Although the country has a comparatively robust standard of health care, the Ghanaian government has received growing calls to raise sector spending and reform the medical system. Access has improved in recent years, but non-governmental organisations (NGOs) are pushing for more public resources to help Ghana achieve its health goals.
In July, a range of Ghanaian civil society organisations issued a joint communiqué calling for the government to meet its pledge to direct at least 15% of the budget to health care. The target was set by the member states of the African Union in 2001 as part of the Abuja Declaration.
Ghana’s 2013 budget comes up short, allocating 12.5%, but the country has reached the 15% goal twice since the Declaration was signed – something few other signatories have managed.
The communiqué was endorsed by 23 organisations involved in health care, including charities, professional groups and religious institutions, as well as the Embassy of the Netherlands. It was issued ahead of a summit between the heads of state of the Abuja Declaration signatory countries.
In a 20-point plan, the signatories urged the government to make specific pledges to address the funding gap, including the prompt release and distribution of funds and additional efforts to limit waste. It warned against increases to the National Health Insurance Scheme (NHIS) premiums as a quick way of raising more cash, saying that instead the system should be reformed to improve its efficiency.
Increased and more efficient health care spending is not only necessary for honouring the government’s Abuja Declaration pledge, but also for achieving the UN’s Millennium Development Goals (MDGs) and ensuring universal access to basic health care, the communiqué said.
Established in 2000, the MDGs were designed to be measurable targets for international development. The UN has set a date of 2015 for meeting several of the goals, including reducing the maternal mortality rate by 75%, ensuring universal access to reproductive health services and cutting the under-five infant mortality rate by two-thirds.
Ghana has greatly enhanced access to health care in recent years through the establishment of the NHIS, which was introduced in 2003 through the National Health Insurance Act to improve citizens’ ability to access and afford health care services by providing yearly premiums of GHS7.50 ($3.52).
In reality, since 90% of the programme’s funding comes from tax levies, the NHIS acts more as a social health care system than a traditional insurance scheme. Regardless of the implementation methods, the effect of the NHIS has been a marked improvement in recoveries and more people are visiting health facilities before the onset of serious problems. The NHIS initiative has built up its user base, with 66.4% of the population having already registered and 80.6% of members considered active.
However, balancing the need for low fees while covering the costs of running the scheme has proved challenging. Ensuring that the NHIS continues to meet demand for health care is one of the reasons why NGOs are calling for more resources to be devoted from government coffers.
But reforms to the system could be equally beneficial. The NHIS has been hampered by budgetary misallocation and problematic investment performance among other issues. Addressing these challenges would help free up resources for frontline health care. More radical measures could include introducing a larger private sector element into the management of the system.
While this could prove politically difficult, increasing the scope of private sector financing and provision in the health care sector might ease some of the burden on the government and enhance allocation of resources.
There are already promising public-private partnerships in the supply of medical equipment, infrastructure and training, which have involved the participation of international companies such as US multinational General Electric (GE) and the Netherlands’ Philips. GE will work with the government to develop diagnostic centres, the first of which will be located at the Korle Bu Teaching Hospital in Accra.
Ghana has one of the better health systems in Africa and is closer to meeting its targets than many other countries. But there is growing support for the argument that more resources, and better allocation thereof, are needed to deliver the standard of care envisaged.