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This volume analyzes Ghana s health system performance and highlights the range of policy options needed to improve health system performance and health outcomes.
Ghana's government has embarked on a decentralization process since the 1980s, but the intended devolution of the health system faces important challenges and shortfalls. This study analyzes the strengths and weaknesses of the decentralization of the Ghanaian health system.
This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.
Private Health Sector Assessment in Ghana is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank?s ongoing research and to stimulate public discussion. The private health sector in Ghana is a large and important sector in the market for health-related goods and services. However, little has been documented concerning the size and configuration of private providers and their contribution to health sector outcomes. With better information about the size, scope, distribution, and constraints of private actors, Ghana?s public policy makers
Despite some recent successes in Ghana, further improvements in health outcomes are in part hampered by the lack of skilled service providers, or human resources for health (HRH), particularly in rural areas, where critical health services are needed most. To address the lack of information and guide the development of policies and programs on HRH, Toward Interventions in Human Resources for Health in Ghana: Evidence for Health Workforce Planning and Results aims to paint a comprehensive picture of HRH, consolidating new and existing evidence on the stock, distribution, and performance of h ealth workers to focus on the what, as in What is the situation on HRH? and the how, as in How is this situation explained? The book highlights new evidence on some of the underlying determinants affecting the stock, distribution, and performance of health workers in Ghana, including health worker production and attrition, capacity to manage HRH, the capacity of health training institutions, and health worker compensation. Policy options on HRH are also discussed, as is the fi scal and political environment needed to develop and implement such interventions. The data and findings presented in this book are the result of extended and close collaboration between the Ghana Technical Working Group on HRH (led by the Ministry of Health) and the World Bank's Africa Region Technical Team on HRH. The information in this book will provide a better basis for Ghanaian decision makers and external partners to have a dialogue on HRH and related policies. More broadly, Toward Interventions in Human Resources for Health in Ghana: Evidence for Health Workforce Planning and Results will be of interest to all those working to improve human resources for health in Africa and beyond.
This study assesses the status of the implementation of this transition to programme-based budgeting (PBB) in the health sector in Ghana. It examines the impact of this change in terms of how funds are budgeted, allocated, used and accounted for across the sector. Ultimately, this analysis considers the linkages of PBB with sector goals and objectives, and how implementation can be improved for greater impact. The study finds that while PBB has helped to consolidate activities and infuse greater performance orientation into the budgeting process, many challenges remain. In particular, the continued dominance of input-based, line items, particularly below the central-level, constrain flexibility and the ability to coordinate activities across departments or disease programmes in the health sector. This degree of inflexibility goes to the lowest level of the health system, with input-based budget ceilings set for the more than 500 budget management centres in the sector, and is driven in part by the large share of the health budget that is dedicated to salaries and wages. The potential benefits of PBB in terms of joint budgeting across health programmes and inputs has not yet been taken advantage of, which contributes to inefficiencies across the sector. Furthermore, while performance indicators have been established, they are not systematically tracked or used in allocation decisions. As Ghana looks to future reforms in the health sector, continued budget reform can be an effective enabler of changes to health financing and overall service delivery in Ghana.
Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.