Free Primary Health Care and NHIS: Two Complementary Pillars for Advancing Universal Health Coverage in Ghana
Ghana’s health sector is once again at the centre of national conversation following the introduction of the Free Primary Health Care (FPHC) initiative, launched by the President of the Republic of Ghana, His Excellency John Dramani Mahama on 15th April, 2026 at the Shai Osudoku District Hospital, Dodowa. While the policy has been widely welcomed as a bold step toward improving access to healthcare, it has also generated public debate and misunderstanding about whether it replaces or duplicates the National Health Insurance Scheme (NHIS).
Some critics have asked a valid question: if the National Health Insurance Scheme already exists, why introduce another intervention? Others worry about duplication of structures, increased administrative costs, low human resource in the health sector, as well as potential inefficiencies in public spending. These concerns deserve attention, but they also require clarification grounded in how modern health systems actually work.
The reality is simple: Free Primary Health Care does not replace NHIS. It strengthens it. To understand why, one must first understand what each system is designed to do. NHIS is fundamentally a health financing mechanism. It pools financial resources from citizens and the government to ensure that people can access treatment without facing catastrophic out-of-pocket costs. It is a vital social protection system that has significantly improved access to healthcare in Ghana since its introduction in 2003.
However, NHIS was never designed to function as a full-scale preventive healthcare delivery system. Its strength lies in paying for treatment once illness occurs, particularly at secondary and tertiary levels of care. This is where services such as surgeries, hospital admissions, specialist consultations, and advanced diagnostics are covered.
But herein lies the structural gap: prevention. The Free Primary Health Care initiative is designed specifically to address this missing link. It focuses on the foundation of the health system—primary care—where diseases can be detected early, treated quickly, and often prevented entirely. It operates through existing structures under the Ghana Health Service, including CHPS compounds, health centres, and polyclinics. Importantly, it does not create a parallel institution or new insurance body. Instead, it strengthens what already exists.
At its core, FPHC ensures that essential services such as routine health screenings, maternal and child healthcare, immunisation, and treatment of common illnesses are accessible free at the point of care. This is not a duplication of NHIS services; it is an expansion of access at the earliest and most critical stage of healthcare delivery.
The importance of this shift becomes clearer when one considers Ghana’s current health realities. Many patients arrive at hospitals too late, when conditions such as hypertension, diabetes, or infections have already progressed into severe complications. This late presentation increases treatment costs, strains hospital resources, and reduces the likelihood of positive outcomes.
From a health systems perspective, this represents inefficiency not necessarily in funding, but in structure. Ghana has improved access to treatment through NHIS but has not yet fully solved the challenge of early detection and prevention at scale. FPHC is designed to fill this gap.
Globally, health systems that perform well tend to follow a dual structure: publicly funded primary healthcare on one side and insurance-based coverage for advanced care on the other. This model is not unique to Ghana; it reflects international best practice under Universal Health Coverage (UHC) principles. Primary care focuses on prevention and early intervention, while insurance systems provide financial protection for complex medical needs.
Under this framework, FPHC and NHIS are not competitors. They are complementary pillars of a single system. The new policy, as explained by His Excellency President John Dramani Mahama, is intended to reinforce, not replace the National Health Insurance Scheme (NHIS), with a strong focus on early detection, routine screening, and public education on healthy lifestyles to curb the rising incidence of Non-Communicable Diseases (NCDs).
Under this initiative, Ghanaians will benefit from free screening and essential treatment services delivered through CHPS compounds, health centres, polyclinics, and newly introduced health kiosks in underserved communities. These services will cover blood pressure and blood sugar testing, body mass index (BMI) assessments, temperature checks, breast cancer screening, and basic medications for common conditions such as malaria, cholera, and respiratory infections.
FPHC ensures that a child can receive immunisation on time. It ensures that a person can be screened for hypertension or diabetes before complications develop. These interventions reduce disease burden before it reaches hospitals. NHIS, on the other hand, ensures that when more serious conditions arise, such as the need for surgery, specialist treatment, or hospital admission, patients are protected from financial hardship.
To suggest that FPHC makes NHIS redundant is therefore to misunderstand their distinct roles. If NHIS were removed, Ghanaians would lose access to essential financial protection for advanced care. If FPHC were removed, the country would continue to struggle with late disease detection, overcrowded hospitals, and rising treatment costs. Both systems are necessary, but for different reasons.
Another major concern raised in public discourse is whether FPHC represents a waste of public funds or an unnecessary expansion of government structures. This argument also does not hold under closer scrutiny. FPHC does not create a new bureaucracy. It does not establish a parallel institution. It leverages existing health infrastructure and channels investment into expanding access, improving facilities, strengthening digital health systems, and enhancing patient care delivery.
From an economic perspective, the argument tilts in the opposite direction. Preventive care is widely recognised in health economics as one of the most cost-effective investments a government can make. Early detection and treatment significantly reduce the need for expensive hospital-based interventions later. In other words, preventing illness is far cheaper than treating advanced disease.
Without strong primary healthcare, NHIS inevitably bears higher costs due to late-stage treatment claims. Hospitals become congested, and national health expenditure rises over time. By strengthening primary care through FPHC, Ghana is effectively reducing long-term financial pressure on the entire health system.
The policy also carries significant implications for equity. One of the persistent challenges in Ghana’s health system is unequal access to care, particularly in underserved and rural communities. By removing financial barriers at the primary level, FPHC ensures that access to basic healthcare is not determined by income or geography, a critical step toward fairness in healthcare delivery.
The claim that FPHC is unsustainable due to understaffing and unpaid health workers is misleading. FPHC is designed to reduce pressure on overstretched hospitals by shifting care to community-level facilities, where prevention and early treatment require fewer specialised staff. This makes the system more efficient, not weaker. While issues like delayed payments exist, they are pre-existing system challenges and not caused by FPHC. Integration with NHIS can improve funding flow and accountability.
Most importantly, FPHC enhances sustainability by cutting long-term healthcare costs. Early detection and basic treatment are far cheaper than managing advanced diseases in hospitals. With its focus on community-based care and task-shifting, FPHC is a proven model for expanding access without overwhelming resources. In short, the Free Primary Healthcare initiative is part of the solution to making Ghana’s health system more efficient, affordable, and sustainable.
The future of healthcare in Ghana depends on integration, not substitution. A strong health system requires both prevention and treatment, access and protection, and community-level care alongside hospital-based services. The policy direction is therefore clear: FPHC and NHIS are not competing systems. They are two halves of a complete health architecture.
In conclusion, the debate should move beyond “either-or” thinking. The real question is not whether Ghana needs NHIS or FPHC. The real question is whether Ghana is prepared to build a health system that prevents illness as effectively as it treats it. The answer, through this reform, appears to be yes. Because ultimately, a strong health system is not one that only responds to sickness but one that actively works to prevent it.