This Report reviews Ghana’s health financing system with a special emphasis on its National Health Insurance Scheme (NHIS). Such an assessment is important since Ghana is often considered a global ‘good practice’ as it is one of only a handful of African emerging market countries to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana’s NHIS has evolved rapidly by transitioning its existing community health insurance schemes into a national health insurance program supported by significant amounts of earmarked national government revenues.
In addition to the global interest in the Ghana ‘model’, this review is timely in view of a recent critique of the system and call to abandon it in favor of a National Health Service (NHS) as well as the availability of several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. The study also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana’s new macroeconomic realities (i.e., a 60+ percent higher (Gross Domestic Product (GDP) as of November 2010).
The study focuses on structural and operational reforms of Ghana’s health financing system in terms of its performance to date and future available fiscal space. The report addresses five key areas:
1. It provides the essential background on: demographic and epidemiological trends; the configuration of Ghana’s health system, health financing functions and health systems goals; and, a brief description of Ghana’s health financing system.
2. The study assesses the performance of Ghana’s health system with respect to these goals through international comparisons of health outcomes, inputs, health spending, and financial protection as well as time series comparisons of trends in neighboring countries.
3. Based on this assessment and the significant body of Ghana-specific health policy literature, the report analyzes the strengths and weaknesses of Ghana’s health system, thereby providing Ghana’s health policy reform baseline.
4. The sustainability of the NHIS in the context of Ghana’s future potential fiscal space, based on revised macroeconomic information positioning Ghana as a lower middle income country (LMIC), is analyzed.
5. Major structural and operational reform options for the NHIS to assure its long-term efficacy and sustainability are then discussed.
World Bank.Document Date: 2012/01/01. Document Type: Other Health Study. Report Number: 67325. Volume No: 1 of 1
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Showing posts with label Ghana. Show all posts
Showing posts with label Ghana. Show all posts
Tuesday, March 6, 2012
A health sector in transition to universal coverage in Ghana
What are Ghana’s health, nutrition and population challenges as it continues its transition to universal health insurance coverage?
1. Ghana has come a long way in improving health outcomes and it performs reasonably well when compared to the other countries in Sub-saharan Africa (SSA). However, when its health outcomes are compared to other countries globally with similar incomes and health spending levels, its performance is more mixed. Ghana’s health outcome performances, in terms of child health and maternal health, are worse than the levels found in other comparable lower middle income and health spending countries, but life expectancy is better.
2. Ghana’s demographic profile is changing, and demographic, epidemiological, and nutrition transitions are well underway. The dependency ratio is expected to be favorably affected by the expanding large numbers of individuals entering the labor force, while fertility albeit still high continues to decline. It is the right time for Ghana to take advantage of this potential demographic dividend. Taking appropriate steps to improve employment opportunities is critical or else the country will face economic pressures as well as political unrest.
3. Unmet needs are high, and contraceptive prevalence is low. Efforts are required to sustain the momentum of a declining population. Families want the ability to space births or to have fewer children, but often do not have the means to control their pregnancy patterns. Better access to contraceptives would have multiple effects: it would positively affect the health of women, and it would give the opportunity for improved quality of life to children.
4. There is a funding shortage for public health goods. Many public health goods, such as immunization and family planning, are generally heavily subsidized, with tax or donor financing. However, Ghana has a low allocation of public funds to meet the demands for family planning commodities. The private sector has responded somewhat to this market failure by selling family planning commodities in private pharmacies, thereby increasing supply. However, many poor are unable to afford and therefore unable to access these commodities. The government has not come up with a feasible solution to provide improved access and affordability to its population.
5. Morbidity and mortality from communicable disease (CD) are highly prevalent in Ghana, and make up fifty three percent of the disease burden. Although, cost-effective interventions are offered, a significant proportion of morbidity and mortality is still CD related. There is a need to have a fresh look at programmatic aspects. Health Systems issues and challenges are a key bottleneck. A quick reduction in CD, would free up resources for new and emerging diseases and for improving quality of care.
