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INITIATIVE © National Development Planning Commission, Government of Ghana, October 2005 HEALTH ND A S C I M O N O C E INITIATIVE GMHI O R C A M G A H N A SCALING-UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION © National Development Planning Commission, Government of Ghana, October 2005 The ideas expressed are those of the consultant and the technical team put together by the NDPC to support the process. Design by rsdesigns.com sàrl. Printed in France. ONOM EC IC O S R A C N A D M H A GMHI E A N L A T H H G INITIATIVE SCALING-UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION Report of the Ghana Macroeconomics and Health Initiative OCTOBER 2005 Resource Mobilisation 66 GOG Domestic Resource Mobilisation 67 TABLE OF CONTENTS HIPC Funds 68 Establishment of Community Health Endowment Fund 69 NITIATIVE Reprioritisation of GPRS Allocations 69 I Transfer of the Exemption Fund under the Cash and Carry System from the Central Government 69 Foreword iv Health Insurance Scheme 70 Message from the Regional Director vi Donors Assistance to Health Care Financing 70 Risks and Constraints to Scaling Up Investments in Health 71 Acknowledgement vii EALTH Controllable Risk 72 Members of the GMHI viii Uncontrollable Risks 73 H List of Acronyms xi Major Constraints 73 Recommendations for Minimizing the Major Risks and Addressing the Major Constraints 77 Part I. Introduction 1 AND What is the Ghana Macroeconomics and Health Initiative (GMHI)? 1 Part III. Analysis of Costs and Investment Plan 79 S Who are the members of the GMHI 2 Introduction 79 The GMHI Report 2 Health Priorities and Health Target Outcomes in Ghana 80 How is the Report to be used? 3 Health Priority Areas in Ghana and MDGs 82 Total and Incremental Costs Analysis 83 Part II. Investing in Health for Economic Growth and Poverty Reduction 5 The Costing Methodology 84 Introduction 5 Assumptions 84 The Link between Health and Development 6 Cost Components 86 Link between Poor Health and Poor Economic Growth in Ghana 8 Resource Envelope 86 Health and Poverty in Ghana 10 Total Costs and Incremental Cost of Scaling-up Health Spending 87 Poverty 11 Cost in Relation to GNP 88 ACROECONOMIC Potential Available Resource Envelope 88 Low Female Literacy 11 M High Population Growth Rate 12 Resource Gap Analysis 90 Proposed Capital Investment Plan 93 Poor Nutrition 12 Resources Allocation by Line Item 93 Limited Access to Water and Sanitation 12 Resource Allocation by Level of Service 96 A Health Profile of Ghana 13 HANA Civil Works 96 Profile of Morbidity and Mortality, and Health Interventions 13 G Maternal Mortality 14 Medical Equipment 98 Child Morbidity and Mortality 19 Transport 98 The Old Agenda of Communicable Diseases 23 Absorptive Capacity Constraints 99 Threats to Gains in Life Expectancy 28 Human Resource Constraint 99 Widening Access to Health Services 37 Bridging the Human Resource Gap 101 CHPS as the Basis of a “CTC” Health System in Ghana 38 Analysis of the Costs of Scaling-up Investment in Water and Sanitation in Ghana 106 National Health Insurance Scheme 40 Design of the Cost Estimation Model 106 Health Care System and Service Delivery in Ghana 43 Model Assumptions 107 FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION Estimating Costs of Coverage for Water and Sanitation 108 S Structure of Service Delivery 46 Policy Framework on Health 46 EPORT OF THE Health Sector Reforms 48 Appendix A 111 R Access to and Utilisation of Health Services 48 Appendix B 131 TMENT S Water and Sanitation Situation in Ghana 50 Description of the Coverage and Costing Estimation Model for Water and Sanitation 131 Financing Health Care 56 Main Assumptions 131 Patterns of Health Care Finance and Expenditure 56 Scenario Building in the Model 131 Health Care Spending by Line Items 58 Population parameters 132 The Medium Term Rolling Health Expenditure Programme 60 Facility Parameters 133 Ministry of Health - Programme of Work (POW) 60 Readiness Factor 134 Financing Plan under POW II 63 Health Expenditure under the GPRS 64 References 136 Under funding of the Health Sector 65 ii • SCALING–UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION SCALING–UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION • iii SCALING-UP HEALTH INVE FOREWORD NITIATIVE “Making investments for a healthy population is a necessary prerequisite for economic The release of this report is timely, as never before in history has there been so much I growth, and poverty reduction”. In recognition of Ghana’s commitment to improve the enthusiasm and political commitment from both the developed and developing worlds health status of all Ghanaians, the President HE John Agyekum Kufuor in his State of to spotlight health as a prime mover for economic well being and poverty reduction. The the Nation address at the first session of the 4th Parliament of the 4th Republic stated environment is very conducive. that” Government is sharpening its focus more by adopting