ABSTRACT
This paper evaluates the feasibility of the "MahamaCares" health policy as a means to achieve universal healthcare access in Ghana, with a particular focus on non-communicable diseases, including stroke, cancer, diabetes, end-stage organ failure, and cardiovascular diseases. It analyses the policy's conceptual underpinnings, execution methodologies, and coherence with established national health systems, including the National Health Insurance Scheme, and employs a qualitative analysis of policy documents, official websites, statutes, stakeholder viewpoints, and comparative health models to assess whether MahamaCares constitutes a revolutionary and practical change or is merely an ambitious political pledge devoid of operational clarity. The findings seek to clarify the policy's shortcomings and makes policy reform considerations for equitable, efficient, and sustainable healthcare financing in Ghana. To identify studies, the Scopus, PubMed databases, and Google Scholar were searched between April and November 2025 using systematic review methodology.
Keywords: MahamaCares; non-communicable diseases, health policy; National Health Insurance Scheme (NHIS); universal healthcare access; health sector reform; policy implementation; healthcare financing; public health governance; political economy of health; health outcomes.
INTRODUCTION
Since the establishment of the Fourth Republic in 1992, Ghana's public health sector has undergone a series of substantial and transformative efforts in its governance, notably the decentralisation of health services, healthcare financing, infrastructure, and initiatives aimed at achieving Universal Health Coverage (UHC) and improving access, equity, and the quality of care. It commenced with the popular "Cash and Carry" or user fees scheme, which required upfront payment prior to treatment and created substantial financial obstacles to healthcare access, particularly to vulnerable groups.[1]The biggest challenge with the cash and carry system was that it was implemented as an all-inclusive health funding method, necessitating individuals, irrespective of their demographics and income levels, to pay for medical care at the point of service, leading to the abrupt decline in patient attendance at public health facilities, especially rural ones, and further increased mortality rates in rural areas.[2]
As a result, a considerable proportion of Ghanaians, particularly in rural areas, turned towards herbal medicine and persisted in depending on traditional healers because of their accessibility, cost-effectiveness, and cultural resonance. The lack of formal regulation raised apprehensions over safety, quality, and standardisation. So, as a special initiative, the Traditional Medicine Practice Act (Act 575) was enacted in year 2000 to incorporate and regulate traditional and indigenous healing practices, demonstrating Ghana's dedication to a diversified and culturally attuned healthcare framework.[3] By the preamble to the Act, it was to establish the Traditional Medicine Practice Council to regulate the registration and licensing of practitioners, as well as the preparation and sale of herbal medicines. However, this initiative did not ameliorate the problems of the cash and carry system and the funding and financing obstacles to access to healthcare.
Again, in designing a definite financing and governance model for public health, the National Health Insurance Act, 2003 (Act 650) was passed to establish the National Health Insurance Scheme (NHIS) and its Authority to oversee both private and commercial health insurance schemes.[4] The scheme provided a significant initiative to alleviate financial burdens at the point of care and broaden access for vulnerable groups. Furthermore, to make health insurance more accessible and beneficial to all, particularly rural populations, the Community-Based Health Planning and Services (CHPS) was established.[5] Notwithstanding these reform efforts, ongoing obstacles persist: inequitable funding, infrastructural deficiencies, specialists personnel shortages, and inequities in rural–urban access continue to hinder universal health coverage, thereby making the healthcare reform debate in Ghana, particularly on the efficacy, effectiveness and adequacy of the National Health Insurance for the most disadvantaged and marginalised populations, of paramount importance.
The Ghana Medical Trust Fund (GMTF), also known as "MahamaCares" has been inaugurated as a significant and bold policy initiative aimed at enhancing preventive care, optimising service delivery, building a database, and offering financial support and protection to individuals afflicted with non-communicable chronic diseases, including cancer, end-stage organ failure, diabetes, stroke and cardiovascular conditions nationwide.[6]Subsequently, Parliament has passed the GMTF Bill, 2025, thereby giving MahamaCares the statutory foundation to take off. However, the concept raises essential questions regarding its potential as a practical advancement towards universal healthcare access financing or merely another lofty political commitment lacking operational clarity, and whose lifespan may likely be coterminous with the presidency of the proponent.