Author: Saleh, Karima; Document Date: 2012/01/01.Document Type: Other Health Study. Report Number: 67298
1. Ghana has come a long way in improving health outcomes and it performs reasonably well when compared to the other countries in Sub-saharan Africa (SSA). However, when its health outcomes are compared to other countries globally with similar incomes and health spending levels, its performance is more mixed. Ghana’s health outcome performances, in terms of child health and maternal health, are worse than the levels found in other comparable lower middle income and health spending countries, but life expectancy is better.
2. Ghana’s demographic profile is changing, and demographic, epidemiological, and nutrition transitions are well underway. The dependency ratio is expected to be favorably affected by the expanding large numbers of individuals entering the labor force, while fertility albeit still high continues to decline. It is the right time for Ghana to take advantage of this potential demographic dividend. Taking appropriate steps to improve employment opportunities is critical or else the country will face economic pressures as well as political unrest.
3. Unmet needs are high, and contraceptive prevalence is low. Efforts are required to sustain the momentum of a declining population. Families want the ability to space births or to have fewer children, but often do not have the means to control their pregnancy patterns. Better access to contraceptives would have multiple effects: it would positively affect the health of women, and it would give the opportunity for improved quality of life to children.
4. There is a funding shortage for public health goods. Many public health goods, such as immunization and family planning, are generally heavily subsidized, with tax or donor financing. However, Ghana has a low allocation of public funds to meet the demands for family planning commodities. The private sector has responded somewhat to this market failure by selling family planning commodities in private pharmacies, thereby increasing supply. However, many poor are unable to afford and therefore unable to access these commodities. The government has not come up with a feasible solution to provide improved access and affordability to its population.
5. Morbidity and mortality from communicable disease (CD) are highly prevalent in Ghana, and make up fifty three percent of the disease burden. Although, cost-effective interventions are offered, a significant proportion of morbidity and mortality is still CD related. There is a need to have a fresh look at programmatic aspects. Health Systems issues and challenges are a key bottleneck. A quick reduction in CD, would free up resources for new and emerging diseases and for improving quality of care.
Author: Saleh, Karima; Document Date: 2012/01/01.Document Type: Other Health Study. Report Number: 67298
Wednesday, December 14, 2011
Ghana.Implementation Status Results Report
The objective of the Project is to assist the Recipient to generate growth and employment by leveraging ICT and public-private partnerships to i) develop the IT Enabled Services industry, and ii) contribute to improved efficiency and transparency of selected government functions through e-government applications.
World Bank.Author: Ampah,Mavis A. Document Date: 2011/12/04.Document Type: Implementation Status and Results Report.Report Number: ISR4365
Ghana.Carbon rights
REDD+ offers monetary incentives that could complement Ghana’s efforts to conserve what remains of its forest estate and further expand forests. State managed forest reserves, covering an area of 1.6 million ha, have been depleted and, to a large extent, degraded: less than 2% of forest reserves are said to be in excellent condition, and no less than half have been described as ‘mostly degraded or in worse condition’ (Treue, 2001; Bamfo, 2010).Outside the reserves, what are known as the “off-reserve forests” occupy an area of4.5m ha and are made up of scattered trees on agricultural fields, secondary forests regenerating from agricultural farming, riparian forest strips along streams, sacred groves and some closed-canopy forests, making them unprofitable to manage (Kotey et al., 1998; Abebrese, 2002). In Ghana, degradation is presumed to contribute more to forest carbon stock reduction than deforestation (Hansen et al., 2009). As REDD has expanded to include other activities, such as the sustainable management of forests and the enhancement of forest carbon stocks (“REDD +”), Ghana has a real opportunity to benefit, given the potential for the enhancement of forest carbon stocks through afforestation and reforestation activities. To take advantage of this, Ghana has been participating in the World Bank’s Forest Carbon Partnership Facility (FCPF) that aims to assist developing countries in building capacity for REDD+. So far, Ghana’s Readiness Preparation Proposal (R-PP) has been approved.
