加纳全民健康覆盖的公共卫生支出

DISCUSSIONPAPER AUGUST2023 PublicDisclosureAuthorized PublicDisclosureAuthorized PUBLICHEALTHEXPENDITUREFORUNIVERSALHEALTHCOVERAGEINGHANA EnochOtiAgyekumElishaNgetichOwenSmith SoazicEliseWangeSonneDorotheeChen PaulAndresCorralRodas PUBLICHEALTHEXPENDITUREFORUNIVERSALHEALTHCOVERAGEINGHANA EnochOtiAgyekum,ElishaNgetich,OwenSmith,SoazicEliseWangSonne,DorotheeChen,andPaulAndresCorralRodas August2023 Health,Nutrition,andPopulation(HNP)DiscussionPaper ThisseriesisproducedbytheHealth,Nutrition,andPopulationGlobalPracticeoftheWorldBank.ThepapersinthisseriesaimtoprovideavehicleforpublishingpreliminaryresultsonHNPtopicstoencouragediscussionanddebate.Thefindings,interpretations,andconclusionsexpressedinthispaperareentirelythoseoftheauthor(s)andshouldnotbeattributedinanymannertotheWorldBank,toitsaffiliatedorganizations,ortomembersofitsBoardofExecutiveDirectorsortothecountriestheyrepresent.Citationandtheuseofthematerialpresentedinthisseriesshouldtakeintoaccountthisprovisionalcharacter. TheWorldBankdoesnotguaranteetheaccuracyofthedataincludedinthiswork.Theboundaries,colors,denominations,andotherinformationshownonanymapinthisworkdonotimplyanyjudgmentonthepartoftheWorldBankconcerningthelegalstatusofanyterritoryortheendorsementoracceptanceofsuchboundaries. ForinformationregardingtheHNPDiscussionPaperSeries,pleasecontacttheEditor,Jung-HwanChoiatjchoi@worldbank.orgorErikaYanickateyanick@worldbank.org. RIGHTSANDPERMISSIONS Thematerialinthisworkissubjecttocopyright.BecausetheWorldBankencouragesthedisseminationofitsknowledge,thisworkmaybereproduced,inwholeorinpart,fornoncommercialpurposesaslongasfullattributiontothisworkisgiven. Anyqueriesonrightsandlicenses,includingsubsidiaryrights,shouldbeaddressedtoWorldBankPublications,TheWorldBankGroup,1818HStreet,NW,Washington,DC20433,USA;fax:202-522-2625;e-mail:pubrights@worldbank.org. ©2024TheInternationalBankforReconstructionandDevelopment/TheWorldBank1818HStreet,NW,Washington,DC20433 Allrightsreserved. Health,NutritionandPopulation(HNP)DiscussionPaper PublicHealthExpenditureforUniversalHealthCoverageinGhana EnochOtiAgyekum,aElishaNgetich,aOwenSmith,aSoazicEliseWangSonne,bDorotheeChen,candPaulAndresCorralRodasd aHealth,Nutrition,andPopulation,WorldBank,Accra,Ghana. bHealth,Nutrition,andPopulation,WorldBank,WashingtonDC,USA. cHealth,Nutrition,andPopulation,WorldBank,Paris,France dPovertyandEquity,WorldBank,Accra,Ghana. Ghana Abstract: Ghanahasmadesubstantialprogresstowarduniversalhealthcoverage(UHC)andcomparesrelativelywellinhealthoutcomesamongitseconomicpeers.InternationalcomparisonsofgovernmentcurrenthealthexpendituresuggestthatGhanaspendslessthanthesub-SaharanAfricannormforitsincomelevel.Thatnotwithstanding,Ghanacomparesfavorablywithitspeersinkeyhealthoutcomeswithamixedpatternofequityinhealthserviceutilization.Thetrajectoryindicatesthatbetterhealthoutcomescouldbeachievedifhealthspendingincreases.PublicfundingthroughtheMinistryofHealth’s(MoH’s)budgetandtheNationalHealthInsuranceScheme(NHIS)constitutethemajorsourcesoffinancingforthehealthsectorinGhana..TotalgovernmenthealthspendinginGhanaalmosttrippledinnominaltermsin2015-20,butitrosebyamodest12percentinrealterms,andnearlyalltheincreasedspendingwaschanneledthroughMoHinsteadofthroughNHIA.Onaverage,80percentofthegovernmentbudgetischanneledthroughtheMoHbudget,whiletheshareofNHISspendinghasdeclinedoverthesameperiodfrom24percentto12percent.TherearepreliminarysignsthatpastachievementsinfinancialprotectionlargelyattributabletotheimpactoftheNHISarebeingeroded.AlthoughthesocialcontractunderpinningtheestablishmentoftheNationalHealthInsuranceLevyisnotinquestion,therecentlyintroducedStatutoryFundsCappingLawfurtherthreatensthesustainabilityoftheNHIS.Thereisaneedtoimproveefficiencyinthefunctionalallocationofdomestichealthresourcesandupscaletheuseofpublicfinancialmanagement(PFM)toolsatthenationalandsubnationallevelstoenhancebudgetcredibilityandexpendituretracking.Toensurenooneisleftbehind,deliberateeffortsshouldbemadetoimproveequityinhealthcareutilizationandoutcomesalongincomeandregionaldimensions. Keywords:Publicexpenditure,universalhealthcoverage,financialprotection,access,primaryhealthcare,Ghana Disclaimer:Thefindings,interpretations,andconclusionsexpressedinthepaperareentirelythoseoftheauthors,anddonotrepresenttheviewsoftheWorldBank,itsExecutiveDirectors,orthecountriestheyrepresent. CorrespondenceDetails:EnochOtiAgyekum,WorldBank(Accra,Ghana), +233596912144;eotiagyekum@worldbank.org;https://www.worldbank.org. TableofContents RIGHTSANDPERMISSIONSII PUBLICHEALTHEXPENDITUREFORUNIVERSALHEALTHCOVERAGE:THEROLEOFGHANA’SNHISIII ACKNOWLEDGMENTS4 INTRODUCTION1 1.2.COUNTRYANDSECTORCONTEXT7 1.2.1.MacroeconomicContext7 1.2.2.HealthSectorContext11 2.KEYHEALTHSECTORPERFORMANCEINDICATORS13 2.1.DEMOGRAPHICANDEPIDEMIOLOGICALTRANSITION13 2.2.HEALTHOUTCOMES15 2.3.BURDENOFDISEASE20 2.4PUBLICHEALTHEMERGENCYPREPAREDNESSANDRESPONSE22 3.HEALTHFINANCING25 3.1OVERVIEWOFHEALTHFINANCINGINGHANA25 3.2.PUBLICHEALTHFINANCINGSOURCESANDSTRUCTURE27 3.2.1.MinistryofHealthBudget29