Ghana’s Health System: Institutional
Arrangements & Health Policy
1
DR. PETER ADATARA, RN
[PHD , M.PHIL., MBA ,BSC, DIP., CERT (HRM)]
LECTURER, UNIVERSITY OF HEALTH AND ALLIED
SCIENCES HO, GHANA
Contact Information
Tel. 0207767425 / 0240867040
Email: padatara@uhas.edu.gh
Dr. Peter Adatara
29/11/18
Outline
 Review of last discussion
 What is a health system
 Health System building blocks
 Institutional arrangement of Ghana’s health
system
 Overview of Ghana’s Health Policy
Definition of Health System
 “A system is a group of interacting, interrelated, or
interdependent elements forming a complex whole”
(Heritage Dictionary, 4th ed., 2000)
 “A health system consists of all organizations,
institutions, people and actions whose primary intent
is to promote, restore or maintain health” (WHO,
2007)
Illustration of a Health System
Healthcare System
 A healthcare system is a means of organised social
response to the health conditions of the population
 It is narrower than a health system and is often
described in terms of the levels of healthcare and
organisational structure of the Ministry responsible
for health in most countries
Health Systems Strengthening (HSS)
 Health Systems Strengthening (HSS) is defined as...
building capacity in critical components of
health systems to achieve more equitable and
sustained improvements across health services
and health outcomes (WHO, 2007)
Nine Characteristics of a Functional
Health System
1.
2.
3.
4.
5.
6.
7.
8.
9.
Access to services
Quality of care and service delivery
Safety
Coverage
Equity
Efficiency
Effectiveness of health care delivery
Ethics, and rights-based approach in delivery
of services
Sustainability of services
Health systems: Organisational
arrangements
 Organisational levels of health
systems
Ghana’ Health system
 Act 525 (1996) sets the institutional arrangements of
Ghana’s health system
o
It advocates for decentralisation by delegation
 Ministry of Health mainly concerned with policy
formulation, Resource Mobilisation and allocation
o
o
Monitoring and evaluation
Agencies and institutions set up to address service
delivery, training, regulation and financing
 New Health Bill (2015) advocating for decentalisation
by devolution
Institutional Arrangements of the
Health Sector
Service Delivery Levels
Ghana operates a pluralistic five-tier gatekeeper health delivery system.
Community Health Planning and Services
(CHPS)
 At the bottom of the hierarchy of health service are
Community-based Health Planning and Services
(CHPS) which serves a population of 5000 or 750
households.
 These may be conterminous with electoral areas
where feasible
 These are mandated to provide mainly preventive
services and treatment of minor ailments with overthe -counter medications.
CHPS: Capacity & Services Delivered
 CHPS are mainly manned by Community Health
Officers (CHOs) and Midwives where delivery service
is approved



CHPS are intended to to provide a minimum package of service
for the universal coverage of Reproductive Health Services
(maternal, neonatal and child health services),
Management of minor ailments,
Provision of health education, sanitation and counselling on
healthy lifestyles and good nutrition for community members.
Health Centres & Polyclinics
 Each district is also divided into Sub-districts which
are served by Health Centres (HCs)
 Health Centre is headed by a Physician Assistant or
analogous cadre
 Health Centres are intended to serve populations of
about 20,000.
 In urban areas, their capacity is often enhanced and
they are then known as polyclinics to serve
populations larger than 20,000.
Health Centre: Services Delivered
 HCs provide the following services:
o Basic curative and preventive services for adults and children, as
well as reproductive health services.
o Minor surgical services such as incision and drainage.
o Outreach services, and refer severe and complicated conditions
to appropriate levels.
o Basic laboratory, nutrition and delivery services
• The polyclinic is the urban version of the rural
health centre.
o
Polyclinics are larger and offer a more comprehensive array of
services than HC and are manned by physicians
District Hospitals
 District Hospitals (DHs) serve as referral centres and
as well provide basic and emergency healthcare to
populations of about 100,000 to 200,000.
o
Quality clinical care by a more skilled and competent staff than
those of the health centres & polyclinics
 The number of beds in a district hospital is usually
between 50 and 60 but many DHs have higher
capacity now
 However, it is estimated that 47% of districts were
without DHs culminating in others operating
beyond their capacity (Saleh, 2012).
Regional Hospitals
 Regional Hospitals (RHs) provides secondary level of
specialized healthcare and serve as referral centres
for each region.
 Regional Hospital are intended to serve a population
of 1.2 million people
 Usually Regional Hospitals have a bed capacity of
150 – 200 beds
 However, as of 2015 there were just seven (7) RHs,
leaving three regions without RHs.
Teaching Hospitals
 Teaching Hospitals (THs) are national referral
hospitals with mandate for managing complex health
problems, research and staff training.
 Each TH is linked with a university to enhance their
functions.
 As of 2015, there were four (4) THs with others on the
offing.
Ghana Health Service Organogram
The Health Sector Goal
The ultimate goal of the health
sector is to ensure a healthy and
productive
population
reproduces itself safely.
that
Health Sector Policy Objectives
 In pursuit ‘…of improving the health of the
people, the following policy objectives will be
pursued’.
1.
2.
3.
4.
5.
6.
Bridge the equity gaps in geographical access to health services
Ensure sustainable financing for health care delivery and
financial protection for the poor
Improve efficiency in governance and management of the
health system
Improve quality of health services delivery including mental
health services
Enhance national capacity for the attainment of the health
related MDGs and sustain the gains
Intensify prevention and control of non-communicable and
other communicable diseases
Principal Areas of Action (Priorities)
The objectives, concerns and challenges in the health
sector are to be addressed through simultaneous action
in seven priority areas:
1. Promoting healthy lifestyles and healthy
environments
2. Providing Health, Population and Nutrition
Services
3. Investing equitably in Capacity Development of the
health sector
Principal Areas of Action (Priorities)
4. Promoting the use of Information for
planning and management of the health
sector
5. Ensuring
sustainable and equitable
Financing
6. Promoting a local Health Industry
7. Ensuring
good
Governance
and
Partnership
Health Financing
At present, the sources of revenue are:

Direct out of pocket payments for health services,

Premiums for NHIS,

Tax revenues including special levies such as the NHIL

Allocation through the national budget,

Grants from development partners

Financial credits.
Health Financing
The objective of this component is to mobilize
resources and ensure equitable and sustainable
financing of the health sector
Key Results Areas
 Resource mobilization (GOG, NHI, grants, loans and
out-of pocket payment)
 Equitable and efficient allocation of health resources
 Efficient utilization of health resources.
Thank you