加纳全民健康覆盖的公共卫生支出

A U G U S T2 0 23 D I S C U S S I O NP A P E R Enoch Oti AgyekumElisha NgetichOwen SmithSoazic Elise Wange SonneDorothee ChenPaul Andres Corral Rodas PUBLIC HEALTH EXPENDITURE FOR UNIVERSALHEALTH COVERAGE IN GHANA Enoch Oti Agyekum, Elisha Ngetich, Owen Smith, Soazic EliseWang Sonne,Dorothee Chen, and Paul Andres Corral Rodas August 2023 Health, Nutrition, and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Global Practice of theWorld Bank. The papers in this series aim to provide a vehicle for publishing preliminaryresults on HNP topics to encourage discussion and debate. The findings, interpretations,and conclusions expressed in this paper are entirely those of the author(s) and shouldnot be attributed in any manner to the World Bank, to its affiliated organizations, or tomembers of its Board of Executive Directors or to the countries they represent. Citationand the use of the material presented in this series should take into account thisprovisional character. The World Bank does not guarantee the accuracy of the data included in this work. Theboundaries, colors, denominations, and other information shown on any map in this workdo not imply any judgment on the part of the World Bank concerning the legal status ofany territory or the endorsement or acceptance of such boundaries. For information regarding the HNP Discussion Paper Series, please contact the Editor,Jung-Hwan Choi atjchoi@worldbank.orgor Erika Yanick ateyanick@worldbank.org. RIGHTS AND PERMISSIONS The material in this work is subject to copyright. Because the World Bank encourages thedissemination of its knowledge, this work may be reproduced, in whole or in part, fornoncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed toWorld Bank Publications, The World Bank Group, 1818 H Street, NW, Washington, DC20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. © 2024 The International Bank for Reconstruction and Development / The World Bank1818 H Street, NW, Washington, DC 20433All rights reserved. Health, Nutrition and Population (HNP) Discussion Paper Public Health Expenditure for Universal Health Coverage in Ghana Enoch Oti Agyekum,aElisha Ngetich,aOwen Smith,aSoazic Elise Wang Sonne,bDorothee Chen,cand Paul Andres Corral Rodasd aHealth, Nutrition, and Population, World Bank, Accra, Ghana.bHealth, Nutrition, and Population, World Bank, Washington DC, USA.cHealth, Nutrition, and Population, World Bank, Paris, FrancedPoverty and Equity, World Bank, Accra, Ghana. Ghana Abstract:Ghana has made substantial progress toward universal health coverage (UHC) and compares relatively well in health outcomes among its economic peers. Internationalcomparisons of government current health expenditure suggest that Ghana spends lessthan the sub-Saharan African norm for its income level. That notwithstanding, Ghanacompares favorably with its peers in key health outcomes with a mixed pattern of equityin health service utilization. The trajectory indicates that better health outcomes could beachieved if health spending increases. Public funding through the Ministry of Health’s(MoH’s) budget and the National Health Insurance Scheme (NHIS) constitute the majorsources of financing for the health sector in Ghana.. Total government health spending inGhana almost trippled in nominal terms in 2015-20, but it rose by a modest 12 percent inreal terms, and nearly all the increased spending was channeled through MoH instead ofthrough NHIA. On average, 80 percent of the government budget is channeled throughthe MoH budget, while the share of NHIS spending has declined over the same periodfrom 24 percent to 12 percent. There are preliminary signs that past achievements infinancial protection largely attributable to the impact of the NHIS are being eroded.Although the social contract underpinning the establishment of the National HealthInsurance Levy is not in question, the recently introduced Statutory Funds Capping Lawfurther threatens the sustainability of the NHIS. There is a need to improve efficiency inthe functional allocation of domestic health resources and upscale the use of publicfinancial management (PFM) tools at the national and subnational levels to enhancebudget credibility and expenditure tracking.To ensure no one is left behind, deliberateefforts should be made to improve equity in health care utilization and outcomes alongincome and regional dimensions. Keywords: Public expenditure, universal health coverage, financial protection, access,primary health care, Ghana Disclaimer:The findings, interpretations, and conclusions expressed in the paper areentirely those of the authors, and do not represent the views of the World Bank, itsExecutive Directors, or the countries they represent. CorrespondenceDetails:Enoch Oti Agyekum,World Bank(Accra,Ghana),+233596912144;eotiagyekum@world