Sitting on a wooden bench in Ghana’s biggest hospital, 28-year-old Gifty Torto breastfeeds her tiny six-week-old son, hugging the newborn she is not allowed to take home.
The baby is being detained pending payment of her hospital bill, so Torto since her discharge three weeks ago has been visiting the Neo-Natal Intensive Care Unit at Accra’s Korle Bu teaching hospital twice a day to care for him.
The spacious hallway where the mother and baby sit, echoes to the cries of other newborns. Torto is one of 27 women whose infants are being detained in intensive care because of the mothers’ inability to pay the high cost of difficult deliveries by Caeserean section.
She owes the hospital close to 3,000,000 cedis (about $340). More than a third of the 74 women in the neo-natal ICU too are unable to pay.
So Torto, who wears a pink ribbon in unkempt hair, turns up mornings and afternoons to breast-feed, bath and change her baby’s clothes.
"It makes me feel uncomfortable,” she told IRIN. “I feel very sad that l have to leave my baby here and sleep elsewhere. My husband has travelled but when he returns he will pay for me to leave."
Torto, who sells groceries on the street and whose husband is a carpenter, was referred to Ghana’s biggest hospital when she developed complications at birth.
Holding babies back until parents pay their bills is not a new debt-collecting technique in this West African country. And it was to address this as well as other problems blocking many Ghanaians’ access to quality health care that the government launched the National Health Insurance Scheme (NHIS) in 2004.
New health scheme aims to replace old "cash-and'carry"
Under the scheme, launched by President John Kufuor, adults were to pay a monthly sum of 6,000 cedis (US $0.66). In return, the government promised health treatment for the aged, the poor and children whose parents both subscribed.
The idea was to replace the old cost-recovery health system in operation since 1985 and known infamously as “cash-and-carry,” under which patients were required to pay up-front for health services at government clinics and hospitals.
The new bid to provide care for even the poor and the vulnerable among Ghana’s 19 million people was described just this week by one editorialist as “perhaps the biggest social development project undertaken by any government since (Kwame) Nkrumah after Ghana’s independence.”
NHIS, which is not yet fully in effect across the country and still has a number of glitches to be smoothed, is supposed to make health care affordable for ordinary Ghanaians.
But one of the scheme’s shortcomings is that it does not cover difficult high-cost surgical deliveries at Korle Bu hospital.
"Sometimes you wonder whether you should let the child go or whether you are being callous if you don't allow the child to go," said Director of Nursing Grace Barnes, who added that detaining the babies created extra problems for the hospital.
"You keep hearing I can't pay, I can't pay, which means there will always be congestion, with some babies unlikely to get to use the facility," she said.
Slumped in a swivel chair working at his computer, the head of the NHIS Secretariat, Sam Akor, sympathised while saying that Ghana's new health insurance scheme must remain sustainable.
"The exemption policy of government is paying for deliveries, however it is paid for at the district level of care,” he told IRIN. “If we allowed everybody to go to Korle Bu, where the cost is three times the cost outside the city centre, we would run out of funds in maybe six months."
Better reimbursements in district hospitals
So if a mother wants the insurance scheme to cover her delivery, then she must deliver in a district hospital, he said.
The NHIS covers 95 per cent of health conditions common to Ghanaians. But according to health officials at Korle Bu, the remaining five per cent of specialised health problems that are not covered by the scheme are exactly those that the hospital specializes in.
At a district hospital, cheerful-looking Janet Asare sings a lullaby for her four-month-old baby, cradled in her hands.
She lives in a blue-and-green wood home by an unpaved road in the Ayorkor Woo community in the Greater Accra Region. The community falls under the Kpeshi district mutual health insurance scheme.
Outside her house are a haphazardly arranged clothesline and a few goats and chickens running about in the compound. Janet, who is unemployed and whose husband sells plastic bands on Accra streets, also had complications at birth but had her baby at the district hospital.
Like Gifty Torto in the bigger hospital, her bill amounted to 3,000,000 cedis (US$ 340).
Fortunately for her, however, she had paid her minimum contribution of 72,000 cedis to the district health scheme, so all her bills were covered by NHIS.
"I don't know how I would have paid for the surgery if the scheme had not covered it," she said.
Officials at the NHIS secretariat say that when the scheme becomes fully operational at the end of the year in all of Ghana’s 123 districts, there will be many people like Janet.
In the meantime records at the secretariat indicate that only 50 of the districts have so far successfully implemented the scheme.
But even once widespread, the scheme still won’t cover births at Korle Bu, so the hospital has set up a fund for needy mothers.
But staff at the intensive care unit say parents need to be educated to understand that state-of-the-art health care comes at a price.