Africa: Malaria Care Improves with Cash

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Africa: Malaria Care Improves With Cash A question had been nagging at Ghanaian researcher Alexander Nartey.
Since Ghana’s government had made health insurance available to the country’s poor to ease the burden of health care, why were so many people still paying cash, including those seeking basic treatment for malaria?
The Ghanaian government in 2003 introduced its National Health Insurance Scheme (NHIS), which Nartey called a “pro-poor policy” to help those less likely to be able to pay for health care. The British charity Oxfam in a 2011 report found a number of problems with the scheme, calling it “severely flawed”, but Nartey was focusing on one key question: why weren’t more poor
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“Most of the poor people use these cheaper, generic drugs and the disease comes back more intense,” he said. “Because it is quite intense they are ready to pay any amount and they pay the highest” when they go to the public hospital for treatment. Those who are willing to pay cash are taken care of first.
Nartey said public hospital staffs generally prefer out-of-pocket payments to payment through health insurance. They rely on the cash to run the hospital, including buying medicine and other supplies. Part of the problem, he said, is that the government releases money to the hospitals each quarter, and there is often a funding shortfall until those payments become available.
When patients arrive at the hospital, there are two lines: one for those paying cash and one for those with health insurance. The longer that poor people have to wait to be treated, the longer they could be missing out on work, time away from their vending stall or other job trying to earn much-needed cash. Sometimes they will sell an asset, such as a farm animal or textiles, to acquire cash to pay for medical treatment.
Nartey said the average Ghanaian in the rural district where he conducted his research is likely to have malaria four times a year, equaling nearly $50 per year spent on malaria treatment.
“It’s really a big challenge,” he said.
In Ghana the minimum wage is less than $100 per month. In Nartey’s district there is an average of five

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