Health financing in Ghana at a crossroads. Draft Final Report January 2012

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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

Health financing in Ghana at a crossroads. Draft Final Report January 2012  x