It is currently in the process of demonstrating how it would comply with the World Bank’s social and environmental safeguards before the grant agreement, which funds the implementation of Ghana’s R-PP and national REDD+ strategy, is signed (Bamfo, 2010). In Ghana the main drivers of deforestation are agricultural expansion, illegal logging and fuel wood collection. Since the 1990s, a number of statutes, regulations and development plans originating in the Forest and Wildlife Policy 1994 (FWP), have been introduced in an attempt to reverse the effects of decades of unsustainable forest management policies and practices. The primary objective of most of these reforms is to safeguard the State’s timber resources. Some of the other objectives, like the enhancement
of [degraded] forest estates, conservation of biodiversity and rural community participation, are compatible with those of REDD+. If Ghana is to benefit from REDD+, key stakeholders, for example the farmers and forest dependent communities who contribute to a significant proportion of the deforestation rate, must be suitably incentivized, for example through ensuring their share in the benefits generated by REDD+. Although rural community participation has been sought, the necessary changes to tree tenure that would incentivize these stakeholders have not been made yet.
of [degraded] forest estates, conservation of biodiversity and rural community participation, are compatible with those of REDD+. If Ghana is to benefit from REDD+, key stakeholders, for example the farmers and forest dependent communities who contribute to a significant proportion of the deforestation rate, must be suitably incentivized, for example through ensuring their share in the benefits generated by REDD+. Although rural community participation has been sought, the necessary changes to tree tenure that would incentivize these stakeholders have not been made yet.
World Bank.Author: Osafo,Y.B.Document Date:2010/10/01.Document Type: Working Paper.Report Number: 65868.Volume No:1 of 1
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Tuesday, December 13, 2011
Ghana.Building Capacity of the Urban Poor for Inclusive Development
World Bank.Approval Date 28-NOV-2011 Closing Date N/A Total Project Cost** .25 Region Africa Major Sector (Sector) (%) Public Administration, Law, and Justice (Sub-national government administration) (100%) Themes (%) Urban services and housing for the poor (100%) Environmental Category C Bank Team Lead Zeman, Andrea Borrower/Recipient SLUM DWELLERS INTERNATIONAL Implementing Agency PEOPLE'S
Ghana.Land,Services and Citizenship for the Urban Poor.Developing a National Urban Agenda
Approval Date 28-NOV-2011.Closing Date N/A.Total Project Cost** .76.Region Africa.Major Sector (Sector) (%) Public Administration, Law, and Justice (Sub-national government administration) (100%). Themes (%) Participation and civic engagement (30%).Environmental Category C.Bank Team Lead Zeman, Andrea. Borrower/Recipient GIZ Implementing Agency URBAN DEVELOPMENT UNIT OF MINISTRY OF LOCAL GOVT
Land,Services and Citizenship for the Urban Poor.Developing a National Urban Agenda
Land,Services and Citizenship for the Urban Poor.Developing a National Urban Agenda
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Thursday, December 1, 2011
Ghana.Energy Development and Access Project
The global environmental objective of the project is to support transition to a low-carbon economy through the reduction of greenhouse gas emissions (GHG) in line with the United Nations Framework Convention on Climate Change and its Kyoto Protocol, to which Ghana is a Party (GEF OP 5 and 6).
World Bank. Author: Mathrani,Sunil W.Document Date:2011/11/30.Document Type:Implementation Status and Results Report.Report Number:ISR4428.
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Wednesday, November 23, 2011
Ghana. Monetary Policy Transmission: Does the Interest Rate Channel Work?
This paper analyzes interest rate pass-through in Ghana. Time series and bank-specific data are utilized to highlight linkages between policy, wholesale market, and retail market interest rates. Our analysis shows that responses to changes in the policy interest rate are gradual in the wholesale market.
