The health sector in Ghana: A comprehensive assessmant
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Washington, D.C.
World Bank
2013
|
| Schriftenreihe: | Directions in development / Human development
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis Klappentext |
| Beschreibung: | XXI, 216 S. Ill., graph. Darst. |
| ISBN: | 9780821395998 0821395998 |
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| 245 | 1 | 0 | |a The health sector in Ghana |b A comprehensive assessmant |
| 264 | 1 | |a Washington, D.C. |b World Bank |c 2013 | |
| 300 | |a XXI, 216 S. |b Ill., graph. Darst. | ||
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| 338 | |b nc |2 rdacarrier | ||
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Datensatz im Suchindex
| _version_ | 1804149368518868992 |
|---|---|
| adam_text | Contents
Foreword
xiii
Acknowledgments
xv
About the Author
xvii
Abbreviations
xix
Overview
1
What Are Ghana s Health, Nutrition, and Population
Challenges as It Continues Its Transition to
Universal Health Insurance Coverage?
1
What Are Some Health System Challenges?
3
How Is Ghana Faring in the Use of Public Resources
for Health?
6
What Are the Population s Health Outcomes and
Access to and Use of Services?
9
Is the Population Financially Protected against
Illness?
13
What Are the Next Steps for Ghana?
15
References
19
Chapter
1
Background and Objectives
21
Background
21
vi
Contents
Chapter
2
Chapter
3
Chapter
4
Population Dynamics and Demographic Changes
24
Epidemiological Changes
28
Labor Market Situation
29
Overview of Ghana s Health System
31
Cross-Cutting Areas of Reform
33
The Book
37
Notes
38
References
39
Health Delivery System
41
Key Messages
41
Health Infrastructure and Other Capital
Investments
43
Human Resources for Health
53
Pharmaceuticals
69
Conclusion
78
Notes
80
References
81
Health Financing System
85
Key Messages
85
Health Financing Functions
87
Trend Analysis on Health Budgets and
Expenditures
94
Fiscal Space Analysis
103
Health Insurance Providers
105
Conclusion
131
Notes
132
References
134
Assessment of Health Financing and
Delivery Performance
137
Key Messages
137
Health Outcomes
139
Health Outputs
144
Efficiency
159
Financial Protection and Equity in Financing
163
Quality of Health Services
173
Conclusion
182
Notes
184
References
185
Contents
vii
Chapter
5
Key Reform Issues and Options
189
Reform Issues
189
Reform Options
195
Summary of Key Reform Options
209
Note
216
Reference
216
Boxes
2.1
Options Available to Address Shortage and Inequity
in Distribution of Health Facilities
49
2.2
The Urban Bias in Human Resource Distribution
60
2.3
The Case of the Additional Duties Hours Allowance
under the Ministry of Health,
1998-2005 68
3.1
The National Health Insurance Act
107
3.2
What Is the One-Time Premium Policy to Be
Introduced by Ghana?
112
3.3
Ghana NHIS: Benefit Package Exclusion
114
3.4
Ghana NHIS: A Description of G-DRG Rates
116
3.5
Efficiency Measured for NHIS Claims Submission,
Processing, and Reimbursements
119
4.1
Country s Capacity to Address and Respond to
Noncommunicable Diseases
157
4.2
Efficiency in Health Service Utilization
161
4.3
The Three Dimensions of Universal Coverage
166
4.4
Benefit Incidence of Public Health Facilities and
Mission-Based Facilities
169
4.5
Satisfaction with Health Care Providers
183
Figures
O.I Ghana, Causes of Death,
2008
Estimates
3
O.2 Number of Health Workers in Ghana Compared with
Other Countries with Similar Incomes and Health
Spending Levels,
2009 4
O.3 Average Public Sector Procured Prices Compared
with International Reference Pricing,
1993-2008 6
O.4 Per Capita Health Spending Compared with Countries
with Similar Incomes,
2009 7
O.5 Total Health Spending Shares,
1995-2009 8
O.6 Global Comparisons of Mortality Rates Relative
to Income and Spending,
2009 10
viii Contents
0.
7 Regional
and Income Differentials in Institutional
Deliveries,
2008 11
O.8 Income Differences in Households with Children under
Age Five with a Fever and Seeking Care,
2008 12
O.9 NHIS Coverage by Gender and Income
Quintile
for
Adults (Ages
15-49), 2008 14
0.