This paper critically evaluates the MahamaCares initiative in the context of Ghana's previous health policy evolution and reforms, analysing its scope and design, strengths, weaknesses, and assessing its potential to facilitate authentic advancement towards universal healthcare access financing in Ghana.
POLICY SCOPE AND DESIGN
The MahamaCares policy arises in the context of Ghana's persistent endeavour to establish a robust, egalitarian, and people-focused healthcare system. It is expected to be comprehensive reform agenda aimed at consolidating prior advancements in the public health sector while rectifying enduring systemic funding and financing deficiencies that obstruct universal health coverage. Similar to the ObamaCare initiative which was passed into law by the US Congress as the Affordable Care Act (H.R.3590),[7] a landmark piece of legislative initiative regarded as the most significant domestic policy accomplishment of the Obama administration because of the several millions of people that have been saved by it, MahamaCares has been passed into law by Parliament. The principal problems and deficiencies in accessing specialised medical treatment in the country encompass the availability of specialist services in urban areas, insufficient diagnostic equipment, inadequate data systems, and the exorbitant costs associated with chronic non-communicable diseases, which have resulted in numerous households descending into poverty within five years of diagnosis.[8]
The initiative, therefore, reframes healthcare access as a right instead of a privilege, highlighting specialist care to persons with non-communicable chronic illnesses, provision of infrastructure, relevant specialist medical care training, digital national database building, and medical financial protection for all citizens. This section analyses the structural framework of the policy by investigating its fundamental pillars, operational tactics, and the mechanisms it employs to improve service delivery, mitigate inequities, and bolster long-term health system financing efficacy in Ghana.
First, its scope is to create, manage and mobilize resources for a Fund, which shall be a corporate entity, dedicated to supporting and financing specialist medical care to individuals afflicted by non-communicable chronic diseases not covered by the NHIS such as cancer, end-stage organ failures, and cardiovascular diseases, stroke, and diabetes, which collectively represent over forty percent (40%) of all-age mortality in Ghana. To achieve its financing scope, an annual budget for the Fund shall be established, sourced from government allocations, public funds, including twenty percent (20%) of all monies designated for the National Health Insurance Fund, Parliament-approved funds, voluntary contributions, and accruals from investments. These arrangements are to ensure diverse financial inflows for the Fund's sustainability, viability and continuity.
Secondly, it shall adopt a strategic approach to healthcare infrastructure, establish a national register or database for non-communicable diseases, and guarantee equitable care through a statutory Board of Trustees, which shall be empowered to manage the Fund, albeit with some approvals and oversights from the Controller and Accountant General as well as the Minister of Finance, and Parliament.
Thirdly, the allocation of funds shall be based on a formula established by the Board of Trustees in conjunction with the Minister of Finance and sanctioned by Parliament for accountability and transparence purposes, thereby ensuring that financial resources are utilised for supporting approved individuals in obtaining specialised medical care for chronic diseases, facilitating access to such care, and investing in initiatives that promote equitable access to specialised care, as determined by the Board of Trustees, including specialist medical training and pertinent medical research.
Policy Governance
The Fund is governed by a Board of Trustees consisting of thirteen members: a chairperson, the Fund Administrator, one delegate from each of the Ministries of Health, Finance, and Social Welfare, and the Chief Executive Officer of the National Health Insurance Authority. The remaining members of the Board include representatives from the public healthcare sector and the pharmaceutical industry, a health professional with a minimum of ten years' experience in chronic diseases, a legal practitioner with at least ten years' experience, and three additional individuals nominated by the President, with at least one being a woman. This structure of the governing Board creates a wealth of diversity in experience and expertise, creating overall public trust and balance.
