The Deputy Chief Executive in charge of Operations at the National Health Insurance Authority (NHIA), Dr. Senanu Kwesi Djokoto, has underscored the importance of post-credentialling activities in ensuring accountability and protecting public funds within the National Health Insurance Scheme (NHIS).
Speaking at a capacity-building workshop organized by the Quality Assurance Directorate (QA) in Sogakope, Dr. Djokoto explained that some health facilities exaggerate the level of care they provide, resulting in inflated claims.
“We have noticed that some facilities that provide services at the level of care that they claim to be in, they don’t. So, it is only on paper that they offer those services. But we are paying them much more for services that they are not rendering,” he said.
Dr. Djokoto said there was the need to enhance post-credentialling tools to help the Authority verify claims and ensure that payments reflect actual services delivered to NHIS members.
He noted that with the introduction of Free Primary Health Care (FPHC), QA staff must play a central role in maintaining standards. “Because if the health facilities are overwhelmed, it is very easy for them to compromise on the level of care that they offer. So, it is your responsibility to make sure that we maintain those standards,” he stated.
He added that effective stakeholder management by QA would boost public confidence in the NHIA and enhance the Authority’s image.
The Deputy Chief Executive acknowledged that more work is needed in clinical auditing to improve patient care and detect fraud.
Dr. Djokoto cautioned that sustaining the NHIS would be difficult if loopholes were not sealed before new tariffs are announced.
“Our survival depends on the work that you do routinely and the only way you can excel is when you do the ordinary task in extraordinary manner,” he said.
The Director of Operations, Ms. Mariam Musah, also addressed the workshop, explaining the distinction between the NHIS and the newly introduced Free Primary Health Care initiative. She noted that while the NHIS is service-based, the FPHC is population-based, focusing on preventive and promotive health services.
According to Ms. Musah, the FPHC is designed to strengthen community-level health delivery and reduce the burden on higher-level facilities by emphasizing prevention rather than treatment.
