Sector Report
Health and Life Sciences Ghana
March, 2014
Embassy of the Kingdom of the Netherlands in Ghana |
Colophone
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Embassy of the Kingdom of the Netherlands in Ghana |
Table of contents
Colophone—2
1
Summary—4
2
Business Opportunities—8
3
Partners—15
4
Address Dutch foreign mission—16
5
Factsheet Health Sector Ghana—17
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Embassy of the Kingdom of the Netherlands in Ghana |
1
Summary
The health sector in Ghana is in transition from a mainly government managed public
sector to greater diversity of health services providers. The public sector faces many
challenges in terms of financing and the resulting diminishing quality of basic services.
The National Health Insurance (NHIS) is a national service that finances the sector but
while effective it faces serious challenges for financial sustainability and efficiency.
In response to the continuing demand and willingness from the middle class and elite
to pay competitive fees for quality health services, the opportunities for international
investors in the health sector will continue to emerge. The construction of hospitals but
also diagnostic centres and laboratory services are examples. While up till now the
international commercial interest was mainly confined to construction and supply of
equipment with some after sales management support, it is likely that in the near
future health services management will become the focus of commercial interest as
demands will emerge.
Ghana is an African front runner in health service delivery. They are keen to welcome
innovation and the prevailing entrepreneurial spirit of most Ghanaian professionals is
a major accelerator for profitable business development by the private sector.
Meanwhile the government keeps a keen eye open for equity and social justice. Ten
years of National Health Insurance is for example an enviable track record for many
other African countries. They look to Ghana for inspiration, example and leadership by
embracing new technology and keeping up to date with global trends.
History
Ghana is since 1998 a development cooperation partner of The Netherlands. The
Netherlands were actively engaged in the national health policy dialogue and
supported the national health sector budget. Civil society and NGO’s programs
dealing with sexual and reproductive health and rights received Dutch funding. ORET
and ORIO are popular instruments for the improvement of the health sector
infrastructure. Ghana was the greatest recipient of ORET financing for a total funding
of € 573 million. Currently 3 Orio projects in the health sector are pending for a total
value of € 70 million. Our bilateral support was predominantly channelled via the
government, but increasingly private parties emerge. As a result of this long and
sustained engagement The Netherlands have a good reputation and a solid track
record in Ghana. The donor-recipient relations are progressively phased out, to be
replaced by equitable partnerships on the basis of mutually added value and
willingness to pay.
Ghana is, in the macroeconomic sense, a healthy country with a positive long term
outlook. In the short term Ghana is facing economic instability due to fiscal and
balance of payment deficits. This has delaying consequences for government
payments and agreements. By improving its budgetary balance sheets the Ministry of
Finance wants to get its house in order. Liquidity is therefore a transition challenge for
the government in its efforts towards healthier public finances. The Government of
Ghana is, for the time being, a less preferential business partner. The international
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Embassy of the Kingdom of the Netherlands in Ghana |
1
support base for the Government of Ghana via the traditional channels of ODA
partners and the development banks dwindles as Ghana reaches Lower Middle
Income status. Opportunities in the emerging private sector are more promising, in
spite of the fact that governmental control over the sector may impede rather than
stimulate investments. In the wake of governmental ineptitude, corruption in all shapes
and sizes becomes an increasing prominent feature that negatively affects the overall
performance of the public sector.
Business Climate
Ghana’s economic growth remained strong over the last decades. Ghana’s growth is
led by its political stability, its relatively liberal economic policies and rising primary
commodity prices. This economic success has been noticed by Dutch companies. The
opportunities in the Ghanaian and regional market continue to attract trade and
investment from The Netherlands.
Trade and investment promotion are the core activities of this embassy. The West
African region has strong growth figures and is seen by many Dutch companies as an
interesting emerging market. Ghana is an attractive vantage point for international
businesses with ambitions to expand in West Africa. Accra is a preferred hub for
companies as it offers security, stability, adequate education and health facilities, an
internationally trained work force at the academic level, and convenient flight
connections to the major destinations in the region.
Economic growth alone is not enough to lead Ghana to sustained higher levels of
development. The government needs to transform its services, to manage the
increasing complexities of a fast growing economy.
The Ghanaian economy has grown steadily over the last ten years, in part due to high
prices in primary commodities such as cocoa, timber and gold and since 2011 oil. The
pace of growth in the Ghanaian economy moderated in 2012 reaching 8 compared to
15% in 2011. The government of Ghana and the IMF project 7 to 8% growth for the
coming years. In order to achieve this, the Government of Ghana will need to speed
up reforms, including measures to budget more realistically and broaden its tax base
by including the informal economy, which forms a large share of economic activities, in
order to increase revenues.
