p

THE GHANA HEALTH SECTOR 

 2008 PROGRAMME OF WORK 

 MINISTRY OF HEALTH 

NOVEMBER 2007 

2

ACRONYMS

AFP Acute Flaccid Paralysis

ART Anti-Retroviral Therapy

ARV Anti-Retroviral

ARI Acute Respiratory Infections

ASRH Adolescent Sexual and Reproductive Health

ATF Accounting, Treasury & Financial

BCC Behaviour Change Communication

BMC Budget Management Centres

BPEMS Budget, Public Expenditure Management Systems

CAM Complementary Alternative Medicine

CAN African Cup of Nations

CEO Chief Executive Officer

CHAG Christian Health Association of Ghana

CHPS Community Health based Planning & Services

CMS Central Medical Stores

CMR Child Mortality Rate

CPR Cardio Pulmonary Resuscitation

C/S Caesarean section

CSRPM Centre for Scientific Research into Plant Medicine

DHMT s District Health Management Teams

DP Development Partners

DEENT Department of Ear, Eye, Nose & Throat

ENT Ear, Nose & Throat

EPI Expanded Programme on Immunisation

FDB Food & Drugs Board

5yPOW Five-year Programme of Work

GCPS Ghana College of Physicians & Surgeons

GHS Ghana Health Service

GOG Government of Ghana

GPRS Growth and Poverty Reduction Strategy

HIRD High Impact Rapid Delivery

3

HIV/AIDS Human Immunodeficiency Virus/Acquired Immune

Deficiency Syndrome

HMIS Health Management Information System

HR Human Resource

ICC Interagency Coordinating Committee

ICT Information Communication Technology

IGF Internally Generated Fund

IMCI Integrated Management of Childhood Illnesses

IPT Intermittent Preventive Treatment

ITNs Insecticide Treated Nets

KATH Komfo Anokye Teaching Hospital

KBTH Korle Bu Teaching Hospital

MDAs Ministries, Departments and Agencies

MDGs Millennium Development Goals

MOESS Ministry of Education, Science & Sport

MOH Ministry of Health

MRI Magnetic Resonance Imaging

MTEF Medium Term Expenditure Framework

NCD Non-Communicable Diseases

NDPC National Development Planning Commission

NGOs Non-Governmental Organisations

NHIC National Health Insurance Council

NHIF National Health Insurance Fund

NHIS National Health Insurance Scheme

OPD Out-patient Department

POW Programme of Work

PPM Planned Preventive Maintenance

RBM Roll-Back Malaria

RHMT Regional Health Management Teams

RHN Regenerative Health & Nutrition

RTA Road Traffic Accident

SARS Severe Acute Respiratory Syndrome

STD Sexually Transmitted Diseases

STG Standard Treatment Guidelines

4

TB Tuberculosis

TRIPS Trade Related Intellectual Property Rights

TTH Tamale Teaching Hospital

WHO World Health Organisation

5

TABLE OF CONTENTS ACRONYMS ............................................................................................................................ 3 TABLE OF CONTENTS .......................................................................................................... 6 MESSAGE FROM THE HON. MINISTER OF HEALTH...................................................... 8 1. INTRODUCTION............................................................................................................ 10 2. POLICY FRAMEWORK ................................................................................................ 12

2.1. VISION..................................................................................................................... 12 2.2. MISSION .................................................................................................................. 12 2.3. POLICY OBJECTIVES ........................................................................................... 12

2.3.1. SECTOR GOAL................................................................................................ 12

2.3.2. STRATEGIC OBJECTIVES............................................................................. 12

2.3.3. GUIDING PRINCIPLES................................................................................... 13

3. KEY LESSONS AND CHALLENGES .......................................................................... 14 4. 2008 PRIORITIES ........................................................................................................... 16

4.1. PROGRAMME PRIORITIES .................................................................................. 16 4.2. EXPENDITURE PRIORITIES ................................................................................ 16

5. HUMAN RESOURCES FOR HEALTH......................................................................... 18 6. AGENCY SPECIFIC PROGRAMMES OF WORK....................................................... 19

6.1. GOVERNANCE AND FINANCING ...................................................................... 19 6.1.1. MINISTRY OF HEALTH HEADQUARTERS ............................................... 19

6.1.2. NATIONAL HEALTH INSURANCE.............................................................. 20

6.2. SERVICE DELIVERY............................................................................................. 21 6.2.1. GHANA HEALTH SERVICE .......................................................................... 21

6.2.2. CHRISTIAN HEALTH ASSOCIATION OF GHANA.................................... 23

6.2.3. TEACHING HOSPITALS ................................................................................ 24

6.2.4. PSYCHIATRIC HOSPITALS .......................................................................... 27

6.3. NATIONAL AMBULANCE SERVICE.................................................................. 28 6.4. REGULATION......................................................................................................... 29

6.4.1. FOOD AND DRUGS BOARD ......................................................................... 29

6.4.2. NURSES AND MIDWIVES COUNCIL.......................................................... 30

6.4.3. MEDICAL AND DENTAL COUNCIL ........................................................... 30

6.4.4. PHARMACY COUNCIL.................................................................................. 31

6.4.5. TRADITIONAL MEDICINE PRACTICE COUNCIL .................................... 32

6.4.6. PRIVATE HOSPITALS AND MATERNITY HOMES BOARD ................... 33

6.5. RESEARCH AND TRAINING................................................................................ 34 6.5.1. CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE ......... 34

6.5.2. TRAINING INSTITUTIONS............................................................................ 34

6.5.3. GHANA COLLEGE OF PHYSICIANS AND SURGEONS ........................... 35

7. CAPITAL INVESTMENT .............................................................................................. 37 8. 2008 HEALTH SECTOR BUDGET ............................................................................... 40

6

9. PERFORMANCE ASSESSMENT FRAMEWORK....................................................... 50 9.1. MILESTONES.......................................................................................................... 50 9.2. INDICATORS AND TARGETS.............................................................................. 50 9.3. MONITORING AND REPORTING ON PERFORMANCEError! Bookmark not defined. 9.4. RISKS AND ASSUMPTIONS................................................................................. 55

10. ANNEXES ................................................................................................................... 57 Annex 1: CAPITAL INVESTMENT PLAN....................................................................... 58 Annex 2: FELLOWSHIP PLAN ......................................................................................... 70 Annex 3: PROCUREMENT PLAN .................................................................................... 72 Annex 4: NATIONAL HEALTH INSURANCE ALLOCATION FORMULA ................ 73

7

MESSAGE FROM THE HON. MINISTER OF HEALTH

The past year saw the introduction and implementation of a new health policy that defines a new paradigm for health delivery. It also aims at placing health within the overall framework of socioeconomic development and thus contributing to the national agenda of transforming this country into middle income status. An imperative of the new policy is the acceleration of improvements in health status through drastic reduction of the disease burden in the shortest possible time.

As some of you are aware, I have been a leading advocate for behaviour and lifestyle changes based on my conviction that the disease burden we carry is the result of choices we made and continue to make in our everyday lives. Most of these diseases are preventable and avoidable and could be dramatically reduced by simple changes in nutrition, physical activity and hygiene. It is for this reason that we have introduced the Regenerative Health and Nutrition Programme.

The 2008 POW is one step in the build up toward the attainment of our set objectives of fast tracking health delivery in a holistic, sustainable and equitable manner. The focus is, therefore, to consolidate the unfinished agenda of high impact and rapid service delivery by expanding to all regions, strengthening the weak and fragmented health system, scaling up the programme of regenerative health & nutrition and expanding the coverage of the National Health Insurance Scheme; while bringing unto the centre stage issues of equity, efficiency and financial sustainability.

In 2008 the sector will address health risk factors through the promotion of healthy lifestyles and behaviours. We will also focus on strengthening the health systems and training of middle level health professionals. We will accelerate the implementation of the high impact health, reproduction and nutrition interventions and services targeting the poor and vulnerable groups and emphasize the improvement of quality and coverage of clinical care focusing on the provision of emergency and essential obstetric care. Efforts will also go into promoting good governance, partnerships and sustainable financing.

Additionally, the sector will introduce a number of new strategic initiatives. These include:

• The Productivity Improvement Initiative following the improvement in salaries of health workers

• New approaches to identifying the poor under the National Health Insurance Scheme as a way of reaching the poor not covered under the narrow definition of indigents under the current provisions in the National Health Insurance Law.

• A general screening programme for the population including screening for breast and prostate cancer in order to facilitate early detection and prompt treatment of diseases

This programme of work will be funded by multiple sources including the consolidated fund, donor funds, NHI and Internally generated funds. Though these are traditional sources of funding, in 2008 the sector will experience a major shift from donor funding through the health fund to budget support through Ministry of Finance and Economic Planning. In addition there will be a substantial reduction in out of pocket payment for health services and an increase in funding under the NHIS. These shifts will require that

8

we ensure effective coordination and complementarity between the different sources of funding, put in place mechanisms to engage MOFEP in enhancing public financial management and ensuring predictability in government funding and improving timeliness and systems for claims management under the NHIS. In addition the sector will ensure effective budget execution including strengthening systems for internal controls and external audit functions.

Obviously the implementation of the POW will call for greater collaboration, harmonisation and alignment of efforts of all stakeholders in the health sector. This is the only way we can ensure synergy in our actions and rapidly accelerate the reduction of the overwhelming disease burden of communicable and pregnancy related diseases as well as the rising non communicable diseases including trauma.

I wish on behalf of the government of Ghana to invite all stakeholders to appraise themselves of the content of this document and join the Ministry of Health and its Agencies in its execution. In particular I request your support to implement the innovations and address the challenges to scaling up priority health interventions.

Major Courage E. K. Quashigah (Rtd)

9

1. INTRODUCTION

The health sector in 2007 began implementing a new health policy and five year programme of work (2007-2011) with a focus on achieving three inter-related and mutually reinforcing objectives namely:

(a) ensuring that children survive and grow to become healthy and productive adults that reproduce without risk of injuries or death;

(b) reducing the risk and burden of morbidity, disability, and mortality especially amongst the poor and marginalized groups

(c) reducing inequalities in access to health, reproduction and nutrition services, and health outcomes.

