On June 4, 2019, the Facility, in partnership with AFD and with support from the Joint Learning Network for Universal Health Coverage (JLN), organized a webinar on NHIS mobile renewal and digital authentication in Ghana. The National Health Insurance Authority (NHIA) administers Ghana’s National Health Insurance Scheme (NHIS), which was established in 2003. Up until 2018, around 10.5 million scheme members needed to renew their membership annually and in person at a NHIA District Office. This time-consuming process deterred members from renewing and resulted in lapsed coverage. Partly as a result of these low renewal rates, the Scheme’s national penetration plateaued at around 40% of the population and remained roughly static from 2014 to 2018. In 2017, the NHIA partnered with the ILO’s Impact Insurance Facility and started a project to digitize the renewal process, allowing members the option to renew their membership digitally on their mobile phones. Secondly, the project planned to establish the related systems for membership and identity verification at healthcare providers. The project has been a huge success; following the launch of the mobile renewal platform by Dr Mahamudu Bawumia, Vice President of the Republic of Ghana, in December 2018 the number of renewals over the mobile phone has increased exponentially. As at March 2019, more than 65% of all renewals were taking place over the mobile phone. The webinar is aimed at a wide local and international audience interested in learning more about digitizing operational processes that can lead to greatly enhanced efficiency. These solutions are applicable in both public and private sector contexts, and help to build scale. Panelists of this webinar were Dr. Lydia Dsane-Selby (Chief Executive, NHIA Ghana), Mariam Musah (Senior Manager, Research, Policy, Monitoring & Evaluation, NHIA Ghana) and Shilpi Nanda (Impact Insurance Fellow alumna, NHIA Ghana). This webinar was moderated by Lisa Morgan (Technical Officer (Health Actuary), ILO).

1. In Partnership With
NHIS Mobile
Renewal &
Digital
Authentication
in Ghana
June 2019
1
Staff at NHIS West
Mamprusi District Office
coaching members on
the use of NHIS Mobile
Renewal Solution
Photo courtesy: Mr.
Orison Afflu 

2. In Partnership With
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3. In Partnership With
Introduction to the ILO’s Impact Insurance Facility
The ILO’s Impact Insurance Facility’s mission: to enable the private sector, governments,
and their partners to realise the potential of risk pooling mechanisms (such as
insurance or other coverage plans)
• Achieved through a strategy of stimulating innovation and unlocking capacity
• Our work is guided by three principles:
• 1) solutions are people-centred
• 2) they are driven by both evidence and experience-based learning
• 3) collaboration among various stakeholders is necessary to deliver results
Our project, focused on improving the renewal process of the National Health
Insurance Scheme (NHIS) of Ghana, is made possible with the generous support of
Agence Française de Développement (AFD)
3

4. In Partnership With
NHIS in Ghana
• NHIS was established in 2004, and has a goal of
universal healthcare in Ghana
• NHIS offers comprehensive healthcare scheme to
all citizens of Ghana and is subsidised by tax
(National Health Insurance Levy)
• The scheme is distributed via a network of 165
branches
• Scheme penetration reached 40% in 2014 and
plateaued
• In 2017 NHIS, with support from ILO Impact
Insurance Facility, started a project to digitalise
the NHIS renewal process aimed at accelerating
population coverage
4
40%
2014 - 2017
11%
2006
NHIS Statistics
165
District Offices
c.3,000
Branch Staff
10.8m
Active Members
NHIS Comprehensive Healthcare Benefits
NHIS Population Coverage
In-patient
Out-Patient Medicines Diagnostics
c.4,000
Healthcare Providers
31%
2010

5. In Partnership With
The problem to solve: reduce those
queues! Save time and money for
everyone involved.

6. In Partnership With
NHIS Mobile Renewal Project - Highlights
6
Data highlights as
at 30th April 2019
1.44 million mobile renewals since launch in December 2018
$3.93 million collected via mobile
10.53 million healthcare attendances validated via digital channel since
launch
c.3,500 healthcare providers using digital authentication service on a
regular basis
c.580,000 higher transactions in 2019 Jan-Apr period as compared to
similar periods in prior years (2017 – 2018)
5% increase in share of informal category since launch of mobile renewal