Projections for the next 5 to 10 years are positive; most probably Ghana will continue
to grow as the main drivers underlying growth are likely to improve.. We expect that
The Netherlands will remain among Ghana’s first export destinations and that exports
to Ghana from the Netherlands will continue to grow as fast as in recent years, with
steadily increasing direct investments form the Dutch private sector in Ghana as well.
The Netherlands is already among the top investors in Ghana.
Organization of the public sector
The Health Sector in Ghana is organized at three main levels: national, regional and
district. Health interventions are packaged for each level and are delivered at the
respective clinics and hospitals. These relate to the minimum benefit package and
accreditation status of each facility as provided for under National Health Insurance
law. At district level, the sub-district services incorporate the community health
delivery. The health sector integrates prevention, promotion and curative services of
1
Official Development Assistance
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Embassy of the Kingdom of the Netherlands in Ghana |
health interventions. The Ministry of Health oversees as the policy guardian the quality
and equity of access to the health services. It also manages the human resources. In
response to the increasing demand for quality health services from the emerging
middle class the private sector is expanding especially in the urban areas of the south.
The Private Hospitals and Maternity Homes Board license and regulate health
facilities and services in the private sector.
Financing the public sector
Ghana introduced 10 years ago the National Health Insurance Scheme (NHIS). While
only 35% of the population is currently registered as paying subscribers, the scheme
is regarded as an innovative tool for the financial management of the sector. The
National Health Insurance Authority (NHIA) manages the system by receiving and
channelling funds from both clients ‘premiums and government levies and public
resources. It processes claims for payments from the accredited health facilities (both
public and private).
With Ghana’s cross-over to the lower middle income status, the ODA contributions
from development partners are decreasing. Increasingly Ghana’s health sector is
looking for ways to sustain their services under their own steam by generating
indigenous resources and managing these in the most efficient way.
Financial resources flow of the health sector in Ghana - 2014
Taxes, NHIL
Household
Income
Budget Support
GOG
revenues
Earmarked
NHIF
Premium
Development
Partners
Support
NHIA
User Fees
Salaries
DMHIS
Private
Claims
MOH
Government & CHAG
Health Services Providers
GOG
MOH
DMHIS
CHAG
Government of Ghana
Ministry of Health
District Mutual Health Insurance Scheme
Church Health Association of Ghana
Pagina 6 van 23
NHIA
NHIL
NHIF
Nat. Health Insurance Authority
Nat. Health Insurance Levy
Nat. Health Insurance Fund
Embassy of the Kingdom of the Netherlands in Ghana |
Health sector transition: challenges and opportunities
The health sector is in transition from a predominant government (public) health
services network towards a more diversified and decentralized system. The public
health system is an extension from its socialist past, when government was the sole
provider. It becomes increasingly difficult to sustain this system on the limited
available public funds. Since the review and subsequent hike of salaries of civil
servants in 2009, the government resources for the sector are disproportionately
2
allocated to salaries (70-65% of current government expenditures). The financial
spaces for other recurrent expenditures and capital investments are seriously
restricted as a result. This reflects the overall environment of public finances in Ghana.
In order to relieve the pressure on the public health budget, the government
3
encourages private sector initiatives to actively engage. The sector is therefore in
transition towards more diversified service delivery, with opportunities for commercial
health services entrepreneurs. The other sides of these dynamics are serious equity
challenges. The poor are exclusively dependent on the constrained public health
4
services and CHAG hospitals. Also access and affordability differences between
regions will be more pronounced.
The NHIA was created as the pivotal financing channel for the health sector. The
NHIA does not have the monopoly as other insurance entrepreneurs are welcome to
enter the market. Next to premiums NHIA receives government funding for its
mandate to implement the national insurance law. For example young people below
18 years, those > 60 years and the poor are assured of free health care. While the
architecture of the national insurance is solid, its functioning is below par. The
processing of claims is notoriously slow. Hospitals and clinics can wait sometimes up
till 4-6 months for their refund. This negatively affects the (financial) management and
in turn the overall performance of the health facilities as suppliers of, for example,
drugs and support services demand prompt payment. As a result, informal payments,
under the counter transactions and other out-of-pocket expenditures are next to
regular user fees common for patients and their attending relatives.
The private sector as the functional counterpart fills in the gaps of the public services.
Their business case is built on the preparedness and willingness of the emerging
middle class to pay for quality assured health services.
The health profile of Ghana is also changing, as
many diseases are life style dependent. In the past
poverty diseases were most common. Most patients
suffered from communicable diseases and diseases
related to poor hygiene and sanitation. But in the
wake of increasing wealth, other disease patterns
emerge. Non-communicable diseases such as
hypertension, cardiovascular diseases, diabetes,
cancer, road traffic accident and obesity are, among
others, now becoming frequent occurrences in
hospitals and clinics.
The transition towards greater wealth
is accompanied by changing disease
patterns. Unfortunately the current
health services are neither prepared
nor experienced to deal with the
prevention, treatment and
rehabilitation of non-communicable
diseases.