10
Household Spending on Health by Consumption
Quintile,
2005-06 15
1.1
Ghana: Real GDP Growth Rate,
1989-2015 23
1.2
Ghana: Demographic Trend and Future Projections,
1990-2050 27
1.3
Ghana: Changing Age Structure of the Population
28
1.4
Distribution of Years of Life Lost by Causes,
2008 29
1.5
Causes of Death,
2008
Estimates
30
2.1
Hospital-Beds-to-Population Ratios Relative to Total
Health Spending and Income,
2009 47
2.2
Facilities with Access to Obstetric Care-Related
Equipment,
2010 50
2.3
Facilities with Access to Filled Oxygen Cylinders,
2010 50
2.4
Limited Obstetric Services Offered in Health
Facilities Due to Limited Access to Equipment, Drugs,
or Supplies,
2010 51
2.5
Access to Transport at Health Facilities,
2010 52
2.6
Health-Workers-to-Population Ratios Relative to Total
Health Spending and Incomes,
2009 54
2.7
Health Worker Profile, Selected Countries from
Sub-Saharan Africa,
2009 54
2.8
Physician-to-Population Ratios, International
Comparison
56
2.9
Selected Health Workers Distribution by Age,
2007 57
2.10
Regional Distribution of Health Workers (Doctors,
Nurses, and Midwives] per
1,000
Population,
2009 58
2.11
Maldistribution of Staffing in Public Health
Facilities,
2010 58
2.12
Ghana: Regional Variation in Health Worker
Productivity,
2006 61
2.13
Annual Wages of Health Workers in Ghana and
the Region,
2007 62
2.14
Average Base Salary across Different Public Sector
Services and Institutions,
2008 63
Contents
¡χ
2.15 Ghana: Health
Worker Attrition
Pronie,
2004-08 63
2 16
Production of Doctors per Million People, International
Comparison,
2007 64
2.17
Ghana: Enrollment into MOH-Run Paramedical
Diploma Programs and Medical Schools,
2000-08 65
2.18
Availability of Essential Drugs in Health
Facilities,
2008 70
2.19
Sources of Drug Procurement: Public and Private
Sectors,
2002 71
2.20
Source of Procurement for Obstetric and Neonatal
Care-Related Drugs,
2010 72
2.21
Average Public Sector Procured Prices Compared
with International Reference Pricing,
1993-2008 73
2.22
Public and Private Sector Procured Prices versus Retail
Prices of Generic Drugs Compared with International
Reference Pricing,
2004 73
2.23
Cost Breakdown of Drugs Procured by the Public
versus the Private Sector,
2004 74
3.1
Ghana: Sources of Financing for Health,
1995-2009 88
3.2
International Comparison: Total Per Capita Health
Spending Compared with Countries with Similar
Incomes,
2009 90
3.3
International Comparison: Health Spending as a
Percentage of GDP,
1995-2009 91
3.4
International Comparison: Out-of-Pocket Spending
for Health Relative to Other Countries with Similar
Incomes,
2009 92
3.5
Ghana Ministry of Health: Sources of Financing for
Health,
2005-09 93
3.6
Ghana Ministry of Health: Actual and Projected
Donor Contributions,
2008-13 94
3.7
Ghana Ministry of Health: Internally Generated Fund
Breakdown between National Health Insurance
Authority and Out-of-Pocket Payments,
2005-09 95
3.8
International Comparison: Public Health Spending
as a Percentage of Total Government Spending,
2009 96
3.9
Ghana Ministry of Health: Spending on Wages as
Percentage of Recurrent and Total Spending,
2005-09 98
3.10
Ghana: Expenditure Allocation at Regional and
District Levels,
2008 100
χ
Contents
3.11
Ghana: Variations
in Subnational Health
Expenditures
Per
Capita across Regions,
2008 101
3.12 Ghana: Total Health
Expenditures Per Capita by
District,
2008 102
3.13 Ghana:
Financing of Pharmaceuticals, Share
(in Percent) of Different Funding Sources,
2008 104
3.14
Ghana NHIS: Financial Sustainability Forecasts,
2008-18 121
3.15
Ghana: Composition of NHIS Membership,
2010 123
3.16
Ghana NHIS: Beneficiary Enrollment,
2005-10 125
3.17
Ghana NHIS: Population Registered by Region and
over Time,
2006
and
2008 126
3.18
Ghana NHIS: Regional Inequity in Coverage among
Adults (Ages
15-49), 2007-08 126
3.19
Ghana NHIS: Income and Gender Inequity in Coverage
among Adults (Ages
15-49), 2007-08 126
3.20
Ghana NHIS: Reasons for People Not Enrolling, by
Quintile,
2008 127
4.1
Ghana: Trends in under Age Five Mortality by Region
and Income Profile,
2003-08 140
4.2
Ghana: Skilled Birth Attendants by Region and Income
Profile,
2008 141
4.3
Ghana: Trends in Maternal Mortality and Achieving