The five year Programme of Work (POW) was woven around the under-listed four objectives that have guided annual programmes of work.

(a) promotion of healthy lifestyles and environment to reduce risk factors that emanate from environmental, economic, social and behavioural causes

(b) improvement of access to quality health, reproduction and nutrition services (c) strengthening capacity of the health system in the regulation, management and

provision of health services (d) fostering good governance, partnerships and sustainable financing.

The 2008 POW presents a portfolio of policies, broad programmes, outputs and actions that are required to be implemented by the health sector in the second year of implementation of the third Five-Year Programme of Work. It derives from the five year POW and its strength lies in the fact that it has been developed through collective work, continuous dialogue and consultation with key partners, agencies and stakeholders in the health sector. The 2008 POW builds on achievements of the 2007 POW. In that regard it continues and consolidates the priorities identified in 2007. These are scaling up the High Impact and Rapid Delivery (HIRD) and Regenerative Health and Nutrition (RHN) programmes, continuously refining the health worker incentive package and consolidating the NHI programme. Like the 2007 POW, the 2008 POW is focus on a limited set of priorities. These are

• Food safety • Quality of clinical care • Expansion of middle level training and enhancing productivity • Intersectoral collaboration

Additionally, the sector will introduce a number of new strategic initiatives. These include:

• The Productivity Improvement Initiative following the improvement in salaries of health workers

10

• New approaches to identifying the poor under the National Health Insurance Scheme as a way of reaching the poor not covered under the narrow definition of indigents under the current provisions in the National Health Insurance Law.

• A general screening programme for the population including screening for breast and prostate cancer in order to facilitate early detection and prompt treatment of diseases

The 2008 POW however makes a point of departure from previous POWs in its design and orientation. It is operational in its orientation and may be described as an Agency-based Programme of Work since it has been developed and authored largely by the implementing agencies in response to the Sector’s Health Policy Framework, GPRS II, Millennium Development Goals (MDGs) and third 5-yr POW (2007-2011). In this context it creates a better alignment between the POW and budget structure thus laying the basis for accountability within the health sector. In a nut shell the 2008 POW maintains the central theme of creating wealth through health with a significant focus on the promotion of individual lifestyle and behavioural change, scaling up of high impact health, reproduction and nutrition interventions, continuing investments in health systems development with emphasis on strengthening district health systems and the promotion of good governance including sustainable financing and partnerships. The document recognises the important role of other stakeholders and consequently emphasises the promotion of intersectoral action to improve health outcomes. Indeed all sectors that contribute to health development will therefore be brought on board in efforts to accelerate progress towards the achievement of the MDGs and GPRS II objectives.

11

2. POLICY FRAMEWORK

The sector’s policies and priorities are located within the context of Government’s overall development agenda as spelt out in the GPRS II, the National Health Policy and the five year POW. It aims at contributing to national efforts of transforming Ghana into a Middle Income Country by 2015.

2.1. VISION The vision of the health sector is to create wealth through health and in so doing contribute to the national vision of attaining middle income status by 2015.

2.2. MISSION Our mission is to contribute to national socio-economic development and wealth creation through (i) the promotion of health and vitality; (ii) ensuring access to quality health and nutrition services for all people living in Ghana; and (iii) facilitating the development of a local health industry.

2.3. POLICY OBJECTIVES 2.3.1. SECTOR GOAL

The ultimate goal of the health sector is to ensure a healthy and productive population that reproduces itself safely.

2.3.2. STRATEGIC OBJECTIVES

The goal is to be achieved through four strategic objectives that provide a more balanced approach to the known challenges of the health system in terms of the changing determinants of health, the unfinished agenda of service delivery, the weak and fragemented health system and the greater need for governance and sustainable fnancing. These strategic objectives are to:

(a) address risk factors to health by promoting an individual lifestyle and behavioural model for improving health and vitality, and strengthening inter-sector advocacy and actions;

(b) rapidly scale up high impact health, reproduction and nutrition interventions and

services targeting the poor, disadvantaged and vulnerable groups and bridge the gap between interventions that are known to be effective and the current relatively low level of effective population coverage;

(c) strengthen the health system’s capacity to expand access, manage and sustain high

coverage of health services through investment; and

(d) promote good governance, partnerships and sustainable financing.

12

2.3.3. GUIDING PRINCIPLES The objectives of the 2008 POW will be achieved through a combination of programmes and investments underpinned by the following guiding principles: Health is multi-dimensional in nature and requires partnerships. Programmes design and development will:

• Be people centered focusing on individuals, families and communities in the life settings,

• Recognise the inter-generational benefits of health • Reinforce the continuum of care approach to health development • Be prioritized to ensure maximum health gains for limited resources

It is expected that the community will be encouraged and expected to be part of the planning implementation and evaluation of activities aimed at ensuring a healthy and productive population. This is with a view to ensuring effective community ownership and involvement – a key element towards sustainability. Planning, resource allocation and implementation will be results-oriented paying attention to equity, efficiency and sustainability

13

3. KEY LESSONS AND CHALLENGES The main challenges of the health sector in 2008 will revolve around financing the programme of work within a budget constraint whilst managing the expectation of rapidly scaling up the delivery of health interventions to meet the MDGs. In particular the sector will need to address the relatively high wage bill without concurrent increases in resources from the consolidated fund for services and investments. At the same time financing through the NHI system is going up. Given that NHIF disbursements are governed by law there is a limit to what NHIF can be used to fund within the sector. This not withstanding the health sector has to depend increasingly on the NHIF to finance its service and investment budgets. However this has to be done in a manner that does not undermine the sustainability of the fund. The NHI programme remains an important pro-poor strategy for the sector. Currently exemptions constitute about 57% of total projected expenditures under this programme. The benefit package under the NHIS includes children under 5, the elderly, pregnant women and indigents. The opportunities under the NHIS and the known difficulties in financing the exemptions under user fee system makes it imperative to transfer all exemptions to the NHI system. On account of the narrow definition of indigents it is expected that some poor people who can not afford the NHI premium may be deprived of services. Approaches for identifying and recruiting the poor under the NHIS need to be tested. The NHIS continues to be confronted by a number of challenges. The desire to scale up registration including possibility of decoupling children from their parents and the persistent demands to expand the benefit package need to be reconciled with the threat of sustainability of the fund. Secondly there is an emerging threat to sustainability of health services from delays in reimbursement of claims. Thirdly, the management of reserves need to be strengthened to ensure the overall sustainability. In the long term the issue of provider and consumer moral hazards will need to be addressed to sustain the scheme. The burden of diseases in the country has not changed significantly since independence and this would undermine the NHIF unless concurrent action is taken in the areas of health promotion and disease prevention. The pattern of diseases continues to be dominated by communicable diseases, persistent under-nutrition and poor reproductive health. The burden of non-communicable diseases such as cardiovascular disorders, diabetes and cancers has emerged as a major challenge to service delivery and a threat to health and national productivity. Similarly, mental health and neurological disorders are also on the increase whilst trauma and other injuries contribute significantly to the most commonly seen outpatient conditions. The two programmes introduced in 2007, the RHN and HIRD programmes present opportunities to reverse this trend and therefore need to be sustained and scaled up. It is however clear that extra effort and investments beyond what the budget can support will be required to scale up programmes for achieving MDG5. An emerging threat in 2008 is a meningitis epidemic likely to coincide with the period of CAN 2008 and in the regions whose health infrastructure has been devastated by recent floods. Indeed the floods have eroded the health gains so far made in these areas in terms of the destruction of health infrastructure, disruption of health services and reversal of progress in the control of diseases such guinea worm, malnutrition and malaria all of which could undermine the achievement of the MDGs. These make re-establishing

14

services and surveillance systems in these regions a priority. It also calls for strengthening mechanisms for epidemic preparedness and response in the country. The changes in Ghana’s demographic profile have major implications for the health sector. Specifically the health sector needs to be positioned to respond to rapid urbanisation, ageing, changes in lifestyle and disruption of the family and traditional structures and support systems. In addition there is the need to integrate gender issues into the sector’s programmes and priorities. This is primarily because men and women differ in terms of their healthcare needs and have different roles to play in their responses to health promotion and the reduction of barriers to accessing health services. Today, the health sector is faced with an increasing demand for health services and rapidly expanding urban and peri-urban areas as well as deprived rural areas. At the same time existing health infrastructure are deteriorating and equipment are fast becoming obsolete thus undermining quality of care. In addition the sector is faced with numerous uncompleted projects with significant sunk costs. These issues will need to be addressed within the medium to long term within the frame work of the Capital Investment Plan III (CIPIII). In 2007 the health sector abolished the additional duty hours allowance and introduced a new salary structure. This is already slowing down the brain drain. The expansion of training institutions with the initial assumption of a high brain drain already suggests that the health sector will have more nurses than required and the wage bill will continue to rise. Medium term programme for rationalising the human resource production needs to be instituted as part of the current HR strategy. At the same time efforts need to go into improving the productivity of health workers. These call for a reappraisal of the role of the public sector in health delivery and the introduction of fundamental changes in the way health workers are managed and motivated.

15

4. 2008 PRIORITIES

4.1. PROGRAMME PRIORITIES

The priorities for 2008 are based on the need to consolidate the gains made in 2007. Specifically the programme aims at scaling up the High Impact and Rapid Delivery (HIRD) and Regenerative Health and Nutrition (RHN) programmes. Efforts at refining the health worker incentive package and consolidating gains made in the implementation of the NHI programme will continue to receive significant attention. The following priorities will also be in focus:

• Promote the enforcement of regulations on food safety in collaboration with the MLGRD

• Improve quality of clinical care with a focus on essential obstetric care • Expansion of middle level training and enhancing productivity • Intensify intersectoral collaboration in he implementation of the RNH programme

Some new strategic initiatives will also be pursued. These include a Productivity Improvement programme to ensure that health worker performance is improved in response to the improvement in salaries. This will involve the definition of job descriptions and performance standards for different categories of health workers, the development of guidelines for roistering and scheduling of work in hospitals, linking job descriptions to performance appraisals and promotions.

