Debates of 27 Mar 2014

PRAYERS 11:25 a.m.


  • [No correction was made to the Official Report of Thursday, 13th March, 2014.]
  • Mr Speaker 11:25 a.m.
    Hon Members, I have admitted one urgent Statement for this morning.
    Hon Member for Salaga South?
    STATEMENTS 11:25 a.m.

    Alhaji Ibrahim D. Abubakari (NDC -- Salaga South) 11:25 a.m.
    Thank you, Mr Speaker, for giving me this opportunity to make a Statement on the breakdown of the Yeji- Mankango Ferry that provides access to both motorists and passengers travelling between southern Ghana and the north- eastern part of Northern Region and beyond.
    Mr Speaker, the construction of the Akosombo Dam in the early 1960s created
    Mr Ignatius B. Awuah (NPP -- Sunyani West) 11:35 a.m.
    Thank you, Mr Speaker, for allowing me to contribute to the Statement ably made by my Colleague from Salaga South.
    Mr Speaker, the Atetebu-Yeji-Salaga road is an alternative route to Tamale should there be a problem on the Techiman-Kintampo-Tamale route. Yeji on the Brong Ahafo side of the lake and Salaga on the Northern Region side of the lake are both market centres. The people trade among themselves and the easiest way of linking the two communities together is the use of the ferry.
    Mr Speaker, even for parts of the land close to Pru District, we still have a portion of it belonging to the Salaga District. So, my Colleague has part of his constituency extending to the Yeji side of the Brong- Ahafo Region and he can only access that part by crossing over the river and he does so through the use of the ferry.
    Mr Speaker, when the ferry breaks down, the people resort to dug-out canoes as an alternative way of crossing the lake and this has caused a lot of fatalities on the lake. This is because in the lake, we still have stumps which were left over as a result of the flooding of the river during the creation of the Akosombo Dam.
    So, Mr Speaker, I would want to add my voice to the Statement made by my Colleague, that the issue of attending to the ferry on the Yeji-Salaga side of the Volta Lake is something which is very urgent and needs immediate attention to promote socioeconomic activities along that part of the country.
    Mr Speaker, on this note, I would want to say that it is urgent and it needs immediate attention.
    Mr Joe K. Gidisu (NDC -- Central Tongu) 11:35 a.m.
    Mr Speaker, as other Hon Colleagues have noted, that is a very important ferry that links the Yeji side in the Brong-Ahafo Region to Mankango on the northern side.
    Mr Speaker, it is not only vehicles that cross this bridge, a very large number of farmers and fishermen along the Volta Lake depend on this ferry. This brings to the fore, the situation of ferries that operate under the Volta Lake Transport. Most of those ferries have seen repairs over the last 20 to 30 years and virtually, all of them are grounding or have grounded to a halt.
    It is the same VLTC which supervises the ferry at Dambai and also at Ekyiamenfurom. We are lucky that one has been rehabilitated through a facility not long ago. But the Yeji ferry, as noted by the Hon Member who made the Statement, has not seen any major repairs over the last 20 to 30 years.
    The span of the water stretch which this ferry crosses is quite long. Like my Colleague Member who just spoke noted, if there is a breakdown of the ferry, people will resort to the use of this outboard motors and this is not the safest for people along that corridor.
    I would therefore, want to take this opportunity to appeal to the Ministry of Transport and more especially, under facilities which they are sorting for other units under that Ministry, for example, the railways and other things to see the river transport system as a major concern as well for the Ministry and commit the Volta Lake Transport to take more prudent measures at least, in sustaining the current ferries while waiting for dependable sources of funding to replace them eventually.
    This is the only way to guarantee but the long-term solution may be a bridge, it will take some time. But in the immediate term, there is the need to see how best to salvage the situation to reduce the frustration among our people leaving in that corridor.
    Thank you, Mr Speaker.
    Mr Speaker 11:35 a.m.
    Hon Minister for Roads and Highways, would you want to say something?
    Minister for Roads and Highways (Alhaji Amin Amidu Sulemani) 11:35 a.m.
    Mr Speaker, I sympathise with my Colleague from Salaga South for the situation we find ourselves in there.
    As he rightly said, the right thing to do, is to construct a bridge over the river but that is a long-term project. So, for now, we would have to manage with the pontoons.
    I was discussing with my Colleague Minister for Transport and she indicated that there was a new pontoon being built for that place. So, I hope that we would try to fastrack and bring the pontoon to operate in the area.
    Thank you very much, Mr Speaker.
    Mr Speaker 11:35 a.m.
    Thank you very much, Hon Minister for Roads and Highways.
    Yes, Hon Member for Subin? The last comment.
    Mr Isaac Osei (NPP -- Subin) 11:35 a.m.
    Mr Speaker, I would want to make a brief comment. I thank the Hon Member for Salaga South for bringing this up. This is at the heart of modern transport planning because these days, we are all looking for a multi-modal approach.
    All of us know that road transport accounts for something like 97 per cent of passengers and maybe, 96 per cent in the movement of goods in Ghana. Therefore, it is extremely important that we pay more serious attention to lake transport.
    It is not just the transport which moves from south to north and back, but it is also cross-lake transport between major cities of our country, especially on the eastern side of our country, from Akosombo, all the way to the North. As has already been pointed out, the goods which are transported using lake transport are of such vital importance to many communities, especially those in the urban areas down South.
    We have to do something about the various ferries we have all over the place. There are modern ferries which are coming up but our ferries, I believe, are not new. They have been rehabilitated over the years but some of them as has been said, have already given up.
    I thank my Hon Colleague for bringing this matter. The way to go is multi-modal.
    Thank you.
    Mr Speaker 11:45 a.m.
    Hon Member for Okaikoi Central, do you have a point of Order?
    Mr Boamah 11:45 a.m.
    Mr Speaker, just to refer you to article 111 of the Constitution. With regard to proceedings on the floor, I have seen the Deputy Minister for Transport, perhaps, she may want to contribute to the Statement. [Laughter.] I have seen her at the back.
    Mr Speaker 11:45 a.m.
    Hon Member for Okaikoi Central, you are out of order. [Laughter.]
    Mr Speaker 11:45 a.m.
    Yes, Hon Member for Manhyia South?
    Dr Matthew O. Prempeh (NPP-- Manhyia South) 11:45 a.m.
    Mr Speaker, I would like to contribute albeit briefly to the Statement made by the Hon Member for Salaga South.
    Mr Speaker, the Road Fund caters mostly for road projects -- but Mr Speaker, when you are travelling between
    -- 11:45 a.m.