Development Partners’ meeting with the President, 13 March 2014.
President’s Speech “State of the Nation” 25 February 2014
4
CHAG – Christian Health Association of Ghana
2
3
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Embassy of the Kingdom of the Netherlands in Ghana |
2
Business Opportunities
The dynamic transition of Ghana’s health sector offers opportunities for commercial
entrepreneurship and engagement. Opportunities emerge over time and are
mentioned as follows:
A. status-quo (current)
B. beyond the horizon
C. beyond convention
Some of these opportunities are obvious as they connect with ongoing or anticipated
tenders. The context for these openings is “here and now”: A. status-quo (current).
Other less clear chances relate to future potentials: B. beyond the horizon. The
context is mainly determined by the ambitions and commitments of Ghana health
sector (both public and private) and their ability and preparedness to invest into new
developments.
Finally there are options that do not (yet) feature on any formal strategy agenda but
that may crop up over time. These potentials are determined by the anticipated local
demand for products and services in the future: C. beyond convention. The ability to
read and appreciate the dreams and aspirations of Ghana’s middle class and elite
consumers is crucial for “early birds” entrepreneurs.
A. Status-quo (current)
A.1 Public Sector
Given the current dominance of the health sector by government actors, the majority
of current business opportunities arise from public tenders. As part of the transition,
the government is currently re-appraising its responsibility and commitment. Given the
government’s budgetary constraints it is understandable that they scan the
international solidarity arena for grants or concessionary loans. With the retreating
donor community these financing options become increasingly scarce. The
counterpart financing by Ghana of soft loans become protracted undertakings with
increasingly uncertain outcomes. In line with the shrinking public resources for health,
business cases proposed by the government beyond the obvious international tenders
must be regarded with great caution.
The few opportunities for commercial engagement within the short term are supported
by international funding or banks (for example ORIO, Nordic Fund, WB grants etc.)
Ministry of Health
Medical education and training (Nuffic/NICHE)
Infrastructural projects
Construction of hospitals and clinics.
Diagnostic and laboratory facilities and referrals (histopathology).
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Embassy of the Kingdom of the Netherlands in Ghana |
Ghana Health Services (GHS)
Drugs
Drug procurement and pharmaceutical supplies management.
Quality assurance at port of entry
Equipment
Digital hospital equipment
ICT Hospital management
Hospital waste management
Diagnostic imaging and digital imaging
Advanced laboratory
Advanced life support and monitoring systems
Emergency response and Ambulance services
Rehabilitation and physiotherapy
National Health Insurance Authority
Health Insurance (NHIS)
Claims management (processing and payments)
ICT links between NHIS and health sector in general
Production of bio-certified identity cards
Capacity building of NHIA to efficiently manage the NHIS using
business/commercial principles without compromising the social
objects of the NHIS.
A.2 Private Sector
Private health facilities complement the public sector. As the days of free health care
in the public hospitals are over, the costs are becoming increasing less of a barrier.
The added values of private facilities are quality and convenience. The private sector
is thus gaining popularity. There is a growing middle class that prefers to use private
health facilities and can afford it. The NHIS works with private health facilities by way
of contracting private facilities to provide services to NHIS clients in order to achieve a
high coverage. The current inefficiency of the NHIS claim-processing is however a
serious barrier for many private facilities, that have to rely more on direct payments or
other commercial insurance schemes.
International competition is stiff with new players (notably from Asia) entering the
market with cheap often low quality products. The awareness and demand for high
quality is increasing especially in the high end of the market. Products and services
from The Netherlands have a good reputation in that respect. Furthermore the
commercial track record of Dutch commercial partnerships in Ghana is a positive
branding.
The emerging market for pharmaceutical products depends heavily on imports rather
than local production. Producing generic pharmaceuticals is also a valid business
case for export to surrounding markets in other West African countries.
Other opportunities merit further exploration:
Commercial health insurance
Hospitals and clinics.
Maternity homes.
Elderly and residential care.
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Embassy of the Kingdom of the Netherlands in Ghana |
Occupational health and rehabilitation/physiotherapy.
5
Dialysis centres
Multidisciplinary cancer treatment centres
First Aid and (air)ambulance services.
Diagnostic services (X-Ray, MRI, CT, advanced laboratory including
histopathology)
Services for maintenance and repairs of medical equipment
Mortuary services/Funeral homes
B. Beyond the horizon
B1 Public Sector
Over time the operational mandate of government for the management of the public
health sector will continue to change. The relevance of the ministry of health for the
sector will therefore diminish for its operational management responsibility and will
increase in terms of quality and equity assurance of the health sector. These new
aspects attract less commercial interest, except for ad hoc health system consultants.