The sector will seek new approaches to identifying the indigents under the National Health Insurance Scheme as a way of reaching the poor not covered under the narrow definition of indigents under the current provisions in the National Health Insurance Law.

A general screening programme will be introduced for the population. This will include screening for breast and prostate cancer in order to facilitate early detection and prompt treatment of diseases. As in all other years, the poor will be exempted as much as possible from payment of user fees through NHIF either by subsidizing or payment of premium. The capital investment budget, on the other hand, will prioritize training institutions as well as provision of infrastructure and equipment that contribute to quality improvements and enhance revenue generation potential of health institutions such as laboratories, pharmacies, theatres and mortuaries. It is hoped such interventions will expand access of health services to the deprived as well as assist institutions to respond adequately to increased service load and challenges of urbanization.

4.2. EXPENDITURE PRIORITIES Though the sector’s resource envelope has increased in absolute terms from GH¢ 439.23 million in 2007 to GH¢763.02 million in 2008, the dwindling size of relative resources allocated to the sector from the government budget, in real terms, and the shift by donors to sector budget support have put resource allocation within the sector under severe pressure. Consequently, all Agencies and Budget Management Centres (BMCs) are to keep the nominal rolls updated throughout the fiscal year and ensure that the payroll is

16

reconciled with staff at post throughout the year. Additionally, all new recruitments are to be approved by the Ministry prior to engagement. As part of the sector’s expenditure programming policies to rein in the wage bill, trainee allowances will be phased out in the short to the medium term. Consequently, a programme is currently underway to phase out these allowances beginning with new intakes into our training institutions in September 2007. The deprived area incentive allowance will also not be implemented. In line with our priority of reversing deteriorating health infrastructure and equipment, the policy of Planned Preventive Maintenance (PPM) will be implemented. In view of this, BMCs are required to prepare PPM plans and dedicate at least 10% of their internally generated funds to the implementation of these plans. In addition, it is envisaged Agencies and BMCs will implement efficiency savings programs targeted at minimising travels and running costs of offices (fuel, utilities, stationery, etc). To take advantage of economies of scale, the budgeting and procurement of public health commodities such as vaccines, contraceptives and Insecticide Treated Nets (ITNs) will continue to be carried out centrally to achieve optimal efficiency in the use of scarce resources. All Agencies and BMCs have also been directed to budget for existing commitments; particularly, maintenance contracts and to operate within the budget as the Ministry will not pay off debts accumulated outside the budget Finally, the item 4 budget will be centrally managed in consultation with heads of Agencies. The budget will give priority to the following capital investment programmes:

• Counterpart funded projects • Expansion of training institutions • Construction of CHPS compounds • Provision of basic equipment for Reproductive and Child health services and

management of pro-poor diseases such as Buruli Ulcer. • Support to hospitals to expand portfolios that enhance quality and generate IGF

e.g. Laboratories, dispensaries, mortuaries, theatres All hospitals are to earmark at least 10% of internally generated funds for the replacement of equipment and machines and minor rehabilitation of infrastructure (minor civil works).

17

5. HUMAN RESOURCES FOR HEALTH The Ministry’s objective for Human Resources for Health is to ensure adequate numbers and mix of well motivated health professionals distributed equitably across the country to manage and provide health services to the population. A strategic plan which seeks to improve and sustain the health of the population by supporting appropriate human resource planning, management and training has been developed. This strategic plan will seek among others to address the imbalance of health workers in favour of highly trained professionals through scaling up the training of middle level health cadres, as well as address the mal-distribution of health professionals. The productivity of the health work force varies considerably across the country and is generally perceived to be low. In 2007 the ADHA was replaced by the new Health Salary Scheme aimed at improving performance and arresting the brain drain. This new salary structure has had a considerable impact on the wage bill however this is not translating into increased productivity of the health workforce. There is therefore the need to evaluate these motivational packages to ascertain the impact on staff retention and performance. In addition there is the need to determine other factors which may influence health workforce productivity so as to find appropriate interventions to the issue. The policy thrust for 2008 is to ensure an equitable distribution of the right numbers and mix of health staff and introduce staff productivity improvement programmes. KEY ACTIVITIES

• Implement the planned Human Resource strategic plan • Conduct impact assessment to ascertain the impact of the new salary scheme and

other incentives introduced on staff productivity • Review the expansion of the middle level training programme • Deploy resources to the recently established Human Resource Observatory to

ensure the HR governance issues are complied with. • Collaborate with MLGRD, MOESS and GCPS to effectively train and distribute

health personnel. EXPECTED RESULTS

• Implementation of HR strategic plan • Adequacy of staff mix • Functional HR observatory

18

6. AGENCY SPECIFIC PROGRAMMES OF WORK

6.1. GOVERNANCE AND FINANCING

6.1.1. MINISTRY OF HEALTH HEADQUARTERS The Ministry of Health is responsible for stewardship of the entire health sector and ensuring equity and efficiency in the sector activities. It exercises this function by providing overall policy directions, institutional development, coordinating the activities of agencies, partners and stakeholders involved in health and ensuring performance and accountability within the sector. In addition, MOH coordinates planning, resource mobilisation, budget execution, human resource development and the over all monitoring and evaluation of the health sector performance.

In the last few years the health sector has been going through a period of organisational reforms that has made coordination very challenging. In addition the financing environment has changed following the introduction of NHIS and movement of partners to budget support. Slow progress in improving outcomes requires stronger focus on performance monitoring, organisational incentives and accountability as well as greater harmonisation and alignment of activities of stakeholders. The Thrust of the Ministry of Health in 2008 is to promote achievement of results through good governance] the efficient, equitable and transparent mobilisation, allocation and utilisation of resources and better harmonisation and alignment of activities and investments by key stakeholders in health. Priority Activities

• Oversee the execution of the 2008 POW and Budget and develop the 2009 POW and Budget.

• Coordinate the activities of agencies and donors, and promote partnerships with other MDAs, Private sector and NGOs/Civil society including the media.

• Define priorities and develop incentives and sanctions for aligning agency and partner activities to priorities.

• Mobilise, allocate, monitor and account for the use of resources within the sector. • Develop, implement and undertake quarterly monitoring of annual Procurement

Plans including the Capital Investment plan • Explore options for aligning the procurement cycle to the budget and harmonise the

systems for budget, procurement, financial, stores and asset management. • Oversee the development of innovations within the sector including scaling up

RHN, testing systems for identifying the poor under health insurance, introduction of screening programmes,

• Integrate traditional medicine into general health system and support the commercialisation of herbal medicines

• Strengthen internal audit systems, facilitate external financial and procurement audit and ensure timely responses and follow-on actions to the audits.

• Develop and execute an agenda for policy research and implement a participatory policy dialogue involving Agencies, Development Partners, NGOs Civil Society, the Private Sector, Media and other MDAs, through monthly partners meetings,

19

quarterly business meetings, biannual summits and relevant interagency/inter stakeholder meetings.

• Review and reform existing systems for reducing wastage, enhancing quality and ensuring standard pricing for medicines and promote local production to ensure continued availability and affordability of essential medicines and logistics.

• Coordinate and harmonize data collection systems in the health sector and build central data repository to support assessment of performance based on the sector wide indicators.

• Continue efforts at rationalising the health sector wage bill and workforce numbers, mix and distribution in line with staffing norms and implement initiatives to improve workforce productivity within the health sector.

• Conduct annual sector-wide reviews and continuously monitor and report on performance of Agencies, policies and commitments of the sector. Work towards aligning the sector reviews to government wide reviews such as the MDBS and the APR.

Expected Results

• Approved 2009 POW and Budget • Improved compliance to financial regulation (Reduction in audit queries) • Effective execution of budget (Predictability and Variance) • Reduced lead time in procurement • Broad and inclusive policy dialogue (Representation at partners meetings) • Stronger evidence for policy and accountability (Timeliness of reporting) • Medicines and Logistics supply security

Collaborators Agencies of the Ministry of Health, MDAs, Development Partners, Private Sector, NGOs/Civil society, Media, Public, Ghana AIDS Commission, Population Council, Ghana Statistical Services, National Development Planning Commission, NHIC

6.1.2. NATIONAL HEALTH INSURANCE The National Health Insurance Council (NHIC) was established by the National Health Insurance Act, 2003 (Act 650) to ensure universal access to basic healthcare services to all residents of Ghana. The Council’s mandate includes among others the regulation of practice of DMHIS, accreditation of health care providers and the management of the NHIF including providing subsidies for the healthcare of indigents and other exempt groups. As at September 2007 the Council had met the target of 55% coverage set for the year 2007 and one hundred, forty-three (143) schemes were fully operational and provisional accreditation granted to all government facilities. An amount of ¢120,000 (GH¢12.00) was paid as subsidy per head to the exempt group members and SSNIT contributors in the year 2007. However, given the rising cost of medical bills evident from bills submitted by service providers and the Review of the Medicines List and Tariff Structure, it has been proposed to increase the subsidy from GH¢12.00 to GH¢14.00 per person for 2008.

20

The delays in reimbursement of claims could potentially undermine service delivery. The scheme also faced double counting of indigents because some population groups are already covered under DHMIS. Chronic patients also do not adhere to referral requirements of the scheme. These challenges have been compounded by delays setting up zonal offices of the council and inadequacy of staff. The thrust for the year is to consolidate gains made in the registration of clients, strengthen the accreditation of providers and streamline claims management. Priority Activities

• Renew the provisional accreditation granted government facilities and mount a programme for accrediting all health facilities

• Extend coverage to cover five (5) more schemes whose establishment began in 2007.