    Mr Speaker 11:45 a.m.
    Hon Member, is the Statement on Road Fund?
    Dr Prempeh 11:45 a.m.
    That is the beginning of my contribution.
    Mr Speaker 11:45 a.m.
    Hon Members, that brings us to the end of Statements. [Hear! Hear!]
    Hon Majority Leader, at the commen- cement of Public Business.
    Dr Benjamin B. Kunbuor 11:45 a.m.
    Mr Speaker, there are two quick procedural items I would like us to take as we commence Public Business.
    Mr Speaker, yesterday, on the Votes and Proceedings, on page 10 (b), you will notice that there was a referral of a matter that was done to a joint Committee of Mines, Energy and Finance. I had the opportunity to take a closer look at the document subsequently and then the parliamentary memorandum accompanying it. I thought that the referral ought to properly go to the Committee on Roads and Transport.
    So, I would like to crave your indulgence for us to take a look at that matter and the proper referral would be done, given the significance of that matter.
    Mr Speaker, these are two procedural matters on item 4 where we still have two Motions that are pending and we would want to take the appropriate opportunity to get the two of them before --
    Mr Speaker 11:45 a.m.
    Let us take them one by one.
    Dr Kunbuor 11:45 a.m.
    That is so, Mr Speaker.
    Mr Simon Osei-Mensah 11:45 a.m.
    Mr Speaker, last week while you were away --
    Mr Speaker 11:45 a.m.
    Hon Member, is it on the matter raised by --
    Mr Osei-Mensah 11:45 a.m.
    No, please. It is in relation to Questions. But because we do not have Questions on the Order Paper today, that is why I would want to raise it now. I would not have the opportunity to raise it in any other section within the Order Paper.
    Mr Speaker, while you were away, I asked a Question to the Minister for Education and the Answer was not appropriate, so the Deputy Minister for Education asked for permission to go back and prepare and report. They have informed me that they are ready with the Answer. So, I would want to beg of you, if it is possible, that we put it on the Order Paper for tomorrow, so that it can be answered. This is because we are rising tomorrow and if we do not do that, it would be delayed for too long.
    Thank you, Mr Speaker.
    Mr Speaker 11:45 a.m.
    Very well.
    Take the matter up with the Business Committee Chairman and the Ranking Member.
    Mr Osei-Mensah 11:45 a.m.
    Thank you, Mr Speaker.
    Mr Speaker 11:45 a.m.
    Hon Members, there is a particular procedural issue that has been raised by the Hon Majority Leader, I would want to dispose of it.
    Hon Minority Leader, do you have something to say? He is saying that the referral of the document should have gone to the Transport Select Committee but it was referred to the Committee on Mines and Energy and Finance. He would want to make an application for that withdrawal, so that it is properly referred to the Committee on Roads and Transport.
    Mr Osei Kyei-Mensah-Bonsu 11:45 a.m.
    Mr Speaker, the Majority Leader had a discussion with me on this and I am in agreement with the suggestion, to the extent that it did not involve any Question being put on it, it was just a directive that you gave. You could amend the referral, so that it would be in consonance with the proposal from the Majority Leader.
    Mr Speaker 11:45 a.m.
    Very well.
    Hon Members, the --
    Mr Speaker 11:45 a.m.
    Papa Owusu-Ankomah 11:45 a.m.
    Mr Speaker, I know that this issue has come up quite often and I believe that probably, the House may have to take a look at its Standing Orders, particularly Order
    A couple of weeks ago, I referred to it but with your permission, I would beg to read it in extenso.
    Mr Speaker,
    “When a Loan Agreement or an international business or economic transaction that requires the authorisation of Parliament through a resolution is laid before Parliament it shall be the duty of the Committee on Finance to examine the Agreement or transaction and make recommendations to the House.”
    Mr Speaker, at all times, the questions the House ought to ask are 11:45 a.m.
    One, whether it is a loan agreement.
    Two, whether it is an international business or economic transaction.
    Three, whether it requires the authorisation of Parliament through a resolution.
    It is rather wide, and I recognise that the time has come for us in terms of exercising our oversight, to let subject matter committees deal with some of these matters, so that it would not only be looking at the financial aspect but also the processes and in terms of the technical issues involved. This is because the Finance Committee lacks the necessary competence to deal with this matter.
    I am drawing the House's attention to this Standing Order, and not to raise any objection to the proposal made by the Leadership of this House.
    Thank you very much.
    Mr Speaker 11:45 a.m.
    In view of Standing Order 171 (1) that you have drawn our attention to, what is your view on the position taken by the Hon Majority Leader and of course, supported by the Minority Leader?
    Papa Owusu-Ankomah 11:45 a.m.
    Mr Speaker, I have no objection to it. But I would want us to bear in mind that when these referrals are made to the Finance Committee, there is the impression created that the Finance Committee wants to take responsibility for almost every Agreement that comes before this House. I would want to emphasise that it is in accordance with our Standing Orders.
    At this time, we need to amend this particular provision. This is because in terms of deepening oversight, particularly relating to commercial Agreements, which may be international business or
    economic transactions, it may not necessarily have to be referred to the Finance Committee.
    So, I support it, except to say that in accordance with Standing Order 171 (1) , the referral was not wrong.