7. In Partnership With
Agenda
The NHIS Ghana, problem statement & solution
Research, monitoring, & expected impact
Journey from pilot to nationwide scale-up
1
2
3
Q&A4

8. In Partnership With
8
NHIS Mobile Renewal and Digital Authentication
in Ghana
Presenter:
Dr Lydia Dsane-Selby
Chief Executive, NHIA
Presenter:
Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow alumni, NHIA
Presenter:
Mariam Musah
Senior Manager,
Research, Policy,
Monitoring & Evaluation,
NHIA
Facilitator:
Lisa Morgan, Health
Actuary
Impact Insurance
Facility

9. In Partnership With
Dr Lydia Dsane-Selby
Chief Executive, NHIA
1. The NHIS Ghana, problem statement & solution

10. In Partnership With
Problem Statements ==> Desired Solutions from
Project
10
Members had to TRAVEL FAR to renew. Renewals
took a LONG TIME at the NHIS office (often hours);
Members LOST INCOME whilst they waited. NHIA
LOST PREMIUM REVENUE due to these hurdles
NHIS district offices were OVERWHELMED with
people queuing. Process bottlenecks and network
issues led to POOR MEMBER and STAFF
EXPERIENCE
Large proportion of healthcare providers had NO
DIGITAL METHOD for VALIDATING MEMBERSHIP
which required NHIS to physically print expiry dates
on back of NHIS membership cards
An EFFICIENT renewal method was desired that
could be accessed by members at their
CONVENIENCE without them needing to travel far to
NHIS district offices
REMOTE RENEWAL and ENROLMENT processes
were required that reduced queues and
RELIEVED OPERATIONAL BURDEN at NHIS
district offices
DIGITAL MEMBERSHIP VALIDATION methods
needed to be IMPLEMENTED at all healthcare
facilities in order for remote enrolments to be
possible

11. In Partnership With
Solution in Three Parts
11
1. Renewal Reminder
Two SMS reminders sent to
every member, 2 months and
2 weeks before membership
expiry
2. Mobile Collection
NHIS Members can renew their
policies by paying their requisite
premium and processing fees
from their mobile wallet
3. Digital Authentication and
Member Feedback
NHIS membership status is verified
digitally at all credentialed
healthcare facilities in Ghana.
Members respond to SMS to notify
if they did not attend healthcare
facility

12. In Partnership With
NHIS Mobile Renewal Solution
BENEFIT PACKAGE:
This option gives a brief
overview of benefit
package with call center
number to find out more
MEDICINE LIST: This
option lists top 10
medicines and prompts
members to call Call
Centre to know about
comprehensive medicine
list and package
CHECK EXPIRY: Using
this option, members
are able to check when
their policy is due to
expire
RENEW: This option
requires NHIS (or GHANA
CARD) number, prompts
requisite premium
amount and completes
payment from mobile
money wallet
*929#

13. In Partnership With
Increased
Engagement between
NHIS and Members
Remote Renewals
Membership Expiry
Reminders
Reduced Waiting
Time
Reduced
Transportation Costs
Reduction in Lost
Income
Mobile Renewals and
Digital Authentication
Benefits to NHIS members

14. In Partnership With
NHIS: Move towards Digitalisation
14
60% - 70% of renewals are
via mobile
c.90% of healthcare facilities that
actively serve NHIS members
have adopted digital validation of
membership
Both cash and mobile premium
collections are accounted via
electronic receipting system. This
has increased accounting
transparency

