The Health Sector in Ghana: A Comprehensive Assessment

241 Pages·2012·5.41 MB·English

by  Karima Saleh

The Health Sector in Ghana

The Health Sector in Ghana
A Comprehensive Assessment
Karima Saleh
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Attribution—Please cite the work as follows: Saleh, Karima. 2013. The Health Sector in Ghana: A
Comprehensive Assessment. Washington, DC: World Bank. doi: 10.1596/978-0-8213-9599-8
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ISBN (paper): 978-0-8213-9599-8
ISBN (electronic): 978-0-8213-9600-1
DOI: 10.1596/978-0-8213-9599-8
Cover photo: Volunteer nurses and Motoko clinic staff working with children. Kudorkopey, Ghana.
Photo by Randy Olson/National Geographic/Getty Images.
Library of Congress Cataloging-in-Publication data has been requested.
Contents
Foreword xiii
Acknowledgments xv
About the Author xvii
Abbreviations xix
Overview 1
What Are Ghana’s Health, Nutrition, and Population
Challenges as It Continues Its Transition to
Universal Health Insurance Coverage? 1
What Are Some Health System Challenges? 3
How Is Ghana Faring in the Use of Public Resources
for Health? 6
What Are the Population’s Health Outcomes and
Access to and Use of Services? 9
Is the Population Financially Protected against
Illness? 13
What Are the Next Steps for Ghana? 15
References 19
Chapter 1 Background and Objectives 21
Background 21
v
vi   Contents
Population Dynamics and Demographic Changes 24
Epidemiological Changes 28
Labor Market Situation 29
Overview of Ghana’s Health System 31
Cross-Cutting Areas of Reform 33
The Book 37
Notes 38
References 39
Chapter 2 Health Delivery System 41
Key Messages 41
Health Infrastructure and Other Capital
Investments 43
Human Resources for Health 53
Pharmaceuticals 69
Conclusion 78
Notes 80
References 81
Chapter 3 Health Financing System 85
Key Messages 85
Health Financing Functions 87
Trend Analysis on Health Budgets and
Expenditures 94
Fiscal Space Analysis 103
Health Insurance Providers 105
Conclusion 131
Notes 132
References 134
Chapter 4 Assessment of Health Financing and
Delivery Performance 137
Key Messages 137
Health Outcomes 139
Health Outputs 144
Efficiency 159
Financial Protection and Equity in Financing 163
Quality of Health Services 173
Conclusion 182
Notes 184
References 185
Contents   vii
Chapter 5 Key Reform Issues and Options 189
Reform Issues 189
Reform Options 195
Summary of Key Reform Options 209
Note 216
Reference 216
Boxes
2.1 Options Available to Address Shortage and Inequity
in Distribution of Health Facilities 49
2.2 The Urban Bias in Human Resource Distribution 60
2.3 The Case of the Additional Duties Hours Allowance
under the Ministry of Health, 1998–2005 68
3.1 The National Health Insurance Act 107
3.2 What Is the “One-Time Premium” Policy to Be
Introduced by Ghana? 112
3.3 Ghana NHIS: Benefit Package Exclusion 114
3.4 Ghana NHIS: A Description of G-DRG Rates 116
3.5 Efficiency Measured for NHIS Claims Submission,
Processing, and Reimbursements 119
4.1 Country’s Capacity to Address and Respond to
Noncommunicable Diseases 157
4.2 Efficiency in Health Service Utilization 161
4.3 The Three Dimensions of Universal Coverage 166
4.4 Benefit Incidence of Public Health Facilities and
Mission-Based Facilities 169
4.5 Satisfaction with Health Care Providers 183
Figures
O.1 Ghana, Causes of Death, 2008 Estimates 3
O.2 Number of Health Workers in Ghana Compared with
Other Countries with Similar Incomes and Health
Spending Levels, 2009 4
O.3 Average Public Sector Procured Prices Compared
with International Reference Pricing, 1993–2008 6
O.4 Per Capita Health Spending Compared with Countries
with Similar Incomes, 2009 7
O.5 Total Health Spending Shares, 1995–2009 8
O.6 Global Comparisons of Mortality Rates Relative
to Income and Spending, 2009 10
viii   Contents
O.7 Regional and Income Differentials in Institutional
Deliveries, 2008 11
O.8 Income Differences in Households with Children under
Age Five with a Fever and Seeking Care, 2008 12
O.9 NHIS Coverage by Gender and Income Quintile for
Adults (Ages 15–49), 2008 14
O.10 Household Spending on Health by Consumption
Quintile, 2005–06 15
1.1 Ghana: Real GDP Growth Rate, 1989–2015 23
1.2 Ghana: Demographic Trend and Future Projections,
1990–2050 27
1.3 Ghana: Changing Age Structure of the Population 28
1.4 Distribution of Years of Life Lost by Causes, 2008 29
1.5 Causes of Death, 2008 Estimates 30
2.1 Hospital-Beds-to-Population Ratios Relative to Total
Health Spending and Income, 2009 47
2.2 Facilities with Access to Obstetric Care–Related
Equipment, 2010 50
2.3 Facilities with Access to Filled Oxygen Cylinders, 2010 50
2.4 Limited Obstetric Services Offered in Health
Facilities Due to Limited Access to Equipment, Drugs,
or Supplies, 2010 51
2.5 Access to Transport at Health Facilities, 2010 52
2.6 Health-Workers-to-Population Ratios Relative to Total
Health Spending and Incomes, 2009 54
2.7 Health Worker Profile, Selected Countries from
Sub-Saharan Africa, 2009 54
2.8 Physician-to-Population Ratios, International
Comparison 56
2.9 Selected Health Workers Distribution by Age, 2007 57
2.10 Regional Distribution of Health Workers (Doctors,
Nurses, and Midwives) per 1,000 Population, 2009 58
2.11 Maldistribution of Staffing in Public Health
Facilities, 2010 58
2.12 Ghana: Regional Variation in Health Worker
Productivity, 2006 61
2.13 Annual Wages of Health Workers in Ghana and
the Region, 2007 62
2.14 Average “Base” Salary across Different Public Sector
Services and Institutions, 2008 63