• Assist schemes to build their administrative and logistical capacity • Streamline the process for the identification of indigents to minimize double

counting • Continue the subsidization of schemes to cover exempt groups • Provide technical and financial support to distressed schemes • Install Integrated MIS and ICT infrastructure to aid communication and data

analysis • Recruit personnel for key positions and supporting roles • Support the Ministry of Health to expand health services in the country in the

training of Health Assistants and KATH’s rehabilitation Expected Results

• One hundred and forty-six (148) operational schemes • Increased coverage of population • Increased coverage of indigents, aged and under 18s • % reduction in fraudulent registration • % reduction in distress schemes • Increased compliance with conditions for referrals

Collaborators Ministry of Health, Ghana Health Service, Ministry of Finance and Economic Planning, Private Hospitals and Maternity Homes Board, Ghana Registered Midwives Association, Teaching Hospitals, Society of Private Medical and Dental Practitioners,

6.2. SERVICE DELIVERY

6.2.1. GHANA HEALTH SERVICE The Ghana Health Service (GHS) has been established under Act 525 to ensure access to health services at the community, sub-district, district and regional levels. Indicators on specific programmes, such as EPI, TB control, malaria, HIV/AIDS and nutrition, showed positive trends. However the burden of other communicable diseases including ‘neglected’ diseases and non-communicable diseases such as hypertension and diabetes continue to increase due to unhealthy lifestyle choices. High maternal mortality, still birth rates and

21

infant mortality rates continue to persist due to the fact that uptake of health interventions are not at their optimal levels. The rollout of CHPS as a strategy to extend health interventions to the doorstep of the community has been extremely slow. In addition, the quality of clinical care services especially for maternal and neonantal health is below approved standards in most facilities. Other more systems challenges facing the GHS include inadequate coverage of some priority interventions; inadequate financing and delays in the disbursement of funds, poor staff attitude and low productivity due to insufficient monitoring and supervision across all levels of the GHS. There is also general lack of commitment and little accountability for performance. NHI claims as a major source of funds remain poorly managed resulting in delays in payment claims The GHS will continue to use the HIRD strategy as basis for scaling up interventions whilst systematically rolling up the CHPS strategy as well as ‘modernize’ clinical care services with special emphasis on maternal and child health outcomes. Priority Activities

• GHS will continuously mount surveillance and timely report on epidemic prone diseases with a view to ensuring rapid response to and effectively manage and control epidemics

• GHS will continue to scale up the implementation of interventions based on the HIRD strategy.

• All GHS health facilities will be prepared to meet accreditation standards as defined by NHI law including strengthening referral systems, instituting quality assurance programmes and providing 24 hour essential services.

• Training in financial management including auditing will be done at all levels and monitoring and supervision will be improved to ensure compliance to available financial rules and regulations.

• The peer review mechanism and district league performance table will be extended as mechanism to motivate lower level managers to perform.

• Introduce systems to improve management and access to health information at the district level.

• Ensure compliance to planned preventive maintenance plans at all levels • Refine and clarify strategies and programmes for promoting gender equity • As part of the modernization agenda the GHS will introduce ICT extensively into

clinical care and as basis for improving claims management. • Quality of midwifery care will receive greater attention and negative staff attitude

will be addressed. Expected Results

• Coverage of key health interventions • Proportion of health institutions meeting accreditation criteria • Timeliness and completeness of surveillance reports • Quality of midwifery care

Collaborators Ministry of Health, Ghana Statistical Service, Ministry of Education Science and Sports (MESS), Ministry of Local Government, Rural Development and Environment

22

(MLGRDE), Christian Health Association of Ghana (CHAG), Quasi-government institutions, Teaching hospitals, Private Sector including NGOs, Research Institutions, Professional and Civil Society Organisations, Regulatory Bodies, St John Ambulance, Ghana Red Cross, Centre for Scientific Research into Plant Medicine (CSRPM), Ministry of Private Sector Development, Ministry of Water Resources, Works and Housing, Development Partners, National Health Insurance Council, Media and Public, Ghana AIDS Commission

6.2.2. CHRISTIAN HEALTH ASSOCIATION OF GHANA Institutions under CHAG exist to contribute to the efforts of the health sector to improve the Health status of the people living in Ghana. CHAG member Institutions are predominantly located in the hard to reach areas with a few in urban slums and are therefore positioned to provide services to the poor and marginalized in fulfilment of Christ’s Healing Ministry. In this context CHAG institutions see the regenerative health programme as a central strategy to the overall efforts to improve the health of people living in these catchment areas. In fulfilling this mandate, CHAG member institutions are faced with the problem of inadequate human resource and weak management capacities and systems. In particular the health information systems at both the secretariat and institutions are not properly developed and this affects their ability to manage and provide services effectively. Finally, CHAG secretariat does not have the requisite personnel, skills and experience to effectively manage and report on its financial activities. The Thrust of the Christian Health Association of Ghana is to draw on its comparative advantage to innovate, fill service gaps and improve quality of health services. Priority Activities

• Set up a Health Management Information system at the secretariat and institutions for data capture and reporting including financial reporting.

• Re-orient and train health workers in the regenerative health and nutrition and other HIRD programmes including a healthy schools programme with emphasis on hygiene, physical exercise and school feeding.

• Collaborate with District Assemblies and other stakeholders to support the scaling up of Community based Planning and Services (CHPS) especially in deprived districts and communities, with focus on increasing package of public health services delivered

• Establish screening and management programmes for diabetes, hypertension, cancers, sickle cell, and asthma in all designated CHAG district hospitals

• Initiate a programme to engage the services of specialised health care providers through a volunteer/part time/exchange schemes.

Expected Results

• Professional staff recruited. • An operational HMIS • Timely and accurate monthly, quarterly and yearly financial reports.

23

Collaborators Ministry of Health (MoH), Ghana Health Service (GHS), Development Partners, District Assemblies, Communities

6.2.3. TEACHING HOSPITALS

6.2.3.1. KORLE BU TEACHING HOSPITAL Korle Bu Teaching Hospital (KBTH) was established to provide tertiary health care for all Ghanaians. It is also to provide facilities to educate and train health professionals, conduct research and provide specialist outreach services to all Ghanaians. Currently KBTH has 17 clinical and diagnostic departments and units and has an average daily out-patients attendance of 1,200 with an admission rate of about 150 patients per day.

The hospital faces on daily basis, challenges such as overcrowding and congestion of departments and wards by patients. In addition to this there are obsolete medical equipment and deteriorating physical structures. These challenges pose a threat to effective and efficient health care delivery at the hospital. The thrust for 2008 is to ensure that resources are directed towards improving the provision of quality tertiary health care through the upgrading of the infrastructure and review of standards of operation at all clinical and management levels. Priorities Activities

• Reorganise services to focus on referral and tertiary services and improve the quality of patient care

• Introduce programmes to promote regenerative health and behaviour change among client.

• Put in place programmes aimed at attracting and retaining the required number of staff to ensure quality of care.

• Expand, modernise and rehabilitate physical structures and facilities, equipment and tools;

• Review financial management systems and improve on internal controls as part of the revenue mobilization efforts.

• Upgrade connectivity and ICT infrastructure to improve information management • Develop operational research capacity at all levels

Expected Results

• Increase in number of referred cases as against OPD cases • Physical structures modernized and rehabilitated • Financial management practices and internal controls improved • Staffing levels improved • New equipment provided to replace obsolete ones

24

Collaborators Ministry of Health, GHS, KATH, Tamale Teaching Hospital, Medical & Dental Council, Nurses and midwives Council, University of Ghana Medical School, School of Public Health, Pharmacy Council, CHAG, Mutual Health Insurance Organization and National Health Insurance Council,.

6.2.3.2. KOMFO ANOKYE TEACHING HOSPITAL Komfo Anokye Teaching Hospital is mandated to provide specialist clinical care services, train under graduate and post graduate medical students and undertake research into emerging health issues in Ghana. However due to funding difficulties the hospital has not been able to fulfil this mandate as expected. Emergency cases recorded over the past 3 years have increased and it is expected that this will increase further in 2008 due to hosting of CAN 2008 in Ghana. Maternal and child deaths are still unacceptably high. The situation is compounded by the congestions at both the Paediatric and Obstetrics and Gynaecology wards. Management systems are also weak resulting in inadequate number of human resources, especially specialized nursing cadres, inadequate equipment and inadequate physical infrastructure. The thrust for 2008 is to improve quality of services for better care outcomes by improving the human resource base and health infrastructure of the hospital. Priority Activities

• Scale up specific specialised services such as Urology, Neurology, Dialysis and Accident and Emergency.

• Introduce the provision of Paediatric Cardio thoracic, Orthodontic and Advanced Restorative and MRI services

• Reconstitute and strengthen mortality audit committees • Expand library facilities for students and Practitioners • Set up faculty for the training of critical care Physicians and Nurses • Conduct operational research, including patient satisfaction surveys • Conduct research into emerging diseases like HIV/AIDS, Diabetes and

Hypertension • Intensify performance monitoring, quality assurance and promote financial

accountability and controls.

Expected Results • Improved care outcomes (reduced institutional deaths) • Increased efficiency in use of resources (optimal use of hospital beds and other

resources) • Improved critical care services (human resource for critical care developed) • Operational research activities increased

Collaborators Ministry of Health, Korle Bu Teaching Hospital, Tamale Teaching Hospital, Ghana Health Service, Medical and Dental Council, Nurses and Midwives Council, Pharmacy Council and Kwame Nkrumah University of Science and Technology.