    Thank you.
    Dr Kunbuor 11:45 a.m.
    Yes, Mr Speaker, I cannot more than agree with him. But sometimes you practise, you gain the experience and you legislate. So, we can experiment with exactly what the Hon Former Leader of the House has said, and perhaps, the experiences that we gain from it, would enrich the Standing Orders Committee on how to do this.
    In fact, it goes even beyond just Order 171 to many more Orders that we need to be more explicit beyond, just the broad categorisation of the referral to guide the person presiding on most of these matters, Mr Speaker.
    Mr Kyei-Mensah-Bonsu 11:55 a.m.
    Mr Speaker, as I indicated the other time, it is about re- opening the debate-- what happened the other time.
    When Parliament is charged with the responsibility of overseeing the Executive, it does so through the various committees. Tracing and tracking the allocation of any resource, especially any moneys to any sector, is done by the relevant sector -- the relevant sector committee. Which is why I have always insisted that it is important that, yes, we may have this as the pivotal provision and yet, it is important that we have committees joining with the Finance Committee in these matters; so, they are positioned appropriately to trace and track the allocation of any such resource. I believe it falls in tandem with the issues that I have been consistent on.
    Perhaps, going forward, we may have to look at how to structure the various provisions in respect of the current exercise that we are doing relating to the review of the Standing Orders.
    Mr Speaker 11:55 a.m.
    Very well.
    Hon Members, two issues have cropped up. In the first place, the referral yesterday was not wrong, if you look at Standing Order 171. But the role of the subject matter committees is very important, especially in this particular Agreement and it is on that basis therefore, that the referral of yesterday is withdrawn and that, it is now referred to the Committee on Roads and Transport.
    Is it Transport? [Interruption] -- Committee on Transport for consideration and report --
    Dr Kunbuor 11:55 a.m.
    Mr Speaker, I was informed that the memorandum was co- signed by the Finance Minister, so you can make it the two.
    Mr Speaker 11:55 a.m.
    Very well --
    Dr Kunbuor 11:55 a.m.
    It is a joint referral?
    Mr Speaker 11:55 a.m.
    Joint referral.
    So, in that case, we are only replacing the Committee on Mines and Energy with Committee on Roads and Transport.
    Very well.
    Dr Kunbuor 11:55 a.m.
    Mr Speaker, we can take item number 4.
    Mr Speaker 11:55 a.m.
    Hon Members, item 4 -- Motions.
    Hon Member for Wa West, Hon Yieleh Chireh.
    Dr Kunbuor 11:55 a.m.
    Mr Speaker, we see that there are three Motions; one, the original Motion; two, an amended Motion and the third Motion, the compromised Motion.
    So, if we could procedurally get them withdrawn, we would then be left with the
    compromised Motion -- on item number 4. So, if we could get the withdrawal on item number 4 and --
    Mr Speaker 11:55 a.m.
    Hon Member for Nhyiaeso.
    Dr Richard Anane 11:55 a.m.
    Thank you, Mr Speaker.
    Mr Speaker, on the 13th of February, 2014, I moved a Private Member's Motion and the Motion was --
    “That this august House urges the Hon Minister for Health to terminate the ongoing Health Insurance “Capitation” programme being implemented by the National Health Insurance Authority in the Ashanti Region.”
    Mr Speaker, after deliberations and noting the national import, you directed for a consensus Motion to be agreed upon by the Leadership and be presented.
    Mr Speaker, today, we have the consensus Motion and in view of that, I cede this Motion in favour of the consensus Motion and therefore --
    Mr Speaker 11:55 a.m.
    So, you are seeking leave to withdraw it?
    Dr Anane 11:55 a.m.
    Yes, Mr Speaker.
    Mr Speaker 11:55 a.m.
    Very well.
    Hon Members, the Motion standing in the name of the Hon Member for Nhyiaeso is accordingly withdrawn.
    Dr Kunbuor 11:55 a.m.
    Mr Speaker, consequen- tially, there was an amended Motion to the Motion by the Hon Member for Nhyiaeso and I was the person that moved that amended Motion.
    In the light of the developments, I seek to withdraw that amended Motion as well.
    Mr Kyei-Mensah-Bonsu 11:55 a.m.
    Mr Speaker, if the Majority Leader and Leader of the House proposes a Motion and has to withdraw it in favour of a consensus Motion, then we are getting somewhere.
    But Mr Speaker, there is a matter of procedure that I would want some guidance on.
    The Hon Member proposed an amendment to a substantive Motion that had been moved by Dr Anane, which has been seconded appropriately. Perhaps, if the Member had not proposed his amendment, the person who seconded his amendment would have proposed an independent amendment. The Hon Haruna Iddrisu really intended to propose an amendment.
    Now, I would want to know from the Majority Leader whether he has the consent of the Hon Member who seconded the Motion to withdraw it.
    Mr Speaker 11:55 a.m.
    Hon Minority Leader, I thought you were going to direct that question to the Hon Member for Nhyiaeso before --
    Mr Kyei-Mensah-Bonsu 11:55 a.m.
    Mr Speaker, when we have settled with this one, we would go there. [Laughter.]
    Dr Kunbuor 11:55 a.m.
    Mr Speaker, it is certainly a procedural matter. But what the Hon Haruna did was to adjust and adorn my Motion. He was really not forcibly trying to come with an amended Motion to my amended Motion. So, I guess that it is just for the express aspects of our records. Otherwise, the withdrawal of the substantive Motion, to which there was an amendment, meant that the amendment too would have gone with the substantive Motion. But we just wanted to make it a bit neater, Mr Speaker.