MDG,
1990-2010 142
4.4
Under Age Five Mortality Rate, Ghana and Select
Neighbors,
1960-2009 144
4.5
Global Comparisons of Health Outcomes Relative to
Incomes and Health Spending,
2009 145
4.6
Life Expectancy at Birth, International Comparison,
2009 146
4.7
Ghana: Causes of Death among Children under the
Age of Five,
2010 147
4.8
Ghana: Causes of Maternal Deaths,
2007 148
4.9
Ghana: Health Payment Shares by
Quintile
Analysis
166
4.10
Ghana: Modeling Per Capita Spending on Medicines
167
4.11
Ghana: Per Capita Expenditures, Gross and Net of
Health Spending
168
4.12
Ghana: Place of Delivery by Type of Facility and over
Time as a Percent,
2003-08 172
4.13
Ghana: Regional and Income Differences in Institutional
Delivery,
2008 174
Contents xi
4 14 Ghana:
Institutional Delivery by Facility Type,
2010 175
4 15
Ghana: Percentage of Pregnant Women Informed of
Signs of Complications during Antenatal Care,
2008 176
4 16
Ghana: Availability of Emergency Obstetric and
Neonatal Care at Health Facilities,
2010 177
4 17
Ghana: Income Differences in Households with
Children under Age Five Who Had a Fever and
Sought Care,
2008 178
4.18
Ghana: Pregnant Women Deliveries by
Quintile
Analysis and by Insured or Uninsured Status
179
4.19
Ghana: Main Reason for Provider Choice
181
4.20
Ghana: Medicines and Laboratory Tests Draw
Consumers to Private Providers
181
4.21
Ghana: Household Perception of the Quality of
Health Services after the Introduction of NHIS,
2008 182
Tables
1.1
Trends in Ghana s Macroeconomic and Fiscal
Performance,
2008-10 23
1.2
Ghana: Population Distribution,
1984, 2000,
and
2010 26
1.3
Estimated Dependency Ratio between
2010
and
2030 28
1.4
Mapping Out Decision Space for Ghana s Districts
Regarding Health
36
2.1
Types of Ownership of Health Facilities and Health
Care Providers,
2009 44
2.2
Regional Distribution of Health Facilities,
2008 44
2.3
Ministry of Health, Workforce Growth,
2005-09 57
2.4
Health Workforce, by Type of Health Care Workers
and by Type of Ownership,
2006 57
2.5
Primary Reasons for MCH-Related Drug Stock-Outs
in Health Facilities,
2010 71
2.6
Ghana s Ministry of Health Drug Price
Markup Policy
74
3.1
Ghana: Sources of Financing for Health,
1995-2009 89
3.2
Ghana Ministry of Health, Health Spending,
2005-09 97
3.3
Summary of NHIS s Functions
108
3.4
Ghana s Hybrid Health Insurance Model
109
3.5
Ghana: Sources of Financing for NHIS,
2008-09 110
3.6
Ghana: NHIS Expenditures,
2008-09 118
3.7
Ghana: Coverage of the Population in NHIS,
2008 125
xii Contents
3.8 Ghana NHIS:
Reasons Registered Persons Did Not
Hold a Valid NHIS Card in
2008 128
3.9
Ghana NHIS: Reasons for Low Renewals of NHIS
Cards in
2008 128
4.1
Health, Nutrition, and Population Outcomes for
Comparable Countries,
2008 143
4.2
Options to Improve Health Promotion and Prevention
Programs for Communicable and Noncommunicable
Diseases
156
4.3
Ghana: Mean Features of Hospitals by Category
163
4.4
Inefficiencies and Options for Improving Efficiency
in the Health Delivery System in Ghana
164
4.5
Ghana: Catastrophic Expenditure Headcounts, by
Various Thresholds
168
4.6
Ghana: Outpatient Use of Health Facilities by Type
(Public, Private For-Profit, and Private
Not-for-Profit),
1999
to
2005-06 172
4.7
Ghana: Maternity Bed Capacity and Use by Type and
Ownership of Health Facility,
2010 175
5.1
Structural Reform Areas and Options
210
Ghana
is undergoing major demographic, epidemiological, and nutrition transitions, while
the government is operationalizing its National Health Insurance Scheme (NHIS) to cover the
entire population. But much work remains to be done. Ghana s health system performance in
the areas, of child and maternal health is worse than in other countries with comparable
income and health spending levels. There are significant issues with NHIS coverage, equity,
and financial sustainability as well as substantial shortages and maldistributions of health
manpower and infrastructure. The Health Sector in Ghana: A Comprehensive Assessment analyzes
Ghana s health system performance and highlights the range of policy options needed to
improve health system performance and to ensure effective implementation of the NHIS.