15. In Partnership With
Move towards financial sustainability by achieving
better balance between inflows and outflows
15
Achieving
better
balance in
Scheme
Inflows and
Outflows
• Simpler renewal process
encourages more
people to renew which
leads to higher premium
revenue
• Digital payments and
electronic receipting
reduce pilferage that is
chronic is cash collection
systems
Increase Income
• Digital authentication (with
feedback loop) helps align
NHIA and provider
interests leading to
reduction in negative
provider behaviour
• Simpler enrolment
processes hold potential to
reduce adverse selection
Reduce Claims
• Channelling transactions
via mobile channel reduces
ICT expenditure at NHIS
district offices
Reduce Expenses

16. In Partnership With
16
LINK TO COMMENDATION OF NHIS
MOBILE RENEWAL IN 2019 STATE OF THE
NATION ADDRESS, BY HIS EXCELLENCY
MR. NANA ADDO DANKWA AKUFO-
ADDO, PRESIDENT OF THE REPUBLIC OF
GHANA:
HTTPS://WWW.YOUTUBE.COM/WATCH?V
=JHHIW9COAYS
LINK TO LAUNCH SPEECH AT JUBILEE
HOUSE, BY HIS EXCELLENCY DR.
MAHAMUDU BAWUMIA, VICE PRESIDENT
OF THE REPUBLIC OF GHANA:
HTTPS://WWW.YOUTUBE.COM/WATCH?V
=C6H2GSL0CL8

17. In Partnership With
Mariam Musah
Senior Manager
Research, Policy, Monitoring
& Evaluation
NHIA
2. Research, monitoring, & expected impact

18. In Partnership With
• Telephonic Survey: 300 respondents
selected randomly amongst members
who renewed via mobile
• Focus Group Discussions: 2 focus
group discussions in pilot district
covering 15 members in total
• Call Center and IT Helpdesk Feedback:
Analysis and monitoring of feedback
received at call center and IT helpdesk
• Transaction and Attendance Data:
Analysis and monitoring of
membership and renewal data to
identify trends
Research and monitoring to evaluate progress
Key ActionsKey FindingsMethodology
• 55% of respondents sought help from
NHIS staff and/or informal mobile
money agents to renew via mobile
• Males and members with higher
education level were more likely to
self-renew
• 92% of respondents found the 1 GHC
m-renewal convenience charge to be
reasonable
• 96% of respondents said renewing via
mobile took less than 5 minutes
• Several survey respondents and FGD
participants reported learning about
mobile renewal via ‘word-of-mouth’
• There was an uptick in share of
informal sector post launch of
intervention
• Based on feedback in survey, roll-out
of digital authentication was
prioritized at referral healthcare
providers
• Members and staff from pilot districts
reported gaps/bugs in renewal
process to call center and helpdesk,
The chinks in process were ironed out
prior to scale-up
• Staff feedback was used to design
supporting processes, e.g. district
accounting and reconciliation
processes, to support scale-up

19. In Partnership With
Expected Impact – Member Experience
19
100% of members surveyed
said that they would
recommend the mobile
renewal service to their
friends and family
98% of members surveyed
(who had claimed since
renewing via mobile) said that
the authentication experience
at provider site was ‘Good’ or
‘Excellent’
On average, members saved
11.3 hours when they renewed
via mobile vs. at the NHIS district
office. In total this is 3 to 5
million working days saved for
NHIS members every year*
On average, members saved 4.20
GHS in transportation costs when
they renewed via mobile vs. at the
NHIS district office. This translates
to savings of c.20m GHS for NHIS
members every year*
Costs saved per memberAuthentication ExperienceRenewal Experience
Excerpts from a survey conducted amongst 300 members who used NHIS Mobile Renewal Service at Pilot
District
*Assuming 50% of renewals go through the mobile channel as has been evidenced in the two pilots
Time saved per member

20. In Partnership With
20
“I was really excited because if it hadn’t gone
through I will have to wait in a queue… I renewed
mine and left all the people in the queue behind.
The mobile renewal is convenient and easy”FGD feedback

21. In Partnership With
21
“I was sick and I
went to the Clinic.
I did not know
that my
membership has
expired. The
nurse asked me
to go and renew
via mobile
money, my card
was renewed and
I used it to take
my medicine ”
FGD feedback