    So, the compromised Motion should not have the title of “Amendment Motion.” Now that we have withdrawn the substantive Motion and the amendment Motion, it should stand on its own feet as a substantive Motion.

    Hon Member for Wa West --
    MOTIONS 11:55 a.m.

    Mr Joseph Y. Chireh (NDC -- Wa West) 11:55 a.m.
    Mr Speaker, I beg to move, that this House urges the Hon Minister for Health to review the ongoing Health Insurance “Capitation” programme being implemented by the National Health Insurance Authority in the Ashanti Region and to report to the House on the way forward within four weeks.
    Mr Speaker, in moving this Motion, I intend to be very brief and speak to some few issues.
    One, Capitation is a payment mechanism which has the characteristics of an advance payment of an agreed rate to a provider and in this case, the National Health Insurance Authority would give a provider one week in advance of all the people for the provider to provide services for one month; that is the payment mechanism.
    It presupposes that the subscribers would have enrolled with a provider -- a preferred primary care provider, which means that it is only the out-patients and primary care givers that this Capitation applies to.
    Mr Speaker, the legal basis is not in doubt. If you look at section 37(c), it is one of the mechanisms for payment.
    Mr Speaker 12:05 p.m.
    Hon Member for Wa West, you know, I am not supposed to take part in the delay, so leave me out of the debate.
    Mr Chireh 12:05 p.m.
    Mr Speaker, I have not asked you to take part. I am only saying something that is of factual basis.
    Now, we all agree that there is a legal basis; we also agree that the reasons and the benefits or the beneficial effects of capitation are very clear. One, it is about the sustainability of the whole scheme and the cost containment of it. It also means that you have to ensure that whereas people were just going to any facility, and a patient could go to about three facilities in a day if wished, now, once you are enrolled with one provider, you are required to go to that provider only.
    After that, if you think that the provider is not satisfying your needs -- for instance, if you advertise the place as a hospital, and I enroll as a subscriber, only for me to go and meet ward-aids, and nurses taking care of me, I would “pot” as we do in the telephone business. When one provider is not doing what you expect, you go to another one.
    Therefore, it would also introduce managed competition among providers in this case. It also enumerated a number of things connected with claims.
    Mr Speaker, once you have a claim, and it should always be predetermined, you are helping the provider in some cases to improve upon the conditions of that facility to be able to maintain the kind of clientele coming to that provider.
    Above all, it eliminates what we call fraud in the claims. It has to be human beings who come to the clinic, who get the treatment or go to the pharmacy shop of any of the providers before you can claim the money that is advanced to you. If, as I said, we do that, it will help us cut down all the expenses that were being incurred by the Scheme and are trying to break down the Scheme.
    The other payment mechanisms were still available; one important fact is that, it did not affect in-patient care at all. It was provided.
    There are challenges that we should talk about in the implementation. Since there has not been any benchmark practice before, it is of no doubt that in implementing it, you will face difficulties. What are the difficulties?
    One of them is the fact that even though the National Health Insurance Authority (NHISA) promised to pay one week in advance of the start of the treatment, in some cases, the rural areas, they did not have bank facilities to be able to access this money. Of course, there is always a delay in making that payment.
    The rate was contested by the providers and the National Health Insurance Authority has written to the providers to explain and also to re-adjust to the rates that are not totally satisfactory, but rates that they could cope with. In doing all these things, we are doing it because of the patients, the provider and the Scheme. Therefore, if there are challenges, what is important for us, is to
    look at how we would resolve the problem. Should we go back? No! It has worked in other places perfectly well and we should as a country also invest in it. We are not arguing about the benefits at all. What we are arguing about, sometimes, is about the fact that it was being implemented in one region.
    Mr Speaker, I can say that having all the concerns that were raised, the National Health Insurance Authority, in a number of ways, tried to visit, have discussions. Incidentally, I was also the Minister at the Ministry of Health at the time of the implementation and I had the opportunity to go to the Ashanti Region to follow up on the concerns that were coming.
    I believe that the Ministry, together with the Authority, can resolve the problems.Therefore, it will be good after the review, to extend it -- as I hear or I understand, the authorities want to do that to three more regions -- Upper East, Volta and Upper West Regions.
    An Hon Member 12:05 p.m.
    Your region.
    Mr Chireh 12:05 p.m.
    Yes, my region.
    In this way, we are not going to ignore the obvious problems associated with the implementation. We have to look at them, thus the implementers -- if there are issues, let us discuss them. If there are problems, let us look at them. Fortunately, the Authority itself and the Ministry have already done a few reviews and discussed them with stakeholders and it is these reviews that are informing us that it is worth maintaining the Capitation as a payment mechanism. This is because it will save us a lot of money.
    You know the Scheme is growing very alarmingly in the releases of the monies to support. In this, is that Mr Speaker, one of the ways to resolve Capitation issue is
    for us to look at how much money we should further put for the Scheme to be able to address these problems.
    Let me conclude by urging all of you to support this Motion and urge the Ministry to bring quickly, the review and possibly, extend Capitation to the three regions.
    Let me also further explain Mr Speaker, that preparations have to be done and they were done in the place of the Ashanti Region. But we know that anything that we are implementing -- to somebody who was benefiting from it and is now at the disadvantage, obviously, it will be a problem. So, the preparations must be thorough in the Upper West, Upper East and the Volta Regions, so that they are aware of what they should do and what they should expect. We want efficient services for the patients and we can only do so when there is competition.
