In ghana, where budgetary decisions are heavily contested and politically expensive, one option available to the government may be to raise taxes or user fees to allow for increased spending on public health care. The donordriven push for policies aiming at uhc raises concerns. The rise on the international scene of advocacy for universal health coverage uhc was accompanied by the promotion of a variety of health financing policies. Chapter two assesses the performance of ghana s health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in africa. The study examined the challenges of financing health care in ghana.
For example gavi alliance have started developing a graduation plan with ghana for vaccines. Improve efficiency in governance and management of the health system 4. Ghanas health care financing system is generally progressive. Progressivity of health care financing and incidence of. In ghana, outofpocket oop payments accounted for 45% of total health care financing in 20056 akazili et al. Vision, values, guiding principles, goals and objectives the vision of the ghana health financing strategy is moving towards universal health coverage.
Health financing in ghana per capita health expenditure in ghana has significantly increased over the past two decades. The assessment is also based on several new and updated sources of information on. The model, however, could not be sustained for long and a token user fee was first introduced in 1972. Chronological development of health care financing in ghana. Trends and challenges of public health care financing. Ensure sustainable financing for healthcare delivery and financial protection for the poor 3. Improve quality of health services delivery including mental health services 5. The history of health in ghana was heavily influenced by international actors such as christian missionaries, european colonists, the world bank, and the international monetary fund. National health insurance scheme derive its funding from general revenues with the intention to have a nationwide coverage through public providers to deliver health care. Ghanas national health insurance scheme nhis was created by the national health insurance act of august 2003, and is one of very few attempts by a subsaharan african country to implement a nationallevel, universal health insurance program. Addaekorankye management and public administration department central university college, accra, ghana abstract the study examined the challenges of financing health care in ghana. The effect of ghanas national health insurance scheme on.
Ghana is among the african countries that promulgated a national health insurance nhi law act 650. Dec 26, 2017 ghana s health challenges and the way forward. The health policy is being executed through a series of health service medium term development plans hsmtdps and programmes of work pow. These financing schemes are different from some of. Stratified sampling technique was employed to select 250 respondents for the study. This chapter provides background on demographic and epidemiological trends, the configuration of ghanas health system, and health financing functions and health systems goals. Ghanas nhis in brief ghanas health care system was founded on the basis of the free health care model.
Government also provides a tax benefit those who purchase private health care cover through medical schemes. Year event rationale features sources of financing results 1957 introduction of a national health service modeled after the british systemdriven by early economic performance, natural resources, and a strong export base everyone entitled to free health care health care delivery. Health care financing continues to be a challenge in many developing countries. It is a long journey and the strategy is intended to enable ghana to continuously make progress on the road to universal health. Improve efficiency in governance and management of the health system. In the absence of effective exemption mechanisms, poorer households suffer as a result of having to pay user fees which are a major component of oop payments. Background the introduction of the national health insurance scheme nhis in ghana in 2003 significantly contributed to improved health services utilization and health outcomes. The results show that personal income tax is clearly progressive and that the burden of corporate tax falls on the rich having a positive kakwani index of 0. Ensure sustainable financing for health care delivery and financial protection for the poor. Jun 27, 2011 health care financing strategies have recently been given greater priority in international health policy debates and research.
Apr 20, 2018 20180420 primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and. As given by the world bank development indicators wdi 2010 public health expenditure for the year 1996 through 2004 was below 3% of gdp. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Health care financing african strategies for health. Organizations such as the world health organization and the united nations childrens fund were active in providing money and support to provide additional western medical care in ghana. Improve quality of health services delivery including mental health services. A consensus is emerging on the need for developing countries to move towards universal coverage through prepayment financing mechanisms, given that user fees and other direct payments have had and continue to have negative effects, particularly on poor individuals. It also identified various funding mechanisms available to finance health care in ghana.