The actual management of the public hospitals, via
GHS and CHAG, will increasingly become less
dependent on the unreliable and insufficient funding
from the government. The NHIA will face similar
challenges, when the contributions from government
6
are not keeping up with the costs of health care . It is
likely that GHS and CHAG will have to find ways and
means to increase their efficiency and effectiveness.
7
8
GenKey and Nearshoring are Dutch companies with
excellent ICT track records in Ghana to introduce and
to service new technologies.
The Dutch company GenKey is a good
example of how to introduce innovation
in Ghana. Their biometric identification
technology for NHIS clients is now
standard to avoid misuse. It saves costs
and increases efficiency.
GenKey is also active in voter
registration for the elections.
Management of public hospitals and clinics that aim for greater efficiency and better
cost containment can benefit from technological innovations that are increasingly
becoming available. Cutting costs requires looking at reducing operational expenses.
Green power generation (i.e. solar, gasifier, biogas) are options for cutting costs.
5
Kidney disease is a growing problem in Ghana (MOH estimates 8,000 cases of renal failure
[MOH, 14-03-14]). About 10 per cent of all hospital admissions in the country are now said to be
kidney-related in Ghana. Korle-Bu handled in 2010 2,121 kidney-related cases. In 2011 that
number shot up to 2,687 cases—a 31 per cent increase. Yet dialysis centres are only found in
Korle Bu and Konfo Anokye Teaching hospitals. Recently however, the police hospital and the
central regional hospital Accra have dialysis centres.
6
This is a phenomenon that is seen in most countries around the world that went through such
transition, including The Netherlands. Several developed countries are still searching for
sustainable solutions (USA-Obamacare).
7
http://www.genkey.com/
8
http://www.nearshoring.nl/
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Embassy of the Kingdom of the Netherlands in Ghana |
The current ICT mobile communication revolution in Ghana will determine the
landscape for a long time to come. Already the coverage of mobile telephone services
and internet, including mobile money and communication platforms are among the
highest in the continent. In line with the ambition of the Ghana people to be the front
runner for Africa, the health sector can take advantage of e-health and telemedicine
innovations and applications.
An interactive e-communication system between health facilities
provides opportunities for the exchange of clinical, managerial
and financial information. The setting-up is a large and expensive
undertaking that involves different hospitals. These hospitals will
become more or less independent management units. Thus the
added value in terms of cost saving, higher staff satisfaction,
professional growth and better health outputs must be
demonstrated before large investments become bankable
propositions.
The Netherlands will finance in 2014 a feasibility study by IICD to
explore the ground work for such undertaking for the hospitals of
Northern Ghana with Tamale Teaching Hospital as the hub.
By linking departments in a hospital via ICT, the overall efficiency increases. Several
ICT hospital management systems have so far been introduced in Ghana. Regrettably
most hospital managers are inexperienced in this field. They invest in commercial ICT
systems on a rather intuitive and opportunistic basis. The subsequent fragmentation of
different ICT management systems in various hospitals does not contribute to the
potential synergy between facilities.
Big efficiency gains for health facilities can be obtained when the NHIA is
electronically linked with the accredited facilities. The current delays of claims
processing result in spiralling of costs: late receipt of funds means late payment for
suppliers, who increase their prices in anticipation of such late payments. By removing
the hard copy paper trail the human factor and related informal and under the counter
payments are reduced. Moreover by reducing the inefficiencies, the credibility and
acceptability of the NHIS will increase. Overall the value chain will become more
transparent and will result in better health outcomes.
Ghana Health Services (GHS)
Digitalization of diagnosis, treatment, monitoring, management and
record keeping.
Standardized ICT hospital management with compatible links with
NHIA, MOH etal.
Setting up mobile phone based patient- and client communications
9
MOVERCADO™ .
Telemedicine through e-connections between hospitals.
Management of hospital waste.
On site oxygen concentration for ambient air
Power generation solutions
o Gasifier (on hospital waste)
o Biogas
o Solar
9
http://healthmarketinnovations.org/program/movercado
Pagina 11 van 23
Embassy of the Kingdom of the Netherlands in Ghana |
National Health Insurance Authority (NHIA)
Setting up NHIS electronic network with accredited facilities
Facilitate premium payments and client registration
Digital automation of registration, claims and processing
Link up with health facilities e-network
B2 Private Sector
It is likely that the current economic growth and related wealth of the middle and upper
class will continue. Thus opportunities for private health initiatives will continue to
emerge especially in urban areas. Many private hospitals operate under the
charismatic leadership of a Ghanaian medical specialist. Such leadership is not
always connected with effective entrepreneurship. The envisioned potential and profit
due to unrealistic planning and revenue forecasting, may not materialize. The
defaulting on bank loans may increasingly occur. It is likely that the commercial
stakeholders of such hospitals/clinics will search for international managers that can
nurse the facility back to health.