22. In Partnership With
Effect on membership
categories
• Share of the informal category
has shown a discernible increase
(from 30% to 35%) since the
launch of the mobile renewal
• Formal, indigent, elderly and
pregnant categories have not
exhibited any significant changes
yet
22
49% 49%
44% 45% 45% 45% 44%
4% 4%
5% 5% 5% 5% 5%
5% 5%
6% 5% 5% 5% 6%
30% 30%
31%
35% 36% 36% 36%
7%
6%
7%
7% 6% 6% 6%
4% 6% 8%
3% 3% 3% 3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct Nov Dec Jan Feb Mar Apr
2018 2018 2018 2019 2019 2019 2019
Split by Membership Category as a % of total transactions
Child Elderly Formal Informal Pregnant Indigent

23. In Partnership With
Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow alumni, NHIA
3. Journey from Pilot to Nationwide Scale-Up

24. In Partnership With
Journey from Design to Scale-Up
24
Design Pilot Scale-Up
Mar – Oct 2018May - Nov 2017
Nov 2018 – Jan 2019
The design of the mobile
renewal and digital
authentication solution
was done via application
of design thinking
methodology
Link to prior webinar on
this topic
The development work
was completed by Feb
2018, and pilots were
launched in two districts
Feedback from members,
staff, management, and
stakeholders used to
upgrade solution to suit
nation-wide scale-up
Nationwide scale-up of
solution commenced in
Nov 2018 and completed
by early Jan 2019
Continuous evolution of
solution ongoing in line
with NHIA’s digitalisation
agenda

25. In Partnership With
25
People hanging phones off trees to get mobile
network connectivity for mobile money
transactions
Project Field Visit, Tanatala, Northern Region
Community
Sensitisation
Project Pilot,
Yigba-Kibori,
Northern Region
Solution
Testing For
Member
Feedback
Project Pilot,
West
Mamprusi
Project team configuring mobile
phones for healthcare providers
Project Pilot, West Mamprusi
Link to video:
https://www.youtube.com/
watch?v=OjKjMjqNzR4

26. In Partnership With
Upgrading Solution for Nation-Wide Scale-Up
Solution
Launched
in ILO Pilot
Work in
Progress
Key
April2018
26
The green portion
was the only part
of the solution that
was piloted. The
expansion of user
options, and
backward and
forward
integrations to
supporting
processes were
undertaken based
on learnings from
pilot in
preparation for the
nationwide launch.
Some of this
development is still
ongoing as the
solution continues
to evolve as new
learnings come in

27. In Partnership With
What does it take to go from 2 to 200 districts in 6 weeks?
1 2 3 4 5 6 7 8
Developed a comprehensive
solution that worked in all
contexts and terrains, in
partnership with excellent
3rd party service partner,
In-person training for ALL
staff (c.4,500 people)
supported by email and
social media campaign
Design of simple, flexible
and standardized
onboarding process (web
portal) for all healthcare
providers
In-person training for
representatives from 3,500
healthcare providers (c. 7,000
people) in c.200 districts
supported by site visits to all
facilities by NHIS staff
Stakeholder engagement at
all levels from regulators,
public sector bodies,
community chiefs,
representatives from local
government
Community outreach by
NHIS district staff supported
by local radio and mass
media campaigns to sensitize
and educate members
Continuous support from call
center, HO IT helpdesk and
3rd party developers to
ensure problems
continuously identified and
resolved
Engagement at high levels
in government, local
development partners and
key stakeholders to
organize Launch by Vice
President at Jubilee House
(1) Lots of Excellent People (2) Tons of Hard Work (3) A bit of luck!