25

6.2.3.3. TAMALE TEACHING HOSPITAL The Tamale Teaching hospital is currently in the process of being upgraded into a teaching facility for the University of Development Studies. Consequently the focus of its activities is related to building the requisite capacity for tertiary and teaching services. In addition the hospital aims at improving quality and affordable referral services by well-trained, highly motivated and customer-friendly professional health staff. The major challenges facing the hospital are the weaknesses in management and support systems particularly with respect to information and records management, equipment management and the inadequate human resource base. In addition to these challenges there are general weaknesses in financial management leading to poor revenue mobilization. There are also significant weaknesses in procurement practices and planned preventive maintenance. To address these challenges, the 2008 programme will focus on building overall management capacity, initiate moves to improve the human resource base and putting in place mechanisms to improve revenue generation. The thrust for 2008 will be on building strong, effective and efficient management and support systems and structures to enhance service delivery and to build capacity towards effective tertiary Health Care and Medical Education Priority Activities

• Decentralise management structures through the creation of sub-BMCs • Develop strategic plan to attract and retain the requisite staff numbers and staff mix • Set up a functional emergency service including emergency preparedness plan. • Initiate activities to improve internal revenue generation and to control expenditure

and minimise waste • Implement a planned preventive maintenance programme for buildings, equipment

and transport • Review and improve records and information management in all departments • Reorganise the procurement and stores management system in accordance with the

procurement law and manual • Reconstitute and strengthen mortality audit committees

Expected Results

• Management practices improved (New management structure with designated sub-BMCs created)

• Staff numbers increased • Revenue generation improved • Emergency services functional

Collaborators Ministry of Health, Korle Bu Teaching Hospital, Tamale Teaching Hospital, Ghana Health Service, Medical and Dental Council, Nurses and Midwives Council, Pharmacy Council, DMHIS

26

6.2.4. PSYCHIATRIC HOSPITALS

The Mental Health Unit seeks to promote mental health, prevent mental illness, provide quality mental health care to persons with mental illness and ensure a sustainable, equitably distributed quality and efficient client-centered community based mental health service to all people in Ghana. The Mental Health Unit has two components: the institutional component comprising the three psychiatric hospitals at Accra, Pantang and Ankaful, and the community component comprising the psychiatric wings of some regional and district hospitals, and community psychiatric nursing. Stigma at all strata of the society remains the core and bane of mental health care. Stigma prevents patients from seeking early treatment and leads to relatives abandoning their wards at the hospitals and in the communities. Through stigma, mental health is often considered as an afterthought in decision making. Human resource remains a major problem in mental health care. There is general shortage of health workers but this is even much more acute in mental health sector. Currently there are about 500 psychiatric nurses for 22 million people in Ghana, giving a ratio of 1 nurse to 44,000 people. The ratio for consultant psychiatrists is 1:2 million people. This poses a great challenge to accessibility and quality of care. Mental health services are skewed to the southern sector as there is no psychiatric hospital north of Accra. Non-availability of psychotropic drugs is another major issue. The old generation drugs are still being prescribed and these are often in short supply. Even though these drugs are purchased at a heavy cost, the current procurement system sometimes leads to expiry of the drugs bought. In addition inadequate financing is an obstacle to mental health care. By policy, mental health care is free and the government is the sole financier yet the release of funds has been inadequate and irregular. This leads to a handicap in our ability to deliver quality care. The National Health Insurance Scheme also does not adequately address mental health. The 2008 POW of mental health combines the three psychiatric hospitals and the activities of the national coordinator of community psychiatric nursing. The thrust for 2008 is to improve the human resource capacity for Mental Health and ensure that all individuals especially the poor and the vulnerable groups have access to quality mental health care. Priority Activities

• Implement programmes to train and recruit additional psychiatric nurses and psychiatrists

• Conduct Research into mental health issues • Re-equip laboratories for the 3 facilities • Ankaful

a. Increase revenue generation by expansion and improvement of mortuary services

b. Re-equip the operating theatre and rehabilitation centre • Accra

a. Provide 24-hour service for dispensary b. Decongest the wards,

• Pantang a. Establish infirmary wing for physically ill patients b. Establish detoxification unit for alcohol and substance abuse

27

c. Establish VCT and prevention of mother to child transmission services for HIV prevention

d. intensify outreach services and mental health education e. Institute private partnership programmes to improve mental health services

in the communities. Expected Results

• Coverage of outreach services • Number of psychiatric nurses and psychiatrists trained/recruited • Functional Detoxification unit established for Pantang • Functional laboratories for all facilities • % increase in IGF

Collaborators Ministry of Health, the 3 Teaching Hospitals, CHAG, Ghana Health Service, NGOs/CSOs

6.3. NATIONAL AMBULANCE SERVICE The mandate of NAS is to provide pre hospital care to the sick and the injured and transport them to health facilities. It aims to improve the outcome of accidents and emergencies through efficient and timely pre hospital care. However, the coverage of ambulance services is limited to regional capitals and a few districts. NAS also lacks the right calibre of personnel and services are limited to provision of only basic care. Again, health institutions also have inadequate infrastructure to respond appropriately to accidents and emergencies. The thrust for 2008 is to increase access to emergency care through the establishment and operation of an efficient nationwide ambulance service. Priority Activities

• Establish 6 additional ambulance stations • Recruit and train 100 emergency medical technicians (EMT)- Basics and upgrade

the skills of 45 EMT- Basics to EMT- Advance. • Introduce a program to ensure timely and efficient management of emergencies • Screen and immunize at risk EMTs against hepatitis B • Strengthen the functional and communication linkages between NAS, facility

based ambulance and health facilities • Finalise the NAS bill for approval by cabinet and passage by parliament

Expected Results

• Six new ambulance stations established/number of districts with functional ambulance services.

• One hundred EMT-Bs trained and 45 EMT- Bs upgraded • Immunisation of 100% EMTs against hepatitis B

Collaborators Ghana Health Service, Ghana national Fire Service, District Assemblies, NADMO, Quasi-Government Hospitals, Teaching Hospitals, CHAG Facilities.

28

6.4. REGULATION

6.4.1. FOOD AND DRUGS BOARD The Food and Drugs Board was set up by the PNDCL 305B (1992) to regulate the manufacture, importation, exportation and distribution of food, drugs, cosmetics, medical devices and household chemicals in the country. In Pursuance of Sections of this law, and in order to ensure the safety and quality of regulated products, the Board prepares guidelines to provide players and stakeholders in the food and drug industry with the requirements of the Food and Drugs Board (FDB) and also provide a comprehensive procedure for bringing their activities into compliance with the law. In line with these provisions the Board has made a strong presence at the ports of entry to inspect, collect data and store information for appropriate regulatory decision-making. Despite these achievements, the capacity of the board to protect consumers from locally manufactured goods is limited due to inadequate personnel. This calls for a concerted effort to extend regulatory activities to the district through increased involvement of the district assemblies. The FDB Policy Thrust for 2008 is to improve surveillance on locally produced food and medicinal products and to protect the consumer by ensuring the safety and efficacy of food and drug products on the local market as well as food and drug products processed for export.

Priority Activities

• Develop relevant regulations and guidelines to ensure food and drug safety • Mount a comprehensive Public Awareness campaign on Food and Drug Safety • Train identified food processors with special emphasis on schools feeding

programmes, major street-food joints and selected local restaurants. • Plan and execute regulatory enforcement programmes in collaboration with the

Metropolitan, Municipal and District Assemblies. • Review and improve systems for continuous monitoring and assurance of quality,

safety of food and medicines including traditional medicines

• Finalize the framework and manual for pharmaco-vigilance Expected Results

• Guidelines on food and drug safety developed • Improved knowledge in basic food safety among food processors and handlers • Increased surveillance activities on safety of food and medicinal products

Collaborators Ministry of Health, Ghana Health Service, The Ghana Standards Board (GSB), Environmental Protection Agency (EPA), Ghana Tourist Board (GTB), Pharmacy Council, Veterinary Council

29

6.4.2. NURSES AND MIDWIVES COUNCIL The Nurses and Midwives Council of Ghana is mandated to regulate nursing and midwifery education and practice. With the current rise in the numbers of trainee nurses, the responsibility of the Council has increased. This situation is compounded by the dwindling staff numbers leading to increased workload and reduction in staff morale within the council. Due to ineffective collaboration between the Council and health care facilities in the country, there are difficulties in regulating standards of nursing and midwifery practice. The effect is that most cases of professional misconduct are not reported to the Council. The thrust of the council for 2008 is to ensure increased adherence to standards of nursing and midwifery practice within health facilities with emphasis on the public sector. Priority Activities

• Recruit more staff to augment the existing staff numbers in the Council. • Update the knowledge of nursing and midwifery educators and practitioners on

current trends in the profession • Conduct support supervisory visits with the view to enforcing standards of

professional practice at all health institutions and facilities throughout the country • Prepare curricula for new post basic nursing programmes like paediatrics, accident

and emergency, community Psychiatry. • Decentralize activities of the Council by establishing two more zonal offices in

Ashanti and western regions • Conduct operational research on topical nursing issues e.g. Attitude of nurses

Expected Results

• Staff numbers of the Council is improved • Supervision strengthened through increased visits to training schools and sites • New curricula for post basic nursing programmes developed. • Two zonal offices of council established.

Collaborators Ghana Health Service(GHS), Teaching Hospitals, National Accreditation Board (NAB), all nursing and midwifery training institutions , International Nursing and Midwifery Regulatory Bodies and Associations, Health Partners (WHO, USAID, CHPS-TA, QHP, DANIDA, GSCP), Christian Health Association of Ghana (CHAG), and the Universities.

6.4.3. MEDICAL AND DENTAL COUNCIL The Medical and Dental Council is a statutory governmental agency that regulates the standards of training and practice of medicine and dentistry in Ghana. It operates by prescribing, developing and enforcing high standards of medical and dental practice that will ensure the safety of the public. It also works through empowering the public to become active participants in their medical and dental treatments.

30

The Council has inadequate requisite staff to manage the secretariat and this affects it operations and the regular update of the register. The council is also faced with inadequate numbers of accredited facilities for training housemen in specific disciplines leading to congestion at the two teaching hospitals in the country. The existing standards and guidelines also need to be reviewed in the context of new developments and policy shifts in the health sector. The thrust of the council for 2008 is to strengthen human resource capacity to improve on regulatory activities of the council. Priority Activities

• Recruit staff to augment the current workforce of the Council • Develop A Comprehensive Registration Information Documentation System • Accredit 2 regional hospitals and 10 district hospitals for housemanship training in

Internal Medicine, Obstetrics and Gynaecology, Paediatrics, and Surgery • Develop policy and guidelines on Continuing Professional Development (CPD) • Develop standards and guidelines for facilities and practitioners to ensure ‘fitness

to practice’ medicine and dentistry. • Review curricula of training institutions to respond to current trends and

developments. Expected Results

• The capacity of the council to pursue its mandate is improved (update of register to reflect actual numbers of doctors and dentists practicing in the country)

• Training Institutions’ curricula reviewed • 10 district and 2 regional hospitals accredited for housemanship training • Standards and guidelines of professional practice updated.