Mobile telephone based health communications for patients and clients are new and
represent a greatly appreciated added commercial value for reaching out to patients
and clients. For example selling insurance or other health related products for hard to
reach people are some of the innovative and commercially viable opportunities (ref.
Movercado™).
In response to the continuing demand and willingness from the middle class and elite
to pay competitive fees for quality health services, the opportunities for international
investors in the health sector will continue to emerge. The construction of hospitals but
also diagnostic centres and laboratory services are examples. While up till now the
international commercial interest was mainly confined to construction and supply of
equipment with some after sales management support, it is likely that in the near
future hospital management will become the focus of commercial interest as demands
will emerge. Similar trends can be observed in the hospitality business (hotels, resorts
etc.).
In the wake of increasing numbers of private health providers, the client base for
hospital- and medical equipment is expanding with more interesting parties that value
and are prepared to pay for good and prompt service. The maintenance contracts with
GHS were often the source of frustration and little profits. When each piece of
equipment is regarded by commercial health sector operators as a potential money
maker, the commercial basis for maintenance work improves.
As a side product of the current track record of the NHIS/NHIA, we will see more
people who can afford health insurance at higher rates but with better and more
reliable benefits. They represent an emerging market for commercial insurance
companies.
Ghana serves as the regional hub for pharmaceutical manufacturing and distribution
to the over 300 million people who live within the Economic Community of West
African States (ECOWAS). There is still room for lots of growth in Ghana's
pharmaceutical manufacturing. Even with production rates as they are, factories in
Ghana are not operating at full capacity. Because of their high quality, Ghana’s
pharmaceutical exports to other countries in the region are valued. Ghana has many
advantages for investors, such as a sound structure in place and access to a large
and in-need market.
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Embassy of the Kingdom of the Netherlands in Ghana |
Opportunities for the private sector:
Mobile telephone based communication platforms for (social) marketing
Private health facilities
Private health insurance
Commercial centres of excellence
Commercial diagnostic centres
Specialized centres like diabetes care, physical rehabilitation and
physiotherapy
Production of micronutrients and food enrichment components
Pharmaceutical manufacturing and export of generic medicines
Production and export of medicinal plants and homeopathic ingredients.
Production and export of non-medicinal pharmaceutical preparations (starch
etc)
C. Beyond convention
Examining the dynamics of the Ghanaian health market guided by the economic and
disease trends, we can explore the types of health related services that have been
successfully introduced in developed countries. It is probably just a matter of time
before the demand of these services will become stronger. Non communicable
diseases will increase like cardio-vascular diseases, cancer and diabetes. Life styles
will change also. With more free time on their hands, people will adapt life styles with
more emphasis on entertainment and sport.
Getting and staying in shape are important preoccupations of a young and wealthy
population. Sports and fitness will become increasingly popular. Sport injuries are part
of any game. Opportunities for sports related rehabilitation can be worthwhile
opportunities as part of investments in sport and fitness facilities.
Sports have always been and will continue to be important parts of Ghanaian life.
Soccer is the main driver. It is also an important export product with many West
African soccer players engaged in the major football leagues of Europe, Asia and
Americas. These players are also major investors in Ghana. West African players with
injuries are treated in sophisticated but western sport rehabilitation centres. There is
no such centre for the treatment and management of top sport injuries in West
10
Africa . A top world class sport health treatment and rehabilitation centre in Ghana
can be a profitable undertaking when players have the option to recuperate “at home”
while receiving the same quality of care as in Spain or Switzerland. It is worthwhile to
explore the willingness of top Ghanaian soccer players to invest in such centre. It
would be very wise to put such centre in the hands of real health professionals
supported by credible commercial management. Big shots from the GFA, CAF, UEFA
11
and FIFA , should be avoided, as they tend to focus on other matters than sport
medicine and footballers’ well-being.
10
An example in Kenya for its top athletes:
http://www.hartmann-international.com/Articles/2/Opening-of-a-new-branch-of-clinic-inKenya.aspx
11
GFA- Ghana Football Association; CAF – Coalition of African Football Association; UEFAUnion of European Football Association; FIFA – Fédération Internationale de Football
Association
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Embassy of the Kingdom of the Netherlands in Ghana |
It is likely that alcohol consumption will increase. The proportion of alcoholics in
leading positions is likely to rise. Also the consumption of hard drugs (notably cocaine
and heroin) will increase. With the entertainment sector becoming commercially
mature, dance/music and festival related use of synthetic drugs is likely to expand.
Commercial sex will increase in size and complexity. This may well result in the
sexually transmitted infections like HIV and Hepatitis. These viral infections are also
transmitted via injecting drug use. We see similar patterns also in Brazil, SE Asia and
South Africa.
Obesity is the unfortunate rising trend that can be seen in almost all transition
countries. Changes in the diet and more sedentary lifestyles contribute. In response to
obesity a market will emerge for slimming clinics. Also the demand for cosmetic
surgery is likely to emerge as well.
