Ghana’s National Health Insurance Scheme (NHIS), set up in 2003 to replace the cash-and-carry system, has become a reference point for several African countries trying to expand access to healthcare. In 2018, the National Health Insurance Authority reported a study tour involving 60 delegates from 14 countries, including Tanzania, Uganda, Kenya, Malawi, Burkina Faso, Mali, Madagascar, Niger, and Côte d’Ivoire. These officials came to Ghana to examine registration, claims processing, provider accreditation, and administration.
Tanzania and Liberia have looked closely at Ghana’s model as they developed their own health insurance arrangements. Ghana’s experience has become part of a wider African search for sustainable health financing. Yet, despite attracting international study, Ghana still struggles with financing, coverage, claims management, and the long-term sustainability of the NHIS.
According to Ghana’s 2025 budget documents, the NHIS had 18.4 million active members in 2024, about 56.3% of the population. That means nearly half of the country’s population remains outside the scheme. Questions remain about whether the NHIS can translate policy coverage into universal health coverage that is financially sustainable.
This pattern of Ghana developing policies that other countries study but then facing challenges in implementation repeats across other sectors. The Livelihood Empowerment Against Poverty programme (LEAP), which provides cash support to vulnerable households, was influenced by Brazil’s Bolsa Família. Brazilian officials took part in Ghana’s policy learning, and Ghana has since become a source of lessons for Malawi and The Gambia. Delegations from these countries have visited Ghana to study social protection systems, including Ghana’s Single Registry used to identify and support vulnerable populations.
Ghana’s school-feeding programme also drew foreign interest. It combined social protection with local agriculture by involving local farmers and food suppliers in supplying school meals. In 2013, officials from Nigeria’s Osun State studied Ghana’s programme before expanding their own O’MEALS initiative. The idea was to treat school meals as more than welfare, creating economic opportunities. Still, Ghana continues to battle with financing, quality, coverage, and sustainability in its own school-feeding programme.
Ghana’s experience with these policies reflects a broader challenge: creating ideas that attract attention but struggle to overcome structural problems at home.
A similar story unfolds in Ghana’s oil-palm sector. While Malaysia sourced some palm materials from Ghana during the colonial period, it went on to develop one of the world’s most productive and sophisticated palm-oil industries. Ghana remains an important producer but has not matched Malaysia’s productivity or industrial integration.
Ghana’s Feed Ghana programme estimates smallholder oil-palm yields at about six tonnes per hectare. Large-scale Ghanaian plantations yield between 15 and 18 tonnes per hectare, while Malaysia’s plantations reach approximately 24 tonnes per hectare. Beyond farm yields, Malaysia built an industrial ecosystem connecting research, planting material, plantations, processing, refining, oleochemicals, food products, cosmetics, industrial products, and exports. Ghana has struggled to develop such a downstream industry, hindered by fragmented smallholder production and weak infrastructure.
This gap illustrates how Ghana has yet to institutionalise, finance, and consistently improve the policies and industries it develops. The challenge is not just designing good policies but making them work in practice, sustainably and at scale.
Ghana’s NHIS remains a model African governments want to learn from. But the system itself still faces significant questions about its reach and funding. The country’s experience shows the complexities of translating policy innovation into lasting results that benefit all citizens.
According to 3News.
