The health sector in Ghana : a comprehensive assessment

74389 The Health Sector in Ghana The Health Sector in Ghana A Comprehensive Assessment Karima Saleh © 2013 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org Some rights reserved 1 2 3 4 15 14 13 12 This work is a product of the staff of The World Bank with external contributions. Note that The World Bank does not necessarily own each component of the content included in the work. The World Bank therefore does not warrant that the use of the content contained in the work will not infringe on the rights of third parties. The risk of claims resulting from such infringement rests solely with you. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved. Rights and Permissions This work is available under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0) http://creativecommons.org/licenses/by/3.0. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions: 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 License: Creative Commons Attribution CC BY 3.0 Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be con- sidered an official World Bank translation. The World Bank shall not be liable for any content or error in this translation. All queries on rights and licenses should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@ worldbank.org. 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