This timely volume discusses some of the key policy debates in Ghana s health sector:
decentralization and governance, private sector partnerships, the strengthening of health
systems, and health financing.The book brings together the key elements of health system
development and challenges, and links them to health financing and delivery performance.
The study reviews the demand-side NHIS financing reform, the reform s coverage of the
population and its effect on service use, and challenges in the financial sustainability of
the NHIS. It also provides a holistic treatment of Ghana s health policy reform needs.
The book is an excellent assessment of the health sector in Ghana. It provides a discussion on
the policy reforms, as well as a situation analysis of changes over time in strengthening health
service delivery, in health service use, and in health financing dynamics.The book provides an
opportunity for policy makers and for policy analysts to understand the health reforms made
in Ghana, the strengths and the current challenges, and provides lessons learnt.
It is a must read!
Chief Director
Ministry of Health, Ghana
This book provides the first comprehensive assessment of the context and initial experience
of a low-middle-income African country at the introduction of social health insurance. It
offers lessons for Ghana but helps to guide and inform other countries on the continent and
low-income countries in other regions with aspirations of introducing health insurance as a
way of financing health care for its citizens. There are lessons for both encouragement and
caution. Either way, the book s analysis is an essential input into rational policy making on
social health insurance and health care financing.
|
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| geographic | Ghana (DE-588)4020949-0 gnd |
| geographic_facet | Ghana |
| id | DE-604.BV040336820 |
| illustrated | Illustrated |
| indexdate | 2024-07-10T00:21:55Z |
| institution | BVB |
| isbn | 9780821395998 0821395998 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-025191156 |
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| physical | XXI, 216 S. Ill., graph. Darst. |
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| publisher | World Bank |
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| series2 | Directions in development / Human development |
| spelling | Saleh, Karima Verfasser aut The health sector in Ghana A comprehensive assessmant Washington, D.C. World Bank 2013 XXI, 216 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Directions in development / Human development Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Ghana (DE-588)4020949-0 gnd rswk-swf Ghana (DE-588)4020949-0 g Gesundheitswesen (DE-588)4020775-4 s b DE-604 Digitalisierung UB Passau application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025191156&sequence=000003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Passau application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025191156&sequence=000004&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Saleh, Karima The health sector in Ghana A comprehensive assessmant Gesundheitswesen (DE-588)4020775-4 gnd |
| subject_GND | (DE-588)4020775-4 (DE-588)4020949-0 |
| title | The health sector in Ghana A comprehensive assessmant |
| title_auth | The health sector in Ghana A comprehensive assessmant |
| title_exact_search | The health sector in Ghana A comprehensive assessmant |
| title_full | The health sector in Ghana A comprehensive assessmant |
| title_fullStr | The health sector in Ghana A comprehensive assessmant |
| title_full_unstemmed | The health sector in Ghana A comprehensive assessmant |
| title_short | The health sector in Ghana |
| title_sort | the health sector in ghana a comprehensive assessmant |
| title_sub | A comprehensive assessmant |
| topic | Gesundheitswesen (DE-588)4020775-4 gnd |
| topic_facet | Gesundheitswesen Ghana |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025191156&sequence=000003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025191156&sequence=000004&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT salehkarima thehealthsectoringhanaacomprehensiveassessmant |