Adnan Adams Mohammed
Government of Ghana’s financing of healthcare from consolidated revenues contributed 67.5 percent to the Ministry of Health budget in 2022, according to the ministry’s data.
The funds for the health system come from non-tax revenues, taxes, donor contributions, and out-of-pocket payments by individuals and households.
Consequently, external assistance for health as a share of total health spending between 2015 and 2019 has decreased from 25% to 11%.
Meanwhile, an international investment firm and rating agency, Fitch Solutions, has projected an increased in government of Ghana spending by about $1.3 billion in 2024.
According to the UK firm, Ghana’s health budget is expected to expand to ¢16.5 billion in 2024, from ¢15.2 billion in 2023. However, the country’s poor fiscal space outlook in addition to factors such as fiscal capacity deficits, debt and relatively low prioritization of health does not create a bright picture for sustained financing for primary health care. All these notwithstanding, the Universal Health Coverage (UHC) roadmap aims at mobilizing the equivalent of at least US$7 billion over 10 years in non-wage-resources including GDP allocation for healthcare delivery, especially primary health care.
This requires significant policy measures to facilitate a transition process from previously supported donor interventions to sustainable domestic public financing of interventions.
Fitch further indicates that, from its projected figures, the cost elements to benefit more will be the medical device market due to increasing government spending on health and economic recovery over 2024.
“We believe ongoing health infrastructure projects and rollout of the National Health Insurance Scheme will continue to support increased budgetary spending on health over the coming decades as well spending on pharmaceuticals and medical devices”, Fitch Solutions said in its new release.
“We further highlight recovery in Ghana’s real Gross Domestic Product in 2024 after sharp declines in 2022 and 2023 will also support private spending on medical devices and medical devices imports in the country over our forecast period.”
GDP forecast
“We forecast real GDP growth to accelerate to 3.7% in 2024 from an estimated 3.0% in 2023. However, GDP will remain below the five-year pre-pandemic average of 5.3% as a result of strong price pressures and fiscal consolidation”, the UK based firm added.
Medical devices market to record double digit growth
In terms of the medical devices market, it said all product categories will post high to double digit growth in US dollar terms, led by consumables and dental products.
Consumables accounted for more than a quarter of the total medical devices market in Ghana, and the category is expected to record the fastest Compound Annual Growth Rate (CAGR) growth of 21.3% in US dollar terms over our five-year forecast period to 2027.
“We believe growth in consumables over the near-to-medium-term will continue to be supported by improving access to healthcare in Ghana as the country continues to implement its universal health coverage goals”, it pointed out.
“While accounting for the smallest portion of the medical devices market, dental products will record a 2022-2027 CAGR of 21.1% in US dollar terms. Dental services such as tooth replacement and filling, root canal therapy, dental X-ray and scaling are provided free of charge in the public health sector in Ghana, however access remains limited in rural areas due to a shortage of equipment and trained dentists”, it furthered.
Fitch Solutions said demand for diagnostic products is also expected to remain strong as the market copes with prevention and treatment with the double burden of chronic and communicable diseases.
Strategic Purchasing for Primary Health
Care in Ghana
At the recent held Ghana’s Health Sector Annual Summit 2023 in Accra, in June this year, it was confirmed that, the National Health Insurance Scheme (NHIS) is the main source of financing primary health care services in Ghana. The Scheme purchases health services for its members from over 4000 accredited healthcare providers.
In 2020, the Scheme spent GH₵ 2.39 billion (approximately USD 408 million) on healthcare providers’ claims. Outpatient care accounted for the largest share of NHIA spending, with GH₵ 1.37 billion (approximately USD 235 million), representing 57.3%. The NHIA has set provider payment rates for healthcare services, which are negotiated annually with healthcare providers.
Available evidence suggests that since the implementation of the NHIS in 2003, the NHIA has employed different payment models, including fee-for-service (FFS) and diagnosis-related grouping (DRG), and piloted the capitation method. However, the scheme continues to face some challenges, including the following:
Exclusion of some preventive, health promotion, and specialized services: The NHIS does not cover all health services, and this leads to
patients paying out-of-pocket for the excluded services.
Sustainable Financing for Primary Health Care towards Attainment of Universal Health Coverage In Ghana:
Over the last three decades, the health sector has implemented interventions to improve services at the Primary Health Care (PHC) level, for example, the Community-based Health and Planning Services (CHPS) concept.
Recent interventions to reorganize PHC services for further improvement in health outcomes include:1) development of the Essential Health Services Package; 2) revision of the incentive package for health professionals in rural areas; 3) introduction of the Network of Practice; 4) implementation of framework contract for tracer medicines; and 4) scaling up of the last
mile distribution of essential medicines and other commodities.
However, efficient allocation of resources to finance these interventions to realize
the desired outcomes is a challenge confronting the stakeholders.
There has not been a dedicated source of funding for PHC services over the years. Funding for PHC services is uncoordinated, leading to wastage,
low service coverages, and poor health outcomes. Although the NHIS pools funds for purchasing PHC for the population, some PHC services are
not covered by the scheme, for example, health promotion and other preventive services. In addition, the effective use of these resources has
been a concern by many health sector actors. Lately, there has been a call by stakeholders to increase resource allocation to finance services at the PHC levels towards the realization of UHC.