    In this regard, I urge this House to support the Motion, so that the Minister will come and give us a brief after four weeks.
    Mr Speaker 12:05 p.m.
    Hon Dr Anane.
    Dr Richard Winfred Anane (NPP -- Nhyiaeso) 12:05 p.m.
    Thank you Mr Speaker, for the opportunity to second this Motion.
    Mr Speaker, I beg to second the Motion. In seconding the motion, I would want to predicate this with the report of the Daily Graphic of January 20. Mr Speaker, the January 20 report of the Daily Graphic had this to say and that was with reference to a meeting that was held at the Miklin Hotel between --
    Mr Speaker 12:05 p.m.
    Which year?
    Dr Anane 12:05 p.m.
    Sorry Mr Speaker. 20th January, 2014. I am talking about this year.
    In the meeting, a lot of things happened and I would want to quote part of the report from the Daily Graphic.
    Mr Speaker, the report is this and I beg to quote 12:05 p.m.
    “Sharp differences in opinions emerged and among participants in a workshop in Accra last Friday on whether the Capitation system of payment under the National Health Insurance Scheme should be withdrawn or implemented nationwide.”
    Mr Speaker 12:05 p.m.
    Do you have a point of order, Hon Member for Efutu?
    Mr Alexander K. Afenyo-Markin 12:05 p.m.
    It is so, Mr Speaker. I am trying to --
    Mr Speaker 12:05 p.m.
    What is your point of order?
    Mr Afenyo-Markin 12:05 p.m.
    Mr Speaker, it is an obstruction. I am trying to concentrate on the matter on the floor. But Mr Speaker, unfortunately, where I sit, directly is where the Hon Deputy Minister for Education and Hon Deputy Minister for Transport -- Mr Speaker, they are in a mood -- so, it is obstructing me.
    Mr Speaker 12:05 p.m.
    Hon Member for Efutu, withdraw your comments.
    Mr Speaker 12:05 p.m.
    Withdraw your comments.
    Mr Afenyo-Markin 12:05 p.m.
    Mr Speaker --
    Mr Speaker 12:05 p.m.
    I say, withdraw your comments.
    Mr Afenyo-Markin 12:15 p.m.
    Mr Speaker, I withdraw them by saying that I am being obstructed.
    Mr Speaker 12:15 p.m.
    Take your seat -- [Laughter]
    Hon Member for Nhyiaeso?
    Dr Anane 12:15 p.m.
    Mr Speaker, with your indulgence, may I repeat that this is a quote from the January 20, 2014 edition of the Daily Graphic. Mr Speaker, paragraph (1) of the report said this and with your permission, I beg to quote:
    “Sharp differences in opinions emerge among participants in a workshop in Accra last Friday on whether the “Capitation” system of payment under the National Health Insurance Scheme should be withdrawn or implemented nationwide.”
    Mr Speaker, paragraph (5) of the same report said this and again, with your permission, I beg to quote:
    “The Ghana Medical Association in the region …,”
    And here, the region is Ashanti Region.
    “… has kicked against that system of payment.”
    Mr Speaker, the meeting was originally scheduled and dubbed as a “stake- holders' meeting”. But in the Daily Graphic report, they are talking about a workshop.
    Mr Speaker, I intentionally quoted this to paint the picture of what is happening on the ground for all of us to appreciate and for us as representatives of the people to appreciate what we have in hand and to see how we will together help to get it resolved, so that this means of payment, which is one of the means and which has been given legal bases in the law, can be managed and managed effectively to the benefit of the people of Ghana.
    Mr Speaker, I rose in support of the Motion as moved by the Hon Member of Parliament for Wa West, Mr Joseph Yieleh Chireh.
    Mr Speaker, this was in reaction to your directive which came after the Private Member's Motion, which I moved on the 13th of February. Mr Speaker, over the time, we have gone through a lot of deliberations and today, we are here presenting this consensus Motion.
    Mr Speaker, I wish to reiterate, as was captured in my previous submission, and here, I beg to quote:
    “We wish to clarify for all that we are not averse to the concept of “Capitation” in health insurance management as we understand it to mean. We supported it as a means of health financing, operational and sanitising mechanism under Act 650 of 2003 and its amendment Act 852 of 2012, and the relevant section of of the Act, section 37 (c), which talks about “Capitation” in the law.”
    Mr Speaker, I also continued in my previous submission, and again, with your permission, I beg to quote:
    “What we have frowned upon and indeed, have been against has been the continued hurried and botched implementation, which has rather left a sour taste in the mouths of all who are experiencing it.”
    Mr Speaker, nobody who has been speaking from this side has ever said the concept of “Capitation” is a bad one. We do know that it is practised in a lot of jurisdictions and we do know that it has a lot of advantages; for the provider -- for the scheme and for the subscriber himself. But Mr Speaker, one of the major bases for the introduction of a health insurance
    scheme, is to ensure that out-of-pocket expenditure is reduced.
    Mr Speaker, unfortunately, since health insurance was introduced in Ghana, there has been seen a well correlated reduction in our out-of-pocket expenditure. This, Mr Speaker, was also shown in my previous presentation. However, when “Capitation” was introduced in the Ashanti Region, there was seen to be a very marked increase in out-of-pocket expenditure.
    Mr Speaker, the Eastern Region has always been used as comparator when the regions are being studied with the Ashanti Region.
    Mr Speaker, in the studies that the National Health Insurance Authority itself did, it was found out that whereas the out- of-pocket expenditure in the Eastern Region was 36 per cent, that for the Ashanti Region has gone up to 64 per cent.
    Mr Speaker, that tells you that there is something wrong. And if you look at the two environments, the only difference is that there has been this change of the introduction of the “Capitation”. If the introduction of “Capitation” has caused that increase, then Mr Speaker, there is the need for us all to have a look, especially when the National Health Insurance Authority is not only thinking about “Capitation” being in the Ashanti Region only, but also being extended to the entire country.
    Mr Speaker, if it is going to be extended to the entire country and if we are going to have an increase in out-of-pocket expenditure, then we would have defeated the entire reason for introducing National Health Insurance Scheme in Ghana.
    That Mr Speaker, should be what this House must address itself to. We, as representatives of the people, we would want to ensure that our people do not suffer for any other reason other than always enjoying and benefiting in systems that are in place or put in place for the people of Ghana.
    Dr Anane 12:15 p.m.