a three-pronged strategy; (1) Recent announcements indicate that Ghana amongst eighteen countries is expected to EALTH Vigorous Human Resource Development, (2) Private Sector Development and (3) a con- benefit from a debt relief of about $40 billion from the multilateral donors (including H tinuing emphasis on Good Governance. … [T]hese priorities will drive all programmes the World Bank, the International Monetary Fund (IMF) and the African Development and accelerate the pace of their implementation. The expertise, health and the progressive Fund). Furthermore, the recently held G-8 in June 2005 decided to grant 25 billion dollars outlook of the human capital are what will move the economy and propel the country per year to Africa to assist it to achieve the MDGs. These announcements in addition into a middle income nation in the next ten years.” AND to current initiatives such as the GAVI, Global Fund, and the Millennium Challenge S It is in this light that The Government of Ghana accepted the recommendations of the Account provide opportunities for Ghana to mobilize the additional resources to supple- report of Commission on Macroeconomics and Health (CMH) by WHO (2001) and sees ment local resources to achieve the health and health related MDGs. it as an opportunity to set the agenda for health as a resource for economic development The required investments to achieve the health related MDGs translates into US$ 21 per in Ghana. To operationalize the recommendations to the local setting, the Ghana Mac- capita per year up to 2007 and up to US$ 40 per capita from 2008 to 2015, compared to roeconomics and Health Initiative was instituted and working guidelines put in place for current total (public and private) per capita expenditure on health of US$ 13.5. This is its functioning. In November 2002 HE the President John Agyekum Kufuor launched the doable and achievable given the conducive environment. Initiative with the objective of developing a report that would detail the cost for achieving the health MDGs through the scaling up of a set of key interventions that address priority The challenge now is for our partners to keep to their promises in making the additional health conditions including water and sanitation provision in the rural areas. resources available and for a common agreement on a monitoring and evaluation frame- work that will set targets to measure resource flows and level of performance. ACROECONOMIC The process to develop the plan has been participatory through numerous consultations M and seminars with several stakeholders and partners. In addition to the local technical We on our side are ready to play our part and also accept our stewardship role in the expertise, technical assistance was also provided by the WHO country office, WHO/ management and utilization of such resources. AFRO and Geneva. The report consists of three parts: Introduction, Investing in health for economic growth HANA and poverty reduction, and Analysis of costs and investment plan. The report addresses G key national health priorities which are mostly poverty related including reducing the maternal, infant and child mortality rates, HIV/AIDS, TB and malaria in addition to rural water and sanitation provision, given the close relation of poor water supply and sanitation to key endemic diseases. Health investments primarily rely on a lot of resources, particularly human resources, Major (Rtd.) Courage Quarshigah Mr. Kwadwo Baah Wiredu equipment, technologies and medicines. These requirements call for substantial addi- Minister of Health Minister of Finance and Economic Planning tional resources which are beyond the scope of most developing countries, including FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION S Ghana. Building partnerships in and out of Ghana will be crucial in mobilising these resources. EPORT OF THE R The report has provided valuable information and inputs for developing the following; TMENT S the health component of the Ghana Poverty Reduction Strategy (GPRS), the Ministry of health annual 2006 POW, as well as the third POW 2007-2011 and the Round 5 proposals for the GFATM. Findings of the report have also been used to develop proposals for the Millennium Project as well as the US Government’s Millennium Challenge Account. iv • SCALING–UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION SCALING–UP HEALTH INVESTMENTS FOR BETTER HEALTH, ECONOMIC GROWTH AND ACCELERATED POVERTY REDUCTION • v SCALING-UP HEALTH INVE MEssAGE FROM THE ACKNOWLEDGEMENTS NITIATIVE The Ghana Macroeconomics and Health Initiative (GMHI) wish to thank His Excel- I REGIONAL DIRECTOR lency, the President of Republic of Ghana Mr. John Agyekum Kufuor for his support and launching the Initiative on November 2002. The initiative also acknowledges the support received from the members of the Advisory Board comprising the Ministers for Economic Planning and Regional Cooperation: (Dr.
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