Collaborators

Training Institutions (Kwame Nkrumah University of Science and Technology School of Medical Sciences, University of Ghana Medical School), Teaching Hospitals, Ghana Health Service, Private Hospitals and Maternity Homes Board, Ghana Medical Association, Society of Private Medical and Dental Practitioners

6.4.4. PHARMACY COUNCIL The Pharmacy council seeks to guarantee the highest level of pharmaceutical care to Ghanaians. In addition, the Council collaborates with related local agencies and international pharmaceutical organizations to enhance the effectiveness of pharmaceutical services and rational medicines use in the country. Though progress has been made to extend pharmaceutical services to all parts of the country, problems with regard to equitable distribution of these services still remain. There is also the need to protect the rights of the consumer by ensuring that medicines are used rationally.

31

The thrust of the pharmacy council for 2008 will be to work towards improving access of Pharmaceutical facilities to deprived areas and to empower consumers to use medicines rationally. Priority Activities

• Develop and implement policies and programmes to enhance access to deprived areas

• Institute public education activities on rational medicines use (RUM) and danger of drug abuse

• Work with collaborators in the pharmaceutical industry to assure quality of medicines available to the population.

• Expand pharmaceutical services to increasingly cover the deprived areas. Expected Results

• Increase number of licenses issued to pharmacies and chemical sellers in deprived areas.

• Percentage population knowledgeable in RUM increased Collaborators Pharmaceutical Society of Ghana, Food and Drugs Board, Ghana Standards Board, Ghana Police Service, Media, NGOs, District Assemblies

6.4.5. TRADITIONAL MEDICINE PRACTICE COUNCIL

The Traditional Medicine Practice Council has the mandate to regulate the practice of traditional medicine in Ghana. Presently the legal instruments to guide its functions and operations exists however the Council is still not in place even though the secretariat has been established. Currently, the key challenges of the Secretariat of the Council include inadequate resources to pursue its mandate effectively. There is inadequate staff capacity and efforts at building these have progressed slowly. These have greatly affected the secretariat’s ability to enforce regulatory provisions on Traditional Medicines Practitioners of which the majority have not received formal education. The thrust for 2008 is to continue to build structures to enable the secretariat enforce the provisions of the law on Traditional Medicine Practice in Ghana

Priority Activities

• Advocate for the establishment of the Traditional Medicine Practice Board • Recruit staff to augment the existing numbers in the secretariat • Organise awareness creation/ public education activities and sensitization on the

registration and licensing of Traditional Medicine Practitioners. • Certify Traditional Medicine Practitioners and licence Practice Premises. • Develop standard Operating Procedures Manuals for quality assurance in

traditional medicines practice.

32

Expected Results • Effective structures for the regulation and practice of Traditional Medicine in

Ghana • At least 500TMPs registered and certified and 300 licensed practice premises.

Collaborators Ministry of Health, College of Health Sciences- Kwame Nkrumah University of Science and Technology, World Health Organization, Pharmacy Council, Food and Drugs Board ,Centre for Scientific Research into Plant Medicine, Ghana Federation of Traditional Medicine Practitioners Association and Ghana Association of Medical Herbalists (GAHM).

6.4.6. PRIVATE HOSPITALS AND MATERNITY HOMES BOARD

The Private Hospitals and Maternity Homes Board was established to assist in the provision of appropriate regulations relating to private health care practice and the delivery of appropriate services by approved private hospitals and maternity homes. The laws and statutes governing health service provision and public health protection are fragmented and inadequate in ensuring quality and efficiency in the private sector. There are different standards for regulating private sector and public sector services. The institutional framework for regulating the sector relies on sanctions for enforcement, with very limited emphasis on providing incentive support and monitoring and evaluation. Non-enforcement and malfunctioning of regulation has also led to the non-recognition of the capabilities and contributions of the Board to the sector’s outcome. In addition the activities of the board have been affected by inadequate management systems and resource flow.

The thrust for 2008 is to reorganize and equip the board to improve on its regulatory function. Priority Activities

• Update database on private health care sector • Review and amend existing legal instruments to ensure that same standards are

used in regulating both public and private health sectors. • Advocate for the establishment of a council for the board. • Assist in the identification of underserved areas for locating facilities to ensure

equitable distribution of private facilities across the country Expected Results

• Private healthcare facilities database updated • Revised and Amendment legal instruments • Functional council established

Collaborators Ministry of Health, Private Medical and Dental Practitioners association, Ghana registered Midwives Association, Medical and Dental Council, Nurses and Midwives Council, Pharmacy Council,

33

6.5. RESEARCH AND TRAINING

6.5.1. CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE

The Centre for Scientific Research into Plant Medicine has the mandate to undertake research and development of plant medicine and to liaise with Traditional Medicine Practitioners in plant medicine development and dissemination of research findings. The center currently works on developing herbal medicines from local herbs, some of which are cultivated under programme of development of local medicinal plants. The center also runs a clinical unit which treats patients with products developed at the center and runs clinical trials on new products. Products developed by herbalists are also sometimes brought for analysis. The key challenge is inadequate budgetary allocation to expand services to meet the ever growing demand for herbal products and information on herbal medicines in use in Ghana. The other challenge is the retention of the core technical and research officers due to high attrition as a result of poor remuneration. The thrust for the centre in 2008 is to reposition the center to respond to the changing needs for herbal medicines in health care delivery in Ghana. Priority Activities

• Reprioritise research on herbal medicines to focus on priority diseases of public health importance.

• Initiate a recruitment exercise to improve staffing situation at the centre. • Streamline procedures for the provision of technical support services to Traditional

Health Practitioners. • Undertake training of students/interns in herbal medicine development and provide

research information on traditional medicines. • Research and develop Herbal Medicines into modern dosage forms. • Establish 2 satellite centers for clinical services

Expected Results

• Increased use of herbal medicinal products developed at the center in health facilities including public health institutions

• Internship programme for Medical Herbalist streamlined. • Two satellite centers for clinical services established

Collaborators CSIR (Health and Environment), Food and Drugs Board, Noguchi Memorial Institute for Medical Research, University of Ghana, KNUST, Traditional Medicine Practice Council, WHO, Other Development Partners, Health training Institutions, Aberdeen University, Scotland, University of Michigan, USA.

6.5.2. TRAINING INSTITUTIONS Training of Health Professionals in Ghana is a shared responsibility between Ministry of Education, Ministry of Health, the private sector and quasi government organizations.

34

However, there has not been much collaboration and consultations between the stakeholders in the production of health professionals. This has created a gap between planning, production and placement of certain categories of health professionals like herbal medicine practitioners and nurse practitioners. There is therefore the need to ensure effective collaboration between the Training Institutions in the public sector and the other sectors to create synergies and harmonization in training. In the last five years, the Ministry has made significant gains in the production of Health professionals following the establishment of new schools and restructuring of programmes as well as expansion of existing schools. These measures have resulted in the establishment of Ghana College of Physicians, Direct Midwifery Training, Direct Medical Assistants Training, Diploma in Community Health and the Middle level cadre Training. Production of certain categories of health professionals has been scaled up resulting in an average of 20% increase in admission into the Health Training Institutions. However, production of health professionals has seen implementation difficulties in the areas of infrastructure, equipment and capacity of tutors. The need to strengthen capacities of Training Institutions is therefore paramount. The policy thrust of the Ministry is to provide adequate resources to support training of appropriate cadres of the health workforce. Priority Activities

• Scale up middle level cadre training with emphasis on midwifery and medical assistants.

• Increase the number of trainees admitted into the training schools. • Increase resource allocation to the training institutions • Organise Continuing professional education for tutors • Work with District Assemblies and other agencies to identify and sponsor students

within deprived areas for middle level training Expected Results

• 20% increase in enrolment of midwives and medical assistants • 35 existing libraries supplied with books • 20 existing demonstration rooms equipped • 10 additional practical sites accredited and 15 new preceptors identified and

trained. • 120 tutors upgraded • 20% of students admitted sponsored by District Assemblies and other agencies

6.5.3. GHANA COLLEGE OF PHYSICIANS AND SURGEONS

The Ghana College of Physicians and Surgeons was mandated to train specialists in medicine, surgery and allied specialties to meet the needs of the country. The college has made a lot of progress since its inception although problems such as inadequate physical facilities, poor revenue mobilisation and poor financial management practices remain. The managerial capacities of administrative staff also need upgrading to bring the performance of the college to acceptable standards. Also, the college is finding it difficult to accredit

35

adequate health facilities to support the training of its students because most facilities are less endowed with the requisite resources. The thrust of the college’s policy is to expand the continuous professional development programme, improve training outcomes and build general capacities to enable the college operate more efficiently. Priority Activities

• Formulate guidelines for the smooth running of the continuous professional development programme

• Generate revenue by offering the college’s facilities to the general public for seminars, workshops and conferences

• Arrange for short training courses, seminars and workshops for the accounting and audit staff of the college to upgrade their knowledge and competencies.

• Provide specialist education in medicine, surgery and related disciplines, • Conduct research in medicine, surgery and related disciplines. • Collaborate with stakeholders to improve the facilities and human resource base of

accredited health facilities • Prepare and publish journals

Expected Results

• Number of articles published • Number of specialists produced • Number of professionals benefitting from continuous professional development • Formulation of guidelines for the professional development programme. • Increased revenue generation to support the college’s activities

Collaborators Ministry of Health, Medical and Dental Council, Medical schools, Teaching Hospitals, Ghana Health Service, Ministry of Education, School of Public Health

36

7. CAPITAL INVESTMENT This section of the POW addresses a combination of investments in infrastructure, equipment, Information Communications Technology (ICT) and transport including ambulance for sustaining and expanding the delivery of health services. In that regard this section contributes to the targets set under Strategic Objective 3 of the POW by strengthening health system capacity to expand, manage and sustain a high coverage of high quality health interventions and services for promoting health, preventing diseases, treating the sick and rehabilitating the disabled. A review of the capital investment environment shows some key challenges that need to be addressed in 2008. These include:

• The increasing demand for health services in response to the National Health Insurance Scheme and the need to scale up achievement of health related Millennium Development Goals. This includes the increasing demand to expand the national Ambulance Service to all regions and districts

• Threats to quality of care arising out of deteriorating health infrastructure and obsolete equipment

• Disruption of the health services from the devastating effects of the recent floods in the affected regions of the country;

• Inadequate funds for the huge capital investment contributing to the several uncompleted capital projects as well as outstanding payments owed to contractors, suppliers and consultants for work done on various projects;

• Ageing of vehicles and relatively slow deployment of ICT affecting service delivery and management.