    Mr Speaker, that was how come the original Motion was moved and it is in view of this that when you advised, we also decided to work with our Hon Colleagues to come out with a compromised Motion, so that at the end of the day, the Ministry and the Authority would be urged to ensure that the people of Ghana benefit from whatever actions that are taken through the benefit of the people and the nation.

    Mr Speaker, I had noted earlier and here, I would also crave your indulgence to mention, that the effects of the Scheme appear to have pushed all the risks onto the weaker legs of the stakeholder group that constitute the Scheme. Mr Speaker, who are the weaker legs? The provider and the subscriber.

    Mr Speaker, when the subscriber found himself constrained, the provider decides to also offload its load onto the subscriber and that is how come we are finding an increase in the out-of-pocket expenditure for the subscriber. Mr Speaker, we must be the defender of that weak leg in this case and that is the people of Ghana.

    Mr Speaker, the end result as I have said, has been the very high catastrophic out-of-pocket expenditure. As demon- strated in our original Motion, this has gone very high. Mr Speaker, we are requesting of the Ministry to take note and urging the Minister to ensure that the studies that are done are brought to the House for the House to at least, have a look and then out of deliberation, we may also give our minds to it to be improved upon.

    But Mr Speaker, in the consideration, we wish the Minister and the Authority to take note of a few points. What to do with the unrolling policy. First, steps to

    be taken to assign clients to providers in the first instance; second, stakeholder interactions on tariffs before any future implementation; third, steps to be taken to ensure the future or further implemen- tation of the “Capitation” policy would not engender an increase in out-of-pocket expenditure.

    We urge the Authority to take note of this, that in all their actions, they ensure that no matter whatever they do, it should not result in an increase in out-of-pocket expenditure for our peoples. Fourth, what compensation to give to both the public and private facilities in the region that have had to endure the botched implementation of the aberration; fifth, what compensation to grant to the people here or residents of the region who potentially have subscribed to the Scheme they have been contributing to through the National Health Insurance Levy.

    Mr Speaker, the other persistent problem is the inability of the Ministry of Finance to make the requisite transfers to the Fund. And Mr Speaker, this is one of the major constraints of the Authority. The Authority should be cooperative to the House and the Ministry, for all of us to push for the Ministry of Finance to do what is right, so that they would be able to do what is also right by their providers.

    Mr Speaker, to cure this, a provision was made in Act 852 of 2012 and that provision was in section 52 (1) and (2). Mr Speaker, perhaps, with your indulgence, I may want to read for the benefit of --
    Mr Speaker 12:15 p.m.
    Hon Members, when we have a compromised Motion, it means that there is a certain kind of agreement between both sides of the House. And since they would bring another report for further action, we just carry the Motion and make progress on the floor of the House.
    Dr Anane 12:25 p.m.
    Very well Mr Speaker. I only wanted to point out for the Ministry of Finance to note that it has a responsibility which is crafted in law for them to obey, so that the National Health Insurance Authority --
    Mr Speaker 12:25 p.m.
    Very well.
    Dr Anane 12:25 p.m.
    So, Mr Speaker, the two provisions are section 52 --
    1. The Minister responsible for Finance shall within thirty days after the collection of the levy, cause the levy to be paid directly into the Fund and furnish the Minister responsible for Health and the Authority with evidence of the payment.
    2. The Minister responsible for Finance shall present to Parliament every six months a report on payment of levies into the Fund.
    Mr Speaker, I wish that we took note of this and urged the Minister for Finance to also play his part in order not to starve the Authority and the Fund, which has also been one of the constraining factors. This is because when Colleague Hon Member for Wa West was making the submission, he said that in Capitation, payments are made, perhaps, a week before the preceding month.
    Mr Speaker, the reality is that, payments are made ten to fifteen days within the month when they should have been made. And it is all because of this financial constraints, and that is why we want to bring them to your attention for all of us to take note, so that we find ways and means of resolving this problem for the benefit of the people.
    Mr Speaker, since we have all agreed that we come back to hear the Minister in his presentation, I would want to thank you and urge all Members to approve this Motion for the National Health Insurance Authority to go on with this programme.

