Talking till the cows come home...

Submitted by Mathew Porter

With the trouble and confusion we have been having at the Fulani camp over NHIS cards, Nurse Lydia suggested that we do a session with everybody so that we can all be clear on what is needed - the National Health Insurance Scheme (NHIS) is a system to get healthcare for most common sicknesses and pregnant women, and children, elderly etc.

To be eligible, one has to either be paying SSNIT - Social Security and National Insurance Trust - or pay membership fees. There are national and local levels and cards... It sounds simple enough, but you have to go and get cards sorted out, and renew them. This is very difficult for non-literate people. Also, the fees they have to pay seem to change a lot...

We invited the ladies and the men to come and listen to what Lydia had to say.

The turn out was pretty good. I think we had all the women with children there. After getting talking for a while, Lydia asked them if they all had NHIS cards. Saying they did, Lydia sent them all back to their houses to get them. We looked through them to see who was in date and who wasn't.

You can see in my left hand are those up to date, in my right hand those out of date. Almost all of the children had been registered - I think it is only some of the cowboys who had not been sick had not been registered - but some were out of date by 2 or 3 years. If they don't go to hospital, they don't update them. They don't realise they are out of date, and don't need to update them by paying, as they aren't sick...

These guys, remember, really can't tell the dates on their cards. They have phones, yes, with date on, but can't figure out what date it is - often not even the day of the week. Adding to the confusion, there is the national card, as you can see in Lydia's hand, and the local ones - some of the booklets. When they go to the offices to have their cards renewed, they don't really know what fees to pay - and what I hear from them is second hand info - translated to me from English/Twi into Fulani and then back into English/French/Twi... So I can't take much to heart from it all.

Lydia deals with the NHIS through her clinic. But she doesn't deal with renewals and applications... so she was also getting confused with what is supposed to happen! She is going to find out though - and even try and get someone from the District Assembly to come and register everyone in the camp for the national card as a one-off thing. It then also means that as national card holders, they can go to her clinic and get care where they are explained everything and people take the time to understand them better, not just processed as they are in the government hospitals.

I have been to the government website - http://www.nhis.gov.gh/ - and it is a bit confusing. It looks to me like the Fulanis should be eligible for free healthcare, under "Indigent"

Are the Very Poor (Indigent) covered under NHIS ?

1. person is classified as Indigent and exempted from payment of premium if she/he meets the following:
Does not have any visible source of income.
Does not have a fixed place of residence.
Does not live with a person who is employed and has a fixed place of residence.
Does not have a consistent source of support from another person."

I don't know what "premium" is, and if the fact that some of the Fulanis have a boss means they are not covered. But I know that Asamau's father should be classed as "Indigent" - but how does one prove it?

I was happy to see Asamau's father made it. He was a bit late, but he was there and listening. Lydia also got a chance to talk to him - tried to make him understand that we are doing this for the girl, not for ourselves! I was happy to see 5 men there - Alai, Karim, Abu, Dramani and Dramani. The fact they took the time to come and listen was great. It means they want to know more. They are all men with families.

Lydia was telling them that we want to get their health under control so we are free for a start, and so are they, and also so that we can focus on other things. Lydia has been wanting to get a clay oven built for a while so they can bake bread. I want to get them growing moringa. But we can't do any of that if we keep going on about the same old stories! But as she was talking to them, and talking about WHEN they are healthy, and have it under control, I could see them thinking about it. Thinking about the future. I think I could see hope! It was also an interesting session - although it last for about 3 hours, we literally talked till the cows came home!

However, I think it was the first time that all of us who were there - the Fulanis, Lydia, Jane, myself, we were all there as friends. And that is the first time I think we have all reached that level, as I felt it. And when you go to being there to help your friends, it makes it a lot easier. It also makes it a lot easier for others to be listening to their friends. For the ladies to be listening to advice from their friend, Lydia. i think we are all, Fulanis included, looking forward to getting past this health business, and onto other ways to improve their lives and economies. On Monday, the children are meeting for their 5th class in a row. They are making progress. We are trying again to get the women there as well for literacy, so they can be reading their own cards!

I took the oppurtunity though to jot down all the card details. So I now have a log of who has a card and who needs a card, and who is due for updates. Interestingly enough, those who had cards updated and those who didn't was by family. There were families with all cards updated, like Ilias' and those with all out of date, like Asamau's. It was also interesting that all the men had no cards - Alai included!

So. Will keep posted on what goes on...