With the improving socioeconomic conditions the overall life expectancy will further
increase. As a result we will see more elderly people who will depend on specialized
services. This will result in the increasing demand for geriatric prevention, treatment
and care. There are currently only very limited provisions for those services.
Based on the above considerations (under “beyond convention”) the following
opportunities are of course based to some extent on speculation. But these scenarios
cannot be ignored in a comprehensive market scan:
Sport medicine and rehabilitation
Top sport centre for surgery and
rehabilitation
Weight loss centres and services
Cosmetic and reconstructive surgery
Pagina 14 van 23
Detox centres and services (alcohol
& drugs)
Specialized addiction clinics
Viral treatment centres (hepatitis)
Geriatric care
Embassy of the Kingdom of the Netherlands in Ghana |
3
Partners
1. Afisah Zakariah, MD, MPH, PhD
Director, PPME
Ministry of Health
P.O. Box M-44
Accra, Ghana
afiyakzak@yahoo.com
2. Dr. Ebenezer Appiah-Denkyira
Director General of the Ghana Health Service
ACCRA/GHANA
appiahd@yahoo.co.uk
3. Dr Maureen M. Martey
Private Sector Unit
Ministry of Health
ACCRA/GHANA
Tel: +233244369807
Office: +23321680350
swiitie@yahoo.com
4. Mr. Sylvester Mensah
CEO, National Health Insurance Authority
PMB, Ministries Accra, Ghana
Sylvester_MP@yahoo.com
5. Dr. Baaba Selby
PMB, Ministries, Accra
Director of Claims
NHIA
baaba.selby@nhia.gov.gh
6. Dr. Docia Saka
Registrar
Health Facility Regulatory Agency
Ministries Post Office
P.O.Box MB 534
Accra
Tel: 0302900995
If applicable, list details of relevant trade fairs, exhibitions, events, journals, etc.
Pagina 15 van 23
Embassy of the Kingdom of the Netherlands in Ghana |
4
Address Dutch foreign mission
The Embassy of the Kingdom of The Netherlands,
89, Liberation Road – Ako Adjei Interchange,
P.O. Box 1647 CT
Accra, Ghana
T. +233 302 214 361
F. +233 302 772 655
I. www.ghana.nlembassy.org
Pagina 16 van 23
Embassy of the Kingdom of the Netherlands in Ghana |
5
Factsheet Health Sector Ghana
FACTSHEET
HEALTH SECTOR
REPUBLIC OF GHANA
2014
Demography:
The 2010 population census puts Ghana’s population at 24,658,823 with a population
growth rate of 2.5% per year. Males constitute 12,024,845 and females 12,633,978.
The rural population is 12,545,229 (50,9%) and that of urban population is 12,113,594
(49,1%). The regional distribution is shown below.
Regional Distribution of
Ghana’s population (2010 pop. census)
Region
Population
Western
2,376,021
Central
2,201,863
Greater Accra 4,010,054
Volta
2,118,252
Eastern
2,633,154
Ashanti
4,780,380
Brong Ahafo
2,310,983
Northern
2,479,461
Upper East
1,046,545
Upper West
702,110
Age in years
Less than 1
1-4
5–9
10 - 14
15 - 19
20 - 24
Total < 25 years
Pagina 17 van 23
% of total
population
3.0
10.8
12.7
11.8
10.6
9.4
58.3
Age
groups
731,201
2,674,205
3,128,952
2,916,040
2,609,989
2,323,491
14,363,878
Embassy of the Kingdom of the Netherlands in Ghana |
Public Health Facilities
The distribution of public health facilities by regions in Ghana are presented on table
below:
Table 1: Distribution of Public Health Facilities in Ghana, 2014.