• Understanding the health service capacity needs of the newly created districts • Rapid urbanisation with its attendant pressures on limited health facilities. • Inadequate emergency and epidemic preparedness of health facilities

The Thrust of the 2008 Investment POW is to complete ongoing projects with priority to projects with significant contribution to enhancing quality and equitable access to health care and scaling up achievement of health related MDGs. Priority Activities Criteria for 2008 Capital Expenditure Priorities

• Commitments such as Matching Funds required for projects funded under mixed credits/grants and payment of accumulated debts from 2007;

• Projects with 100% secured/earmarked funding; • Ongoing projects procured under international competitive tendering with legal

implications for GOG arising from delays in payments; • Ongoing projects with high level of completion and substantial sunk cost that can

be completed in 2008; • Investments that respond to priorities of the MOH POW III (2007 – 2011) and the

MOH Health Policy with emphasis on investments that could propel the achievement of the MDGs by 2015;

• Basic emergency and essential obstetric care equipment, transport and ambulance requirements;

• MIS/ICT requirements for full integration of the NHIS and its DMHIS

37

Infrastructure

• Finalize the 2007-2011 Capital Investment Plan • Execute the 2008 Capital Investment plan with emphasis on projects that promote

equity and improve quality of care. These include Offices for regulatory bodies, Facilities for training institutions, Staff accommodation, CHIPS and health centres, District hospitals, DHMT & RHMT office facilities, Accident and emergency preparedness facilities, Specific facilities in regional and tertiary hospitals, Reconstruction/rehabilitation of health facilities destroyed by recent floods

• Deploy the Capital Investment Planning Model in the development of the 2009 Capital Investment Plan

• Appraising and mobilizing resources to finance priority projects including renovation and planned preventive maintenance of existing health service facilities

• Design a framework for routine progress and expenditure tracking system for capital investment in collaboration with Development Partners;

• Collaborate with the District Assemblies to construct and equip CHPS compounds in the sub-districts.

Equipment • Provide equipment for emergency and essential obstetric care in selected districts • Develop sustainable strategies for financing planned preventive maintenance and

replacement of equipment • Review, rationalize and manage equipment maintenance contracts such as contracts

with Taylor & Taylor, Philips, etc. • Provide requisite equipment for CHPS facilities constructed by the District

Assemblies of the Ministry of Local government and Rural Development; • Install and commission equipment procured under Spanish Protocol in selected

hospitals Transport and Ambulance

• Implement the medium term vehicle replacement plan targeting over aged vehicles particularly in the deprived districts;

• Monitor and enforce adherence to guidelines on transport use and management; • Ensure financing and implementation of planned preventive maintenance to

increase vehicle availability; • Procurement of ambulances to support expansion of National Ambulance Service

and upgrading existing ones to enhance quality of Ambulance Service.

Information Communication Technology (ICT) • Implement a strategic plan to support the development of an integrated and

consolidated National Health Information System including a link between financial management and service delivery information;

• Scale up the district wide system for information management in collaboration with NHIS and the District Mutual Insurance Schemes to ensure the availability of accurate and reliable routine service-based data;

• Deploy integrated MIS solution and ICT to health institutions and District Mutual Health Insurance Scheme as part of the NHIS-World Bank funded ICT project aimed at effective communication between the schemes, the secretariat and service providers;

38

• Maintain and continuously update the MOH website The following major projects with secured funding and completed preparatory activities including appraisals will be commenced:

• Major rehabilitation and upgrading of Tamale Teaching Hospital ORET funding • Construction of Bekwai and Tarkwa District Hospitals under ADB III • Construction District Hospital at Nkawie with ORET funding • Sunyani Regional Hospital staff accommodation project

Expected Results The following projects will be completed and commissioned:

• Ghana College of Physicians and Surgeons office complex at Ridge. Currently the facility is only at the stage of practical completion.

• Offices and Laboratories for Food and Drugs Board • Offices for the Nurses and Midwifes Council • Office Complex and Training Centre for NAS/ST. John’s Ambulance, Accra • KBTH Medical Block • Doctors’ Flats at KBTH • KATH Maternity and Children’s Hospital • National Accident and Emergency Centre at KATH • Doctors’ and Nurses’ Flats at KATH • Office blocks for Ghana Health Service at LFC • Gushegu District Hospital • Dental facilities in 22 hospitals nationwide under ORET sponsorship. Final

completion envisaged in 2008 • 35 District hospital projects including 3 under OPEC sponsorship • 43 Health Centres nationwide including 21 under OPEC sponsorship • 2nd Phase of the Bolgatanga Regional Hospital project with BADEA funding • 6 no. DHMT & RHMT office facilities • 34 no. staff accommodation projects in selected districts • 50 new CHPS Compounds • Reconstruction/rehabilitation of about 50 district health facilities destroyed by

floods in the 3 northern regions comprising mainly CHPS, nutrition and health centers

• Equipment procured under the Spanish Protocol installed and commissioned to replacement obsolete equipment in selected hospitals and health centres.

• Procurement of basic essential obstetric and emergency equipment • Procurement of transport for various levels of the sector with emphasis on the

districts • Integrated MIS solution and ICT infrastructure for NHIS deployed nationwide. • Classroom and/or hostel blocks in 10 selected nursing training institutions.

39

8. 2008 HEALTH SECTOR BUDGET The year 2008 which marks the second year of the third Five Year Program of Work of the sector is a year of uncertainty as far as funding of the sector is concerned. This suggests that an end to the initial SWAp arrangement is in sight. The health sector 2008 budget derives from the third health sector Medium Term Expenditure framework.

The sector is going through a budgetary transition. From the previous common fund arrangements of having most of our donor funding passed through the Health Fund (or pooled donor funds) most of the funding from our health partners will now be channelled through the sector budget support (SBS) and the earmarked funds. On the other side, the NHIS is beginning to play a major role in the funding of the sector.

It is not clear how the SBS will operate. It is also not certain how inflows from the NHIS would be. The only traditional source which remains the same is the GOG source but even there ,sharp variation in proportion of funding to the item levels do exist with the implementation of the new salary regime which proves to leave little for the service provision, support and investment services.

Macro level analysis of 2008 allocation to the MOH Of total GOG vote of GH¢2.805 billion, the MOH has been allocated GH¢ 0.268 billion constituting 9.6% compared with the 2007 provision of 13.8% of GOG to the ministry. This is a 4 percentage fall from the 2007 provision. In nominal terms there is an increase. The likelihood that this would be revised upwards exists because of the head count which is still in progress. What ever the increase may be, the P.E. would take a near 80%age of the total. As in previous years, not much would be available for service delivery and service delivery will suffer if no buffers are found. MOH’s share of the total of Donor, IGF and HIPC is 12.7%, 38.5%, and 2% respectively. Overall, 12.1 % of MOFEP ceilings has been allocated to the MOH. This level is yet below the 15% Abuja pledge. Table 1 presents these details.

Table1: Macro level analysis of 2008 allocation as presented by MOFEP1 (‘000) GOG Donor User fee HIPC Total

MOH 268,509.10 126,731.00 115,071.00 2,500.00 512,811.10 Total country 2,805,928.00 1,000,166.00 299,184.00 127,550.00 4,232,828.00

MOH share of total (%)

9.6 12.7 38.5 2.0 12.1

1 The expected NHIF inflows are not included.

40

Total 2008 resource envelope

A total resource envelope of GH¢ 722.573 million is expected to finance the health sector in 2008. GoG provides the largest with 37.2%2 followed by NHIS, User fee, Budget support, Earmarked Funds, and HIPC inflows with 32.6%, 15.6%, 7.3% , 7% and 0.3% respectively –see Table 2 a

Against the GH¢ 921.1 million estimated as the need in 2008 (see Table 3) a funding gap of GH¢198.5 million exists.

Table 2a : Total 2008 resource envelope(‘000 GH cedi Source GOG NHIS User Fee HIPC Budget Support Earmarked Total

level

268,509

235,430 112,630 2,500 52,866 50,638 722,573 % of total 37.2 32.6 15.6 0.3 7.3 7.0 100.0

The trends of the health budget from 2005-2008 indicate nominal increases in successive years. The budget increased by 33.34% in 2006 from 2005 and in 2007 increased by 18.68% over the 2006 level, whiles in 2008 (Indicative) the increase has been 33.87 over the 2007 level. These do not include the NHIF. With the NHIF added the increase of 2006 over 2005 was 95% (The operation of the NHIF began in 2006 which accounts for the big jump.) The increase in 2007 over 2006 was 22% whilst the increase in 2008 over 2007 with the NHIF inclusive is 28%. Considering the level of inflation, these can be said to be increases in real terms. It should however be noted again that the PE component over shadows most of these increments.

Table 2b: Trend of MOHbudget allocation (GH¢ ‘000) (Total Budget excluding NHIF) ITEM/YEAR 2005 2006 2007 2008

1 132,896.00 172,938.00 221,437.00 254,7672 20,283.00 24,350.00 25,101.00 42,966.003 32,136.00 79,804.00 96,754.00 120,788.004 59,961.00 49,962.00 44,845.00 101,081.64

Total 245,276.00 327,054.00 388,137.00 519,602.64 % Increase over previous year 33.34 18.68 33.87 National total Budget including NHIF 245,276.00 478,419.00 583,737.00 748,234.00 % Increase over previous year 95.00 22.00 28.00

2 A head count is underway of all health staff and the exact amount to be provided for personal emoluments is yet to be determined. Meanwhile, a …estimate of GH¢298 million is projected.