The primary responsibilities of the Board of Trustees include overseeing the mobilization, collection and accounting for resources, approving expenditures from the Fund, and, in accordance with the Public Financial Management Act, 2016 (Act 921), appointing a fund manager to invest the Fund's surplus capital in financially advantageous instruments and ventures.[9] The Board is mandated to determine and coordinate fundraising activities to generate revenue for the Fund and undertake any additional functions related to the Fund's objectives, including creating awareness and disseminating information to the public regarding the services available to beneficiaries, their rights and responsibilities, and mechanisms for complaints and dispute resolution.
Patient eligibility requirements are set as part of the governance design. An individual qualifies for the Fund if they are a citizen insured under the NHIS and are afflicted with a chronic non-communicable illness. An application to the Fund may, among others, be submitted via a specialist medical practitioner. This application method transfers the responsibility of enduring bureaucratic processes from the patient and their families to the medical practitioner, caregiver, and hospital, who have assessed the patient and own the patient's records and data. This mode of application for a support under the Fund creates transparency and openness and potentially avoid fraud and misrepresentations of cases.
To promote and maintain high-quality outcomes, the Fund shall guarantee that only medical practitioners certified by the appropriate national or international regulatory bodies and licensed to deliver specialist medical services by the relevant authority in the country may provide services to beneficiaries under the Fund. Also, the Fund shall engage with pertinent agencies to execute policies and procedures that ensure quality care for beneficiaries and conduct audits of clinical quality and treatment outcomes for service providers. This mandate of the Fund excludes traditional medicine and healers, and the Fund shall maintain a comprehensive register, updated annually, of all accredited and licensed specialists in certain medical fields to validate the applications that may be submitted by a practitioner or carer on behalf of a patient.
FLAWED POLICY? SHORCOMINGS AND AMBIGUITIES
Although MahamaCares is portrayed in media as a courageous and empathetic initiative aimed at enhancing healthcare access, equality, and equity, its considerable shortcomings and ambiguities in implementation and operational risks may jeopardise the fundamental structure of Ghana’s public health financing system. First, there is a paucity of data concerning the classification of the chronic non-communicable ailments that the initiative aims to address. There is a deficiency of data from districts, as well as regional and national levels to identify and determine the public health facilities that require the most urgent attention by way of patient-applicant numbers and category of illnesses. Although the Board is tasked with establishing a national database and promoting public awareness and education, the absence of an initial database presents a significant challenge, potentially delaying the commencement of operations as it must clearly define its starting point and outline numerical expectations. The lack of reliable data on cancer and its classifications; end-stage organ diseases of the heart, kidney, lungs, pancreas, and liver; transplant waiting lists; as well as stroke, diabetes, and the various forms of cardiovascular illnesses, presents a significant challenge to the Fund.
Secondly, the Fund may be inundated with the volume of patient applicants beyond its operational capabilities. For end-stage kidney patients undergoing dialysis, for example, unofficial data sources suggest that the numbers are in the hundreds; however, there is no documented record of the official dialysis relief hospitals across the country and how many of them have functioning machines, leading to a key flaw in the high risk of the Fund becoming overwhelmed and overstretched due to the potentially large and unforeseen volume of applicants from various districts and regions.
Again, there is no documentation of patients on organ transplant waiting lists. From 2020, when the Covid-19 pandemic broke out, until 2024, Ghana experienced a renal dialysis crisis that revealed significant flaws in the nation's health financing system, as out-of-pocket dialysis costs in public hospitals escalated beyond the affordability of hundreds of patients, resulting in distressing instances of individuals being denied treatment or missing dialysis sessions thereby increasing the fatality rates for individuals undergoing dialysis. The NHIS temporarily mitigated the situation, even though the category of illness was beyond its statutory mandate, by absorbing some of the cost.[10] That intervention was a spontaneous and ad hoc effort to provide financial assistance to only kidney disease patients requiring dialysis, and not transplants or cancer patients requiring chemotherapy.