2010
Region
Western
Central
Greater
Accra
Eastern
Volta
Ashanti
Brong
Ahafo
Northern
Upper
east
Upper
West
National
Hospitals
29
27
84
Health
Centre
59
61
21
Clinics
114
54
238
CHPS
182
168
78
33
29
89
30
82
146
141
84
117
71
151
114
400
157
67
168
15
7
83
40
0
48
146
178
9
65
11
166
352
785
918
1710
Table 1A: Health Financing Statistiscs,
Republic of Ghana
2010
Population
24,658,823
Exchange Rate (GH¢:US$)
1.4738
Total GDP in GH¢
43,388,000,000
Total GDP in US$
29,439,544,036
Total Health Expenditure (THE) in GH¢
1,421,749,293.80
Total Health Expenditure (THE) in US$
964,682,652.87
THE per capita in GH¢
57.66
THE per capita in US$
39.12
Source, MOH - Ghana
Per Capita OPD Attendance in the Public Sector Facilities by Regions
Table 2: OPD per capita by region, 2006-2011 , Source GHS
Year\ Region
2006
2007
2008
2009
2010
2011
2012
AR
0.59
0.72
0.73
0.89
0.96
1.17
0.96
WR
0.57
0.72
0.86
0.69
1.12
1.35
1.44
NR
0.3
0.31
0.49
0.53
0.64
0.62
0.70
BAR
0.91
1.02
1.3
1.15
1.19
1.48
1.63
CR
0.5
0.7
0.68
0.71
0.75
0.79
1.00
VR
0.41
0.51
0.73
0.69
0.64
0.87
1.01
UER
0.55
0.69
1.01
1.37
1.45
1.40
1.99
UWR
0.46
0.65
0.7
0.72
0.88
1.06
1.12
ER
0.65
0.94
0.97
0.95
1.01
1.18
1.38
GAR
0.47
0.6
0.51
0.51
0.59
0.64
0.95
Private Health Facilities
The private health sector in Ghana is a large and important actor in the market for
health related goods and services. While nearly all health experts acknowledge that
the private sector is a major provider of health services, available estimates on the
size of the private sector vary widely and are outdated. The Health Facility Regulatory
Agency, an agency of the MOH is a body responsible for accrediting and maintaining
records of private sector hospitals, clinics, and maternity homes. Requested
information provided by the Health Facility Regulatory Agency on accredited private
th
health facilities in Ghana by 12 May 2014 are as indicated in table below.
Pagina 18 van 23
Ghana
0.55
0.69
0.77
0.81
0.92
1.05
1.14
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Table 3: Distribution of Private Health Facilities by Regions
Region
Greater Accra
Volta
Eastern
Central
Western
Ashanti
Brong Ahafo
Northern
Upper East
UpperWest
Total
Clinic
194
11
31
26
55
87
28
15
22
5
474
Hospital
37
5
7
5
12
42
7
2
2
0
119
Maternity Home
44
10
30
19
26
68
31
7
5
1
241
Total
275
26
68
50
93
197
66
24
29
6
834
Source: Ghana Private Hospital and Maternity Home Boards of the MOH
Human Resources.
Public Sector Health Workforce: In the public sector health workforce grew from
42,193 in 2007 to 57,038 in 2011, (increase of 26%). Health worker / population
density trends have improved from 1.88 health workers/per 1,000 pop in 2007, to 2.11
in 2009, but dropped back to 1.9 in 2010.
Nurses
Table 4: Nurse/ Population Ratios from 2009-2012(1 nurse per population)
Year : 2009
Ratio: 1:1,497
2010
1:1,489
2011
1:1,240
2012
1:1,251
Table 5: Distribution of Nurses by Region, 2009-2012
Total no.
of nurses
2009
Total no.
of nurses
2010
Total no.
of nurses
2011
Total no.
of nurses
2012
Pop. / 1
nurse
2012
AR
WR
NR
BAR
CR
VR
UER
UWR
ER
GAR
Ghana
2,325
1,422
1,191
1,214
1,373
1,533
892
586
1,994
3,698
16,228
2,397
1,376
1,194
1,207
1,370
1,477
904
583
1,914
3,846
16,268
3,096
1,712
1,645
1,562
1,655
1,733
1,142
725
2,259
4,502
20,031
3,253
1,739
1,640
1,645
1,873
1,789
1,152
775
2,219
4,649
20,734
1,550
1,422
1,601
1,470
1,250
1,244
930
941
1,237
917
1,251
Pagina 19 van 23
Embassy of the Kingdom of the Netherlands in Ghana |
Doctors
Table 6: Doctor Pop Ratio 2006-2012 (1 doctor per population)
Year
2006
Ratio: 1:15,423
2007
2008
2009
2010
2011
2012
1:13,683
1:13,499
1:11,649
1:11,698
1:10,217
1:10,452
Table 7: Distribution of Doctors by Region, 2009-2012.
No. of docs. 2009
No. of docs. 2010
No. of docs. 2011
No. of docs. 2012
Pop. / 1 doc. 2012
AR
600
562
630
519
9,715
WR
80
91
91
89
27,775
NR
50
72
117
137
19,163
BAR
140
141
145
154
15,705
CR
87
88
106
104
22,505
VR
78
80
91
90
24,728
UER
34
29
27
27
39,697
UWR
17
14
18
18
40,502
ER
157
155
165
139
19,748
GAR
839
876
1,085
1,204
3,540
Source HR MoH
Midwives
Table 8: Distribution of Midwives by region
Total no.
of
midwifes
2009
Total no.
of
midwifes
2010
Total no.
of
midwifes
2011
Total no.
of
midwifes
2012
12
WIFA /1
midwife
2012
AR
WR
NR
BAR
CR
VR
UER
UWR
ER
GAR
Ghana
606
276
279
341
291
381
197
153
478
792
3,794
630
277
299
356
284
353
190
145
462
784
3,780
754
279
298
370
308
358
198
147
489
833
4,034
779
277
274
352
294
303
190
131
451
812
3,863
1,553
2,142
2,300
1,649
1,911
1,763
1,354
1,336
1,461
1,260
1,611
Source HR, MoH
Pharmacists
According to the Registrar of the Pharmacy Council, there are 2,327 pharmacists on
the register as at May 30, 2013 out of which 1,652 are working in the country with the
remaining 675 working in the Diaspora. This brings the ratio of one pharmacist to
14,528 persons which is far below the World Health Organization’s (WHO)
recommendation of one pharmacist to 2,000 persons.
