The Health Sector in Ghana : A Comprehensive Assessment

Abstract

Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of health care. In 2005, we launched a publically financed comprehensive health benefits package that included within it preventive care and treatment for communicable and non communicable diseases. To attain universal coverage requires addressing the health system holistically. The Ghana health sector is going through a comprehensive set of reforms. The National Health Insurance Scheme (NHIS) is a major step forward. Reforms in the area of human resources have helped reduce attrition, especially of physicians. Decentralization and a policy on retention and use of internally generated insurance funds have ensured a better availability of drugs and incentivized staff in health facilities. The Ghana health sector, like those in all emerging market countries, is, however, facing challenges on many fronts. Health outcomes are not on track to meet several of the health-related Millennium Development Goals, reflecting the need for both better targeting of public health programs and improvements in the functioning of the health delivery system. Increases in NHIS coverage, while significant, have been slow, and half of the country's population still lacks formal coverage. The primary challenges have been improving the risk pool, including informal sector workers, and redefining the stringent definition of the contribution exempt poor. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance. The book is targeted toward those who want to learn about the Ghana health sector. It is for those who want to understand what reforms have been undertaken, the results to date, and the remaining challenges that need to be addressed. The book will be useful to policy makers and to others for many years to come, given its evidence base and short- and medium-term policy reform options.