28. In Partnership With
Healthcare Providers Using Digital Authentication
28
• Rapid scale-up of digital
authentication at thousands of
healthcare provider sites possible
due to:
• Simple and flexible
registration process for
healthcare providers
• Large-scale stakeholder
engagement at all levels (from
grass-roots to healthcare apex
bodies)
• Efforts on-behalf of hundreds
of NHIS district, regional and
head office staff
• c.10.5 million healthcare
attendances have been validated
via this solution as at 30 April 2019
Key Inferences
Up to 3,500 healthcare providers use the
digital authentication service to validate
c.500,000 healthcare attendances every
week
Nationwide Launch

29. In Partnership With
Mobile Renewals as % of Total Renewals
29
• 1.44 million mobile renewals in
total as at 30 April 2019
• On average, c.90,000 mobile
renewals every week
• c.200,000 members have
renewed over weekends as at 30
April 2019. Weekend renewals
were not possible before m-
renewal
• 60% to 70% of renewals are now
via mobile which has resolved
operational bottlenecks and
reduced long queues at NHIS
district offices
Key Inferences
Nationwide Launch

30. In Partnership With
Amount Collected via Mobile Renewal
30
• Collection amounts via mobile
now averaging c. $1.0 million
every month
• Average collection via mobile
channel is 33.5% higher than
average collection via cash
channel. This could be due to: (a)
greater penetration in urban areas
(b) rise in share of informal
category and (c ) fully exempted
groups disallowed from use of
mobile renewal
Key Inferences

31. In Partnership With
Impact on Population Coverage?
31
• Higher scheme coverage possible via higher
renewals and new member registrations
• In period Jan – Mar 2019, there were
c.200,000 additional new member
registrations compared to similar periods in
2017 – 2018
• Similar improvements in trends in
renewals; c.380,000 additional renewals in
Jan – Apr 2019 compared to similar periods
in 2017 – 2018
• However, trend of new member
registration relatively flat since launch
suggesting that other ecosystem factors,
e.g. quality of healthcare delivery, may
continue to act as a barrier to enrolment
behaviour
Key Inferences
Bring lapsed members
back to scheme via
simple mobile renewal
process
Refocus staff capacity
towards acceleration of
new member
registrations
Increase NHIS
Scheme
Membership

32. In Partnership With
Key Priorities for NHIA going forward
Focus on Improving Active
Membership
NHIS aim to reverse
membership trends from
last 3 years to achieve an
increase in 2019 on the back
of simpler renewal
processes and utilization of
spare staff capacity at
district offices
Leverage New and Legacy
Data for Actionable Insights
A big focus area going
forward is in the field of
applying data analytics tools
to generate actionable
insights for better
healthcare usage
monitoring, identification of
fraud and improvement of
claims processes
Pushing Digital Agenda
Forward
More processes will be
digitalized in coming
years, with a particular
focus on claims
submission, vetting and
payment functional areas
Pursue Policy Reform for
Financial Sustainability
Large scale policy reform
options will be evaluated in
coming years to bring
scheme back to full financial
sustainability

33. In Partnership With
33
NHIS Mobile Renewal and Digital Authentication
in Ghana - Q&A Session
Presenter:
Dr Lydia Dsane-Selby
Chief Executive, NHIA
Presenter:
Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow alumni, NHIA
Presenter:
Mariam Musah
Senior Manager,
Research, Policy,
Monitoring & Evaluation,
NHIA
Facilitator:
Lisa Morgan, Health
Actuary
Impact Insurance
Facility

34. In Partnership With
Introduction to the Joint Learning Network for
Universal Health Coverage (JLN)
The Joint Learning Network for Universal Health Coverage (JLN) is an
innovative, country-driven network of practitioners and policymakers from
around the globe actively engaged in exchanging tacit knowledge on
challenges faced and co-developing practical solutions to extend health
coverage.
• Resulting tools equip countries with the how-to’s of designing and implementing
efficient, equitable and sustainable healthcare systems, while contributing to
global knowledge resources for achieving Universal Health
Coverage (UHC).
Ghana is a founding member country of the JLN.
34

35. Thank you!
/ImpactinsuranceFacility
@IIFacility
/in/impactinsurance
Follow us on social media!
Visit our website!
www.impactinsurance.org
For further questions, please contact
Lisa Morgan at morgan@ilo.org