In addition to the absence of dependable data regarding individuals requiring financial assistance for their non-communicable diseases, there is also the issue of the twenty percent (20%) allocation of NHIS funds.
The allocation of 20% of all NHIS funds to the new Fund has elicited valid concerns and enquiries among health policy practitioners over the thoroughness of the planning and the breadth of funding and financing sources considered. The methodology behind the figure remains ambiguous, and the Memorandum accompanying the Bill failed to elucidate it, rendering it susceptible to arbitrariness and capriciousness. If the NHIS, with its complete one hundred percent (100%) budget allocation, was unable of financing the targeted illnesses, how could it be anticipated to operate well with twenty percent (20%) of its funds now removed? Could the NHIS be restructured to manage the financing of the specified illnesses using the 20% currently allocated to the new Fund? Is there proof that when the specified illnesses are incorporated into NHIS coverage and 20% of funding is legally designated for that purpose, the NHIS is incapable of managing those illnesses, necessitating the establishment of a new fund to oversee the 20% allocation of the NHIS?
Again, it remains ambiguous the contribution of actuarial, finance, and cost statistics, together with stakeholder consultations, to the decision to allocate 20% of the limited and strained budget of the NHIS to another Fund, resulting in the duplication of public health insurance in Ghana. This move, potentially motivated by the urgency or political momentum, jeopardises the foundational insurance plan that Ghana has developed since 1992. It is regrettable that the NHIS, despite its imperfections, remains to be Ghana’s principal mechanism for UHC, yet currently faces challenges with reimbursement delays, a restricted benefits package, and escalating provider discontent.[11] Consequently, allocating one-fifth of its revenue without increasing the overall public health budget is not only fiscally precarious but also structurally hazardous.
Additional ambiguities and uncertainties remain beyond the uncertainty related to financial effect. Who is eligible for funding? The absence of a definitive definition or established qualifying criteria permits the Fund’s Board to exercise discretion in decision-making. In the absence of testing and objective standards, access may become capricious or subject to political manipulation and abuse. How will this interact with NHIS, given that the establishment of a rival finance structure raises concerns about fragmentation, perhaps forcing patients to navigate numerous bureaucracies and placing providers in a conflict between two payment systems?
A further concern relates to the risk of political manipulation and elite influence. Can the Fund be adequately protected from political and elite capture to prevent its benefits from being diverted to individuals who do not genuinely need them? This apprehension is grounded in Ghana’s political history, which demonstrates that even well-intentioned public funds are often susceptible to becoming instruments of patronage. It is without a doubt that without independent scrutiny and citizen engagement, the Trust Fund may encounter a similar predicament.
The administrative expenses associated with operating the new Fund are concerning and may detract from its intended advantages. Establishing a new national fund necessitates recruiting personnel, developing systems, and instituting supervision as well as monitoring and evaluation frameworks within a constrained economic environment, where expenditures must be judiciously evaluated against their prospective advantages. It is therefore argued that it is untenable to spend so much money to set up a new fund to do the work that the NHIS, which if funded and resourced adequately and sufficiently could do.
Overall, the purpose and intendment of the Medical Trust Fund is unequivocal. The critical issue is whether the implemented solution will function effectively in practice without compromising existing structures such as the NHIS and the gains that Ghana has made in its public healthcare reforms thus far.
CONCLUSION AND REFORM CONSIDERATIONS
Undoubtedly, MahamaCares has been established and may continue into the foreseeable future, at least for the duration of the proponent's tenure in power. Consequently, the paramount objective should now be to make immediate modifications or adjustments and to guarantee that the Fund's implementation, which should factor citizen oversight, stakeholder engagement, and expert participation, is accurate, deliberate, judicious and transparent, minimising opportunities for discretion, ambiguity and abuse and does not undermine the overarching goal towards access to universal health care.