Prolonged deviation in the interbank interest rate from the prime rate illustrate the challenges the Bank of Ghana faces when targeting a short-term money market interest rate. Asymmetries in the wholesale market adjustment possibly relate to monetary policy signaling, weak policy credibility, and liquidity management. In the retail market, pass-through to deposit and lending interest rates is protracted and incomplete
IMF.Author/Editor:Kovanen,Arto.Series:Working Paper No. 11/275.Authorized for Distribution: November 01, 2011
Ghana.Public-Private Partnership Project:environmental and social management framework report
The objective of the Public-Private Partnership (PPP) Project is to assist the Government of Ghana (GoG) to tackle the binding infrastructure constraints that hamper firm productivity and employment generating growth.
Negative impacts includes: air, water, and noise pollution; soil erosion; flooding; destruction of flora and fauna habitat; changes in biodiversity; spread of disease; micro climate changes; and agro chemical usage. Mitigation measures includes: 1) dispose of waste at district assembly approved waste dump Sites; 2) provide drums or containers for temporarily storage of spent or waste oil from vehicles and equipment; 3) reduce traffic speed on unpaved roads through communities and at project sites; 4) project sites should be boarded off from public view and ensure good house-keeping at construction sites; 5) avoid unnecessary exposure or access to sensitive habitat; 6) areas close to water bodies that are disturbed during construction activities should be rehabilitated as soon as possible; and 7) place notices and warning signs at working areas.
World Bank.Document Date:2011/11/09.Document Type:Environmental Assessment.Report Number:E2889.Volume No:1 of 1
Ghana.Second Urban Environmental Sanitation Project
The project development objective of the Second Urban Environmental Sanitation Project for Ghana is to improve urban living conditions in regard to environmental health, sanitation, drainage, vehicular access, and solid waste management in a sustainable fashion, with special emphasis on the poor. The borrower has requested a reallocation of credit proceeds among disbursement categories and an 18 month extension of the credit closing date, which would be the first extension.
As indicated in more detail below, the reallocation of funds is necessary to cover underestimates in some categories from the unallocated category and from other activities that have funds in excess of the expected needs. The reallocation and extension would allow the borrower to complete all the key project activities. Good progress has been made in regard to sanitation, storm drainage, community upgrading with most investments completed or well advanced. The solid waste component has progress very slowly but the contracts for the construction of two of the three solid waste landfills (Tema and Sekondi) are ready to be executed and are expected to be completed within the requested 18-month extension.
The reallocation of funds is necessary to cover underestimates in some categories from the unallocated category and from other activities that have funds in excess of the expected needs. The actions are: (i) a reallocation of funds among disbursement categories as indicated on the table above; and (ii) an extension of 18 months to the original closing date, i.e. making December 31, 2011 the new closing date
World Bank.Document Date:2010/05/25.Document Type:Project Paper Report Number:65741.
Main report
Data sheet
Ghana.Commercial Agriculture Project
The Government of Ghana has received an advance on the proceeds of a credit from the International Development Agency (IDA – World Bank Group) to finance the preparation of the GCAP – Ghana Commercial Agriculture Project. The project preparation is under the overall responsibility of MoFA. The development objective of GCAP is to improve the investment climate for agri-business and establish inclusive Private Public Partnerships (PPPs) and smallholder linkages aimed at increasing on-farm productivity and value addition in selected value chains.
Ghana’s current agricultural policy framework and national development plan emphasizes the importance of graduating from a subsistence-based small-holder system to a sector characterized by a stronger market-based orientation based on a combination of productive small-holders alongside larger commercial enterprises engaged in agricultural production, agro-processing and other activities along the value chain.
A major thrust of the new approach centres on enhancing the role of commercial agriculture and strengthening agricultural value chains. Under the program the Government is seeking to broaden and deepen private sector investment in agriculture – noting that it is already occurring but can be augmented – in the following ways:
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