Ghana s health care financing system is generally progressive. This organization is the service provision arm of the health care system in the country, and works to implement national health care. Health financing functions revenue contribution and collection. Health care financing in ghana began with a taxfunded system that provided free public health care services to all after independence. The strengths and weaknesses of ghana s health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. Determinants of public health expenditure in ghana. In addition, the democratic shift in ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the national health. Pdf factors influencing the burden of health care financing. An mfiorganized and managed alternate healthcare financing scheme provides access to preventive and curative health services as well as financing in the form of health savings plans and emergency health loans. It accounted for 25% of the total funds for the hospital during the study. The progressivity of health financing is driven largely. Under this system, the taxfinanced public institutions directly. Ghana is now a middle income country since ghana became a middle income country, some dps and global health initiatives have given indications of graduating their support to ghana. These problems led to yet another debate to look for other alternatives of health care financing.
Health care financing strategies have recently been given greater priority in international health policy debates and research. Financing involves three aspects, namely revenue collection, risk pooling, and purchasing. The nigerian policies and plans for addressing health care financing includes. The institutional architecture and interaction of the health care program hcp, in this case the pcs, is discussed in section 3. Chapter two assesses the performance of ghanas health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in africa. A fullyfledged user fee scheme known as cash and carry came into effect in 1985. Pdf progressivity of health care financing and incidence. Major donors presented health insurance, user fee exemption, and resultsbased financing policies as relevant instruments for achieving uhc in subsaharan africa. For example, in 1995, expenditure on health care services was estimated to be about 3% of the countrys gross domestic product gdp.
Enhance national capacity for the attainment of the health related mdgs and sustain the gains. In recent years, there has been a growing demand for access to highquality and affordable care for all, thus the government is committed to respond with a process of developing health financing. The ghs continues to receive public funds and thus remains within the public sector ghana health services website. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality.
These financing schemes are different from some of the communitybased health insurance and mho schemes. Hitherto, the country had been providing free health care services for her citizens after independence in 1957. Ghana has come a long way toward developing a modern health care delivery system, improving the availability of effective drugs, and operating effective public health programs but continues to grapple with interrelated management, delivery system, and financing issues. Table 1 illustrates the incidence of the various health care financing mechanisms in ghana. The strengths and weaknesses of ghanas health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. Ceo, cape coast teaching hospital health summit gimpa 12th may 2015. Equity in financing and use of health care in ghana, south. As a share of gdp, total health expenditure in ghana, at 5. Health care financing is among the key component of a functional health system.
Section 2 provides context for the discussion by summarizing key reforms and the impact of the pcs and describes brazil s health care delivery and financing system. The ghana health service ghs together with other health agencies of the ministry of health. They include the millennium declaration, the ghana poverty reduction strategy and the growth and poverty reduction strategy gprs i and ii, the 2007 maternal health survey report. The ghana health service ghs together with other health agencies of the ministry of health moh and its development partners are committed to the provision of quality and adequate health care services to the people of ghana. Factors influencing the burden of health care financing and the distribution of health care benefits in ghana, tanzania and south africa. Year event rationale features sources of financing results 1957 introduction of a national health service modeled after the british systemdriven by early economic performance, natural resources, and a strong export base everyone entitled to. In ghana, where budgetary decisions are heavily contested and politically expensive, one option available to the government may be to raise taxes or user fees to allow for increased spending on public health. In ghana, public health expenditure has been fluctuating since the 1970s. Under this system, the taxfinanced public institutions directly delivered health care to the people of ghana. These policies are to serve as guide to the way government allocate and effectively manage fund in the health care sector.
Progressivity of health care financing and incidence of service benefits in ghana. A combination of primary and secondary sources was used to collect data for the study. As this system gradually became financially unsustainable with economic stagnation in the 1970s, initially low user fees were established for hospital services to discourage unnecessary use, locally recover. This financing takes place via contributions to medical schemes, direct outofpocket expenditure and to a limited extent to other forms of private insurance. Ghana is among the african countries that promulgated. Minister for health through its governing council the ghana health service council.
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