Additionally, the 20% allocation from the NHIS should be reversed, thereby providing the NHIS with its complete budgetary allocation from the common fund and ensuring that the new Fund remains financially independent rather than subordinate to the NHIS.
A 24-hour operational coordination with NHIS should be established for the sharing of data, experiences, and information from the district to the regional and eventually to the national level, thereby transforming the Fund into a vital resource.
Furthermore, infrastructural allocations from the Fund may be directed towards the completion and operationalisation of the Agenda 111 hospitals, which are strategically located in nearly every district, to establish them as the referral hospitals or facilities for the Fund’s applicants. This could efficiently facilitate accountability, coordination and database management.
In conclusion, proceeding without giving consideration to these modifications risks transforming a well-intentioned Fund into a bureaucratic and complex obstacle within Ghana’s healthcare system.
REFERENCES
Biritwum, R.B., 1994. The cost of sustaining the Ghana's" Cash and Carry" system of health care financing at a rural health centre. West African Journal of Medicine, 13(2), pp.124-127.
Hall, M.A. and Lord, R., 2014. Obamacare: what the Affordable Care Act means for patients and physicians. Bmj, 349.
Ibrahim, A., Maya, E.T., Donkor, E., Agyepong, I.A. and Adanu, R.M., 2016. Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study. BMC pregnancy and childbirth, 16(1), p.385.
Ministry of Health: 2025 PRESIDENT MAHAMA LAUNCHES GHANA MEDICAL TRUST FUND TO SUPPORT CHRONIC DISEASE CARE. Available at: https://www.moh.gov.gh/president-mahama-launches-ghana-medical-trust-fund-to-support-chronic-disease-care/ (accessed on 20 October 2025).
National Health Insurance Act, 2003 (Act 650): The Act was subsequently replaced by the National Health Insurance Act, 2012 (Act 852).
Okine, P.E.N.A., 2024. An evaluation of community health care service in Ghana: A case of the Community-Based Health and Planning Service (CHPS) compound in Ghana (Doctoral dissertation, Brunel University London).
Public Financial Management Act, 2016 (Act 921)
Rockmer Pharma 2025: Ghana’s Medical Trust Fund: Lifeline or Landmine? Available at: https://rokmerpharma.com/ghanas-medical-trust-fund-lifeline-or-landmine/ (accessed on 30 July 2025).
Tannor, E.K. and Antwi, S., 2023. Global Dialysis Perspective: Ghana. Kidney360, 4(12), pp.1776-1779.
Traditional Medicine Practice Act, 2000 (Act 575): preamble.
[1] Biritwum, 1994, pp. 124-125.
[2] Ibrahim et al., p.385.
[3] Traditional Medicine Practice Act, 2000 (Act 575): preamble.
[4] National Health Insurance Act, 2003 (Act 650): preamble. The Act was subsequently replaced by the National Health Insurance Act, 2012 (Act 852).
[5] Okine, 2024. p. 2.
[6] Ministry of Health: 2025 PRESIDENT MAHAMA LAUNCHES GHANA MEDICAL TRUST FUND TO SUPPORT CHRONIC DISEASE CARE. Available at: https://www.moh.gov.gh/president-mahama-launches-ghana-medical-trust-fund-to-support-chronic-disease-care/ (accessed on 20 October 2025).
[7] Hall et al., 2014, p. 349.
[8] Ghana Medical Trust Fund Bill, 2025: Memorandum
[9] Public Financial Management Act, 2016 (Act 921): preamble.
[10] Tannoret al., 2023, p. 1776.
[11] Rockmer 2025. Ghana’s Medical Trust Fund: Lifeline or Landmine? Available at: https://rokmerpharma.com/ghanas-medical-trust-fund-lifeline-or-landmine/ (accessed on 30 July 2025)