    Question proposed.
    Mr Speaker 12:25 p.m.
    Hon Members, a lot of discussions and negotiations have gone behind the scene to arr ive at a compromised Motion and therefore, debating -- since the Motion is calling on the Minister to submit a report to the House, why do we not wait for that opportunity,and then we can have a full blown debate on the floor? I will take one from each side.
    Hon Majority Chief Whip and also the Member for Sekondi.
    Alhaji Mohammed-Mubarak Muntaka (NDC -- Asawase) 12:25 p.m.
    Mr Speaker, thank you very much. I am very grateful for your change of mind, but we would try to be very brief since we would be waiting for the report.
    Mr Speaker, I would also equally beg to support the Motion before us and in doing so, just to say some facts. One has to do with, as what all my Hon Colleagues have mentioned, Capitation is lawful. It is found in Act 650 that has been changed to 852. It is also in the Legislative Instrument (LI) 1809 that was done sometime 2004/205. So, it is a very lawful exercise.
    Secondly, it is among the best practices in terms of payment mechanism all round the world. You cannot just find any health insurance anywhere in the world that does not have an aspect of Capitation.
    Mr Speaker, during the implementation also, a number of things happened. Because it was the first time that we were starting, a very effective committee was
    Mr Speaker 12:25 p.m.
    Last Comment. Hon Member for Sekondi?
    Papa Owusu-Ankomah (NPP- Sekondi) 12:25 p.m.
    Mr Speaker, I am happy that we have had this Motion. I do not claim to be too knowledgeable about the National Health Insurance Scheme. But what I certainly know is that, it is an important Scheme that is supposed to help, particularly the vulnerable and underprivileged in our society.
    Mr Speaker, so, anything that we, as a House can do to ensure that it may generally be acceptable by those it is supposed to help, we do it.
    I would just finally propose to Mr Speaker that, Hon Members who have various ideas to this Capitation, could even formerly present them to the Minister, so that she considers it before reporting to this House as we have indicated.
    I am urging all of us in terms of these matters, to as much as possible, be seen to be speaking with one voice, so that when the people of this country get to know this, they would know that, in terms of going forward, there is a consensus on it before this House.
    Mr Speaker, I thank you for the opportunity.
    Mr Speaker 12:25 p.m.
    Hon Members, that brings us to the end of the debate. I would now put the Question.
    Question put and Motion agreed to.
    Resolved accordingly.
    Mr Speaker 12:35 p.m.
    Minister for Health to submit report to the House within four weeks.
    Hon Majority Leader?
    Dr Kunbuor 12:35 p.m.
    Mr Speaker, I would like us to take item 9, so that we can clear it and consider the possibility —
    Mr Speaker 12:35 p.m.
    Yes, I thought that one could take one minute. Why do we not take the two amendments on item 10, then as we agreed this morning in my lobby, we can suspend Sitting. We have Committee of the Whole, then when we come back, we can —As for the Third Reading, anybody can move it on behalf of the Minister —
    Dr Kunbuor 12:35 p.m.
    That is so, Mr Speaker.
    Mr Speaker, I was also looking at item 5. But since that is your Committee's Report, we can take item 10 and take item 9 in addition, and then we can go for the Closed Sitting.
    Mr Speaker 12:35 p.m.
    Very well.
    Hon Members, this morning, I discussed with Leadership that because of the consideration of the formulae of the three Statutory Funds, we should have an extended Sitting. So, we will suspend Sitting at a point, consider the three Statutory Funds and then we come back and take the rest of the items on the Order Paper. That was the understanding we reached this morning.
    Hon Majority Leader, so, are we taking item 10?
    Dr Kunbuor 12:35 p.m.
    We would take items 9 and 10.
    Mr Speaker 12:35 p.m.
    If you want us to take items 9 and 10, then let me start with item 9 first.
    Item numbered 9 on the Order Paper -- Hon Attorney-General and Minister for Justice?
    BILLS -- THIRD READING 12:35 p.m.

    Mr Speaker 12:35 p.m.
    Item numbered 10, Anti- Terrorism (Amendment) Bill, 2013 at the Consideration Stage.
    BILLS -- CONSIDERATION 12:35 p.m.

    STAGE 12:35 p.m.

