The Healthcare financing system is facing mounting pressure following the introduction of the ‘Mahama Cares’ Trust Fund—an ambitious new social protec
The Healthcare financing system is facing mounting pressure following the introduction of the ‘Mahama Cares’ Trust Fund—an ambitious new social protection initiative launched by the government of President John Dramani Mahama.
Funded through the reallocation of 20 percent of National Health Insurance Scheme (NHIS) contributions, critics argue the move threatens the financial sustainability of the NHIS and could mark a return to the dreaded “cash-and-carry” era in public healthcare.
The Mahama Cares policy, officially launched in April 2025, is part of the administration’s broader agenda to expand access to basic healthcare and social protection services.
However, health policy analysts, civil society organizations, and opposition voices warn that the policy is being implemented at the worst possible time—when the NHIS is already grappling with deep structural funding deficits
An Already Fragile System
According to the 2025 national budget, the National Health Insurance Levy (NHIL)—a key revenue stream for the NHIS—is expected to generate GHS 8.57 billion in 2025.
However, the government has programmed GHS 9.3 billion in expenditures for the NHIS, resulting in an immediate GHS 730 million funding gap.
This structural imbalance between revenue and projected spending threatens the scheme’s ability to reimburse service providers and ensure uninterrupted health services.
The situation mirrors previous trends. In 2024, NHIL revenue was projected at GHS 7.93 billion, but actual collections amounted to only GHS 7.16 billion—creating a shortfall of GHS 770 million.
Year after year, the NHIS has faced difficulties in receiving full and timely disbursements from the Ministry of Finance, leading to payment delays to hospitals, shortages of essential medicines, and strained healthcare delivery across the country.
Loss of Donor Support Adds to the Pressure
The funding crisis was further exacerbated on February 4, 2025, when the United States government officially suspended its annual USAID health support to Ghana.
In 2024 alone, USAID provided approximately USD 150 million (GHS 1.8 billion) in bilateral assistance targeted at bridging funding gaps in healthcare, including NHIS support. The withdrawal of this critical external aid now leaves an even deeper hole in the nation’s healthcare financing framework.
Mahama Cares GHS 1.86bn Reallocation Raises Alarms
Under the new policy, the Mahama administration plans to allocate GHS 1.86 billion—roughly 20 percent of NHIS contributions—to the Mahama Cares Trust Fund, aimed at direct healthcare interventions for vulnerable groups.
While the intent is to strengthen access for the poorest households, critics warn that siphoning funds from the already overstretched NHIS will only accelerate its financial collapse.
When added together, the NHIS is now confronted with a cumulative funding shortfall of GHS 4.39 billion—comprising the GHS 730 million projected deficit, the GHS 1.8 billion loss from USAID, and the GHS 1.86 billion reallocation to Mahama Cares.
Fear of Return to ‘Cash and Carry’
Health experts warn that unless the government identifies alternative funding sources or restructures the financing model, the NHIS could become insolvent, forcing health facilities to revert to out-of-pocket payments for basic services.
The NHIS, once hailed as a model for universal health coverage in Africa, was designed to eliminate the “cash-and-carry” system that forced patients to pay upfront for medical services.
Any threat to its survival not only endangers public health but also undermines years of investment in equitable healthcare access.
Calls for Policy Review and Fiscal Transparency
As debate intensifies, stakeholders are calling on government to reconsider the implementation of the Mahama Cares Trust or at least ring-fence NHIS funds from political reallocation.
Many are also urging the Ministry of Finance to improve transparency in NHIL disbursements and commit to closing funding leakages.
In the meantime, the Mahama administration maintains that Mahama Cares is a necessary intervention to address critical health needs and reduce inequities. Whether that promise can be kept without sinking the NHIS remains to be seen.
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