12
Women in Fertile Age Group
Pagina 20 van 23
Ghana
2,082
2,108
2,475
2,481
10,452
Embassy of the Kingdom of the Netherlands in Ghana |
Funding trends in the public health sector
The Table below depicts proportional share of the various sources of funds.
Table 9: proportional share of the various sources of funds to the Ghana health sector (Public Sector)
by years
2012
2011
Amount (GHC
2010
Amount (GHC Mn)
%
GoG
1,750.48
60.17
771
53.5
474
42.6
IGF/NHI Claims
427.04
14.68
367
25.5
286
25.7
NHIF
434.6
14.94
23
1.6
28
2.5
Program – Donor
181.6
6.24
139
9.6
190
17.1
Sector Budget Support
109.25
3.76
105
7.3
60
5.4
F/Credits
6.36
0.22
36
2.5
72
6.5
4
0.4
1,113
100
Mn)
%
Amount (GHC
Source of Fund
HIPC/Fund
TOTAL
2,909.33
100
1,441
100
Mn)
%
Government Budget For 2014
The approved health sector budget for 2014, set out in the 2014 Budget Statement,
indicates a total for the sector of GH¢4,280,318,322. This comprises the discretionary
budget: GOG, Donor and IGF plus the statutory allocation which constitutes funds
from NHIF.
Table 10: 2014 Health Sector (Public Sector) Resource Envelope by source of fund (in GH¢ ‘000)
Amount
Share
(%)
GOG
1,208,823.01
28.2
IGF
1,363,622.80
31.9
781,262.00
18.3
3,353,707.81
78.4
Source of Fund
Donor
Total Discretionary
NHIF
Overall
926,610.51
21.6
4,280,318.32
100.0
Source: 2014 Budget Statement Appendix
Table 10 represents the total budget approved for the public health sector for 2014
which is GH¢4.28 billion, consisting both discretionary and statutory. The total
discretionary funds approved for the sector is GH¢3.35 billion; representing a 78.4%
share of the total health sector budget. This includes funding from GOG (28.2%), IGF
(31.9%) and Donor contributions (18.3%). The statutory budget constitutes funds from
NHIF which represents a 21.6% share of the sector’s envelope.
The health sector share of the total government budget has increased in nominal
terms from 2009 to 2014 but declined marginally in 2012. In 2014, it depicts a 1.0%
increase from last year. However, tracking progress towards Abuja target indicates
that the proportion of the domestic budget allocated to the health sector has fallen by
0.7% from 2013.
Pagina 21 van 23
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Table 11: Progress towards Abuja Target (2009 – 2014)
2009
2010
2011
2012
2013
2014
Abuja Target
15.0%
15.0%
15.0%
15.0%
15.0%
15.0%
Health Share of Total Government Budget
9.8%
11.1%
11.6%
10.7%
12.5%
13.5%
Health Share of Domestic Resources
7.9%
7.6%
8.4%
6.5%
11.1%
10.4%
Source: Ghana Budget Statement, (2009 – 2014)
Significant proportion of the budget from GOG will likely be in jeopardy due to fiscal
and macro-economic challenges this year and reduced ODA contributions. Internally
Generated Funds (IGF) constitutes the largest source and this is mainly from out of
pocket payments.
Health Expenditure
According to the 2005 and 2010 National Health Accounts, Total Health Expenditure
(THE) showed a drop of international funding while public fund allocations increased.
However most of the public expenditures are absorbed by salaries (approx. 65%) and
capital investments (approx. 20%) leaving little fiscal space for operational expenses
for service delivery.
Table 12 : Total Health Expenditure Percentage Change among Financing Sources, 2005 & 2010
%
2005 (US$)
International Funds
360,479,692.54
52.97
178,932,270.64
18.55
Private Funds
118,661,796.53
17.44
122,831,726.54
12.73
+3.51
Public Funds
201,408,758.71
29.59
662,918,655.69
68.72
+229.14
Total
680,550,247.78
100.00
964,682,652.87
100.00
+41.75
Pagina 22 van 23
2010 (US$)
%
% Change
2005 - 2010
Financing Sources
-50.36
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