    Mr Bagbin 12:35 p.m.
    Mr Speaker, we intended proposing an amendment to clause 2 by adding a new paragraph. But Mr Speaker, upon a second reading of the totality of the laws, we would step down that. We withdraw the proposed amendment.
    (Amendment withdrawn by leave of the House.)
    What about the second proposed amendment?
    Mr Bagbin 12:35 p.m.
    Mr Speaker, I beg to move, clause 2, paragraph (e), definition of “without delay”, line 1, delete “ideally”.
    So, the definition of “without delay” will now be “without delay” means “within a matter of hours of”.
    So, the “ideally” is what --
    Mr Speaker 12:35 p.m.
    Hon Chairman of the Committee, if you may recall, yesterday, when we were doing the Anti-Money Laundering (Amendment) Bill, we tried to delete “without delay” and substitute it with “within twenty-four hours”, which was a subject matter of debate or discussion on the floor of this floor. You know that these two Bills or laws run together? While in one law, we deleted “without delay” and substituted it with “within twenty-four hours”. We are now keeping “without delay” and defining it. I know they are different laws but they are interrelated.
    Mr Bagbin 12:35 p.m.
    Mr Speaker, I am aware of what you are saying but you know, dealing with terrorism, you do not need to give time. You can act within a second. But in the case of anti-money laundering, which deals with a process, we need to give some time and that was why we gave the time limit.
    But terrorism is something that one can act immediately without waiting for timelines. In fact, that is why we are defining it differently from the definition in the Anti-Money Laundering Bill. So, if you give timelines, then you will defeat the purpose of the action.
    Mr Speaker 12:35 p.m.
    Why are we adding “not within minutes” but “hours” then? [Laughter] -- Based on your own argument of not giving timelines --
    Mr Bagbin 12:35 p.m.
    Mr Speaker, the issue of the use of “hours” could mean “seconds” because it is “within”; it could be a second.
    Mr Speaker 12:35 p.m.
    Very well. I am raising these issues because under the new Interpretation, the discussion on the floor is in the Interpretation, so that it can be clarified.
    Mr Peter Wiafe Pepera 12:35 p.m.
    Mr Speaker, I still think that in consonance with the Anti-Money Laundering Bill, even if there is no longer time limit, five seconds or five minutes, is still within the twenty-four
    hours. So, they should be harmonised. I do not see why we should leave it open- ended. If you say “within twenty-four hours”, you are forcing the issue.
    Mr Speaker 12:45 p.m.
    Hon Member for Abetifi, we should take the explanation of the Hon Chairman because matters of terrorism are serious ones and we should give some discretion to the law enforcement agencies, so that they can have -- We should not give timelines as he has explained.
    Mr Pepera 12:45 p.m.
    Well, Mr Speaker, he is a wise man, so, I cannot say anything. -- [Laughter] -- [Ms Ursula Owusu: Former wise man.] -- All right, former.
    This is because the thing is that if we say “within”, that even adds more seriousness to it. That is what I am saying. However, if I am the only one then fine, I would agree with my senior Colleague.
    Maj. (Dr) (Alhaji) Mustapha Ahmed (retd): Mr Speaker, just as the Hon Chairman explained, I think that definition should be couched such that it should carry the meaning of immediate.
    If you say “within an hour”, it gives whoever is taking the action the luxury of time, maybe, to delay a minute or two when he should have acted the moment the notice is brought to his action.
    Mr Speaker 12:45 p.m.
    Hon Chairman, have you seen paragraph (a) of (e) where we are amending -- where we have the freezing action?
    Mr Bagbin 12:45 p.m.
    Mr Speaker --
    Mr Speaker 12:45 p.m.
    Is there not a certain kind of relationship between that freezing action with regard to the Anti-Money Laundering Bill, which we have just passed? The freezing actions?
    Mr Bagbin 12:45 p.m.
    Mr Speaker, we are aware of that clause.
    Mr Speaker 12:45 p.m.
    Very well.
    Question put and amendment agreed to.
    Clause 2 as amended ordered to stand part of the Bill.
    Long Title ordered to stand part of the Bill.
    Mr Speaker 12:45 p.m.
    Hon Members, that brings us to the end of the Consideration Stage of the Anti-Terrorism (Amendment) Bill, 2013.
    Hon Majority Leader.
    Dr Kunbuor 12:45 p.m.
    Mr Speaker, I was of the view that in the light of our pending Closed Sitting, if we are obliged, we can actually suspend Sitting and then move in to consider the formulae and then reconvene to continue with the Business for today. I would also use the opportunity to say that provision has been made for extended Sitting.
    Mr Speaker 12:45 p.m.
    Very well. Are we suspending for some time or we are continuing straight?
    Hon Majority Leader.
    Dr Kunbuor 12:45 p.m.
    Mr Speaker, I guess that we can suspend for at least, two hours.
    Mr Speaker 12:45 p.m.
    So, when is the House -
    - 12:45 p.m.

    Dr Kunbuor 12:45 p.m.
    Mr Speaker, we should return at 1.00 p.m.
    Mr Speaker 12:45 p.m.
    No! We are suspending, when will the House reconvene -- 3.00 o'clock or 4.00 o‘clock?
    Dr Kunbuor 12:45 p.m.
    Mr Speaker, my clock was turned upside down. Let us suspend to 3.00 o'clock.
    Mr Speaker 12:45 p.m.
    Very well.
    Mr Speaker 12:45 p.m.

    12.49 p.m. -- Sitting suspended.

    5.15 p.m. -- Sitting resumed.
    ANNOUNCEMENTS 12:45 p.m.


    Mr First Deputy Speaker 12:45 p.m.
    Order! Order!
    Hon Members, we have Communication from the Office of the President.

    Some Hon Members -- Tweaa! Tweaa!
    Mr First Deputy Speaker 12:45 p.m.
    Hon Members, I believe that having regard to the state of affairs, you are exhausted and I would therefore, direct that the House be adjourned --
    Mr Kyei-Mensah-Bonsu 12:45 p.m.
    Mr Speaker, before the adjournment, the House really was programmed to adjourn sine die tomorrow but I guess there has been some development. So, if we can hear from the Hon Majority Leader, so that we do not come prepared, that we may adjourn sine die tomorrow. It would be very important for the conduct of Business in this House.
    Secondly, Mr Speaker, when you announced that the President had sent some communication to inform us that he was to travel outside the country, there was a loud response of “Hear! Hear!” Mr Speaker, what is the purpose of that? A President leaving the jurisdiction and there is a loud “Hear! Hear! To that; what is the purpose? Maybe, the Hon Okudzeto could explain to us what it means.
    Mr First Deputy Speaker 12:45 p.m.
    Hon Minority Leader, I cannot -- Shakespeare said it, “there is no art to find the mind's on the face”. So, I cannot.
    Suffice it to say that while we heard one side shouting “Tweaa”, the other side shouted “Hear! Hear! Although we know for a fact that Tweaa is unparliamentary.
    Dr Kunbuor 12:45 p.m.
    Mr Speaker, it was originally the idea that after some discussions had taken place, we would have called an emergency Business Committee meeting tomorow and we
    SPACE FOR 12:45 p.m.

    ADJOURNMENT 12:45 p.m.

  • The House was adjourned at 5.20 p.m. till Friday, 28th March, 2014 at 10.00 a.m.