care is not rhetoric; it requires enforcement and ethical stewardship.
Credit is also due for the tone and strategy from NHIA leadership. Dr. Bampoe’s insistence on transparency, accountability and financial controls — backed by visible action — signals a shift from promise to practice. The Authority’s recent achievement of being debt-free on claims, supported by timely government funding and the uncapping of the National Health Insurance Levy, offers an important runway for reform. But funding alone is not enough; funds must be disbursed appropriately and outcomes monitored. The Akim Oda audit shows NHIA is prepared to do both.
While we commend the NHIA, we also urge a balanced approach going forward. Enforcement should be paired with capacity building for public facilities so that credentialing errors, tariff misclassification and poor prescribing practices are corrected, not merely punished. Accelerated digital claims technologies, stronger internal controls at facility level, regular public reporting of audit outcomes, and robust whistleblower protections will reduce fraud and errors long-term. Providers must be partners in reform — trained, supported and held to clear standards — while patients should be better informed about their entitlements under the NHIS.
The NHIA’s resolve to expand clinical and compliance audits nationwide is welcome. If sustained, transparent, and complemented by systemic improvements, these measures will protect members, secure the scheme’s finances and bring us closer to President Mahama’s vision of universal, affordable healthcare. Today the NHIA deserves praise not for a single audit, but for demonstrating that accountability in health care is achievable — and that the public interest can, and must, come first.