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The decision by the Christian Health Association of Ghana (CHAG) to reject National Health Insurance Scheme (NHIS) subscribers at its facilities with effect from yesterday is yet to be carried through by its members across the country. While some members of CHAG have started the implementation of the cash-and-carry system for NHIS card holders, others are yet to do so. Those facilities which could not start the implementation yesterday also indicated that they would do so from today because they did not get the circular in time. Notice The Board of Trustees of CHAG, in a public notice published in yesterday�s edition of the Daily Graphic, explained that they had been forced to take that decision due to the inability of the National Health Insurance Authority (NHIA) to pay CHAG health facilities outstanding bills and economic tariffs for services rendered. It said the decision was to avoid further deterioration in the quality of the services provided and the imminent collapse of CHAG health facilities. HISPAG But just when CHAG had issued its directives, members of the Health Insurance Service Providers Association of Ghana (HISPAG) also announced a resort to the cash-and-carry system for all NHIS card-bearing patients. The decision was contained in a statement signed jointly by the HISPAG National Executive Committee Chairman, Dr Edward Tagoe, and its Executive Director, Mr Frank Richard Torblu, and issued after a HISPAG stakeholder meeting. Emergencies �This notwithstanding, all clients who deserve emergency services from service providers across the country will be attended to and given the right care,� it added. ACCRA In Accra, the Daily Graphic observed during a visit to some private and mission health centres yesterday that some health facilities did not accept NHIS cards, reports Doreen Andoh. Those clinics, however, accepted the nationwide mutual health insurance cards. Sources close to the Light House Mission Clinic and the Holy Trinity Hospital, both at North Kaneshie, indicated that the hospitals did not accept NHIS cards, even before CHAG�s directive. However, the Daily Graphic observed that a private clinic, the Faith Community Clinic, accepted the NHIS cards. Meanwhile, some NHIS card holders at the Faith Community Clinic who spoke to the Daily Graphic on condition of anonymity complained that they were not given prompt and desired attention as those patients using the cash-and-carry system. A patient at the Holy Trinity Hospital told the Daily Graphic that even though the hospital did not accept NHIS cards, she would not have used it there if the hospital worked with NHIS cards because they were inefficient and not worthwhile. She said she had witnessed how NHIS card holders went through a number of receptive challenges at some government hospitals where she had expected that they would be good promoters of the scheme. From Kumasi, Donald Ato Dapatem reports that at the Kwadaso SDA Hospital, the medical director said the facility had to resort to the difficult situation because it had run out of resources to purchase basic disposables. Mr Kwame Amoateng of the St Michael�s Catholic Hospital at Pramso also confirmed that the hospital had started implementing the directive of CHAG to ensure that it would not increase the debt it owed many of its suppliers, some of whom had threatened to take court action against the hospital. However, at the Agroyesum St Martin�s Hospital, Mr Richard Adusei, the Administrator, said because the circular for the implementation of the cash-and-carry system got to the hospital only yesterday, the management would meet and start full implementation today. He said patients with NHIS cards were attended to yesterday, adding, �But I don�t think we will serve them today.� Wa Emmanuel Modey reports from Nandom in the Upper West Region that the two Catholic mission hospitals in the region operated at full swing yesterday. At the St Theresa's Hospital at Nandom, an official who spoke to the Daily Graphic on condition of anonymity said the hospital was operating its normal services and all subscribers of the NHIS were being attended to until the authorities received further directive from the Catholic Bishop of Wa. That, he said, was because the health of the patients was important to the hospital. The situation was not different at the St Joseph�s Hospital at Jirapa, where the authorities carried out normal services pending further directives from the Catholic Bishop of Wa. According to Madam Alijata Jangu and Ms Ethel Yeli, both patients who had NHIS cards at the St Joseph's Hospital, they had received treatment without paying anything. Cape Coast When the Daily Graphic visited some private hospitals in the Cape Coast metropolis, their outpatients departments (OPDs) were crowded with patients, report Timothy Gobah and Zadok Kwame Gyesi. Some of the patients who spoke to the Daily Graphic indicated that when they went to the Central Regional Hospital, they were told that they could not be attended to due to the unavailability of health materials. The Clinical Service Manager at the Standford World Clinic, Ms Thywill Degley, said although the hospital had not received money from the NHIS, �we have not turned our clients away�. She said due to speculations that the Central Regional Hospital did not accept NHIS cards, �a lot of people are coming to our hospital�. She said the hospital would continue to accept NHIS cards from their clients. Bolgatanga Vincent Amenuveve reports from Yorogo near Bolgatanga that the authorities at the Upper East Regional Presbyterian Eye Centre accepted NHIS cards from patients. A visit to the facility by the Daily Graphic showed that patients were undergoing the processes without any problem. One of the patients, Madam Martha Bugri, said she was happy at the way the health authorities were treating them at the facility. The General Manager of the Presbyterian Health Service for the Northern Sector, Mr John Abugri, explained that the eye centre was not under any obligation to use the cash-and-carry system because it was not a registered member of CHAG. Tamale As of 10 a.m. yesterday when the Daily Graphic visited the only mission hospital in Tamale, the SDA Hospital, the OPD was empty as a result of the directive issued by CHAG to withdraw its services to subscribers of the NHIS, reports Samuel Duodu. According to Mr Benson Ansah, the Accountant of the SDA Hospital, who spoke on behalf of the facility, the facility was not turning away NHIS card holders but only complying with the directive issued by CHAG, since it was a member of the association. Koforidua George Folley reports from Koforidua that the two mission hospitals in the Koforidua municipality were still attending to clients with NHIS cards, despite the decision of CHAG to withhold services to such subscribers. The hospitals are the St Joseph�s Catholic and the SDA hospitals. A visit to the St Joseph�s Catholic Hospital at Effiduase showed that the authorities were going about their normal duties and were ready to accept NHIS cards. Ho Checks at the two mission health centres and some private hospitals in the Ho municipality, as well as information gathered from health centres in the Akatsi-Keta and the Jasikan dioceses, confirmed that patients were being allowed to access medical care with their NHIS cards, reports Mary Anane. However, patients who attended the health centres yesterday were informed of the decision to withdraw services to NHIS card holders in a couple of days. The Manager in charge of the Mater Ecclesiae Clinic at Sokode-Gbogame, Sister Comfort Ashinyo, said effective today, July 3, 2014, the facility would not accept NHIS cards. She explained that the facility attended to NHIS patients yesterday because most of them came from distant places and were not aware of what was happening. HISPAG issues The statement from HISPAG said the low tariffs of the NHIS, coupled with delayed payments, had resulted in significant financial challenges to service providers, making it nearly impossible for them to remain financially viable. That situation, it said, was further compounded by the recent introduction of VAT of 17.5 per cent on the cost of medicines which was not reimbursed by the NHIA. Adjudication Committee It called on the Minister of Health to take immediate steps to establish the adjudication committee of the NHIS, as required by Section 106 of Act 852. That, it said, would facilitate the speedy adjudication of cases among service providers, subscribers and the NHIA.