Anakin

The National Health Insurance Authority has published years of annual reports. For the longest time, the public record stopped at 2018. The reports now run to 2024. I went through it and analyzed 10 years of data. The numbers are staggering. The core mandate of the NHIA is to pay the people who provide care when you walk into a health facility. In 2015, 71.5% of the Authority's expenditure went to that purpose, paying claims. By 2024 it was 44.7%. More than half of what the NHIA spent did not go to paying for treatment. Adjust the spending for inflation and it gets worse. Total NHIA expenditure in 2024 was 1.23 billion cedis in 2015 prices, against 1.26 million in 2015. The expenditure quadrupled in nominal cedi terms and stood still in real terms. So this is not a case of everything growing and some things growing faster. It is a shift inside a fixed envelope, out of claims and into administration and partner support. In real terms since 2015, partner support is up 292% and administration is up 111%. Claims are down 39%. Active membership rose 63%, from 11.3 million to 18.5 million. Real claims spending per member fell from 79 cedis in 2015 to 30 in 2024, a decline of 62% and the lowest in the ten years. Membership up 63%. Benefit per member down 62%. We have been issuing cards faster than we have been funding the care those cards promise. cc @nkquakyi

Cities far larger than Accra don’t run national clean-up exercises to manage solid waste. You have to address the root cause. A two-day cleaning exercise does nothing about waste generation and collection. Who dumps trash in drains when they know it will be collected every week or every other week? You have to invest in waste transfer stations. Collection trucks deposit waste there before it is hauled to the final disposal site. That cuts travel time and stops waste being dumped or burned in communities. You also need to invest in additional final disposal capacity. The Kpone landfill has been nearly full since 2019. Current analysis says it could be shut down in six months. I’m not coming up with any new ideas. I’m regurgitating the appraisal document for the $350m Greater Accra Resilient and Integrated Development Project (GARID) project, which allocated US$42.2 million to solid waste management: transfer stations, capping old dumpsites, and extending disposal capacity. We have the ideas and the funding to attack Accra’s floods from different angles. Why are we still looking at communal labour and the associated clown show to deal with waste management?