41

Item-wise distribution of 2008 budget

The share of resource by item indicates that item 1 constitutes 35.26%, Item two constitutes 8.09% while items 3 and 4 constitute 42.83% and 13.82% respectively (see table 2c). The table also indicates the source of funding the items. Item one is financed basically by GOG although NHIS and user fees also provide for some item one. User fee and the NHIS are the major source for item 2 with GOG providing about half the levels of NHIS and user fees. The biggest source of funding for item three is the NHIS while item four funding source is earmarked funds and the NHIS. Table 2c provides the details.

Table 2c : Total resource envelope by item and source in GH¢ ‘000

Source GOG NHIS User fee. HIPC Budget Support

Earmarked * Total

% of total

Item 1 239,311.00 10,490.00 4,966.00 254,767.00 35.26Item 2 10,904.10 21,820.00 24,736.00 500 500 58,460.10 8.09Item 3 10,039.00 148,780.00 74,299.00 39,900.00 36,467.85 309,485.85 42.83Item 4 8,263.10 54,330.00 8,629.00 2500 12,466.00 13,669.81 99,857.91 13.82Total 268,517.20 235,420.00 112,630.00 2,500.00 52,866.00 50,637.67 722,570.87 100.00% of total 37.16 32.58 15.59 0.35 7.32 7.01 100.00

* level of Earmarked is still in compilation and not definite Detailed analysis of 2008 by item

The 2008, health sector budget is guided by the principle of efficiency gains to ensure prudent allocation of resources. The budget also tries to protect essential commodities, pro poor activities and public health programmes through ring fencing. There is a gradual shift of resources from IGF generating institutions to non IGF generating institutions as well as support to pro poor and other public health programmes.

The table 3 below shows the total health budget by source and how this has been allocated to the sub-items and to support 2008 health programmes.

Personnel Emoluments – Item 1 Personal emoluments are costs pertaining to manpower employed by the Ministry of Health to carry out its functions. The item one budget prioritizes payment of salaries of staff at post and other related expenditure as summarised in Table 3. The main source of Item 1 expenditure is GOG and it constitutes 86% of the total GoG vote and 29.46% of the national health budget. The NHIF vote for Item 1 covers the emoluments of the Council and District Secretariats of the District Mutual Health Insurance Secretariats. The IGF component of item one is used to pay for the emoluments of contract workers in the IGF generating institutions. The total need is GH¢ 298 million as against GH¢ 254.767 million indicative available

Administrative Services - Item two These are the overhead costs and include items such as utilities, maintenance of vehicles & equipment printing and publication, office consumables, allowances, etc.. The main

42

funding sources of Administrative cost of the Ministry of Health are GOG and user fees/NHIF. It must be said that most of the NHIF funding goes to support the NHI council and the DMHIS. Table 3 provides details on the share out to item two. Service Vote - Item 3 Service vote covers the cost of service delivery incurred by BMCs in their operations and covers a wide range of activities that underpin the core functions of the Ministry and its agencies. These include essential commodities expenditure, public health goods, special programmes, and pro poor activities. The table3 shows how the Service budget for 2008 has been allocated. Apart from the operational cost of agencies which are decentralised, most of the Item 3 vote has been ring fenced to ensure that the essential inputs required for service delivery are protected. Ring fenced items are centrally located at MOH headquarters and this explains the relatively high percentage of the budget found in the summary table. Investment- Item 4 The aggregated budget available for the sector in 2008 by all sources of funding is GH¢101.081 million compared with a total need of GH¢254.159 leaving a gap of GH¢153.07 million

Allocation to Agencies Tables 4a, b & c present allocations to the agency level of the 2008 budget. In table 4a, some ring-fenced items have been lodged in Health Hq but to be benefited especially by the district level. Sending the ring-fenced items to the beneficiary levels, as in tables 4b and 4c, the allocations become clearer. The non-wage recurrent share indicates 59% to the district level, 18% to the Teaching Hospitals, 9% to GHS Regional health services, 5% to Health Hq and 1 percent each to GHS Hq and Psychiatry hospitals. The Health Hq includes all the Medical Statutory bodies and other subvented organizations. This excludes NHIS.

Table 4a: 2008 budget by item and sub-head (including undistributed NHIF) Ring fenced lodged in Headquarterss* INCL NHIS level/item PE Admin Service Investment TOTAL % Total Ministry of Health 254,767,000 41,966,617 266,283,063 101,081,644 654,807,649 100Health Headquarters 26,322,950 1,934,297 4,061,294 78,065,887 110,384,428 17Subvented Organizations 6,357,000 1,192,000 3,738,000 2,992,000 14,279,000 2Teaching Hospitals (Tertiary Health Services) 61,396,336 8,500,081 11,594,498 3,594,033 85,084,948 13Ghana Health Service Headquarters 3,598,385 813,466 883,416 13,786,124 19,081,391 3Psychiatry Hospitals (Tertiary Health Services) 15,579,209 631,513 396,903 0 16,607,625 3Regional Health Services 16,730,684 7,970,011 2,663,604 0 27,364,299 4District Health Services 101,991,761 20,043,439 5,893,052 103,800 128,032,052 20Training Institutions 13,500,000 881,810 1,632,296 2,539,800 18,553,906 3National Health Insurance. 0 0 235,420,000 0 235,420,000 36

* The investment vote under Health Hqrs includes debt servicing to be administered by the MOFEP.

43

Table 4b: 2008 budget by item and sub-head) excluding NHIS, and RINGFENCED SENT TO THE BENEFICIARY LEVELS level/item PE Admin Service Investment TOTAL % Total Ministry of Health 254,767,000 42,966,617 70,763,063 101,081,644 460,287,649 100Health Headquarters 26,322,950 1,934,297 4,061,294 78,065,887 110,384,428 24Subvented Organizations 6,357,000 1,192,000 3,738,000 2,992,000 14,279,000 3Teaching Hospitals (Tertiary Health Services) 61,396,336 8,500,081 11,594,498 3,594,033 85,084,948 18Ghana Health Service hq 3,598,385 813,466 883,416 13,786,124 19,081,391 4Psychiatry Hospitals (Tertiary Health Services) 15,579,209 631,513 396,903 0 16,607,625 4Regional Health Services 16,730,684 7,970,011 2,663,604 0 27,364,299 6District Health Services 101,991,761 21,043,439 45,793,052 103,800 168,932,052 37Training Institutions 13,500,000 881,810 1,632,296 2,539,800 18,553,906 4National Health Insurance. 0 0 0 0 0 0 Table 4c: NON WAGE RECURRENT (excluding NHIS) level/item PE Admin Service Investment TOTAL % Total Ministry of Health 42,966,617 70,763,063 113,729,680 100Health Headquarters 1,934,297 4,061,294 5,995,591 5Subvented Organizations 1,192,000 3,738,000 4,930,000 4Teaching Hospitals (Tertiary Health Services) 8,500,081 11,594,498 20,094,579 18Ghana Health Service hq 813,466 883,416 1,696,882 1Psychiatry Hospitals (Tertiary Health Services) 631,513 396,903 1,028,416 1Regional Health Services 7,970,011 2,663,604 10,633,615 9District Health Services 21,043,439 45,793,052 66,836,491 59Training Institutions 881,810 1,632,296 2,514,106 2National Health Insurance. 0 0 0 0 0

44

Table 3: Details at item and sub-item/programme level (‘000 GH¢)

Need GOG HIPC Budget Support NHIS IGF Earmarked

Total Available Gap

ITEM 1 Established post

241,670.00 225,318.00 10,490.00 235,808.00 5,862.00 Trainees on Payroll

6,007.00 6,007.00 6,007.00 0.00 Regulatory Bodies

1,151.00 1,151.00 1,151.00 0.00 Ambulance Services

1,080.00 1,080.00 1,080.00 0.00 Attrition

-8,140.00 -8,140.00 -8,140.00 0.00 Training Allowance

-160 -160 -160.00 0.00 Contract Appointments

9,897.00 4,966.00 4,966.00 4,931.00 Promotion

9,164.00 0.00 9,164.00 Waiting for financial clearance

10,284.00 10,284.00 10,284.00 0.00 Waiting for processing onto pay roll

3,771.00 3,771.00 3,771.00 0.00 Recruitments

22,582.00 0.00 22,582.00 Consultancy

471 0.00 471.00 Intake into training institutions

360 0.00 360.00

Subtotal 298,137.00 239,311.00 0.00 0.00 10,490.00 4,966.00 0.00 254,767.00 43,370.00

0.00

ITEM 2 -

Operational costs for MOH & agencies excl NHIS

33,420.00

8,684.00 24,736.00 33,420.00 0.00 Cuban Doctors 1,000.00 1,000.00

1,000.00 0.00 Procurement 3,000.00

0.00 3,000.00 Reviews, health summits and Audits

2,000.00 500

500 1,000.00 1,000.00 Blood Transfusion 300 120

120.00 180.00 ICT Maintainance 100 100

100.00 0.00 Audit/ Financial Magt Strengthen

1,000.00 500

500.00 500.00 NHIS Administration / Logistics

21,820.00

21,820.00 21,820.00 0.00

Subtotal 62,640.00 10,904.00 0 500 21,820.00 24,736.00 0 57,960.00 4,680.00

-

ITEM 3 -

Operational costs for MOH & agencies excl NHIS 42,827.00 7,128.00 34,699.00 41,827.00 1,000.00

Procurement 0.00 0.00

Pharmaceutical 36,660.00 36,660.00 36,660.00 0.00

Vaccines 7,133.00 1,900.00 2,000.00 3,233.00 7,133.00 0.00

Contraceptives 3,986.00 300 1,400.00 1,986.00 3,686.00 300.00

TB drugs 450 450 450.00 0.00

Procurement of psychiatric drugs 450 450 450.00 0.00

45

Printing & Publication 940 500 440 940.00 0.00

HIV/AIDS 1,200.00 1,200.00 1,200.00 0.00

Malaria/ACT 8,402.00 500 7,902.00 8,402.00 0.00

ITNs 6,820.00 2,000.00 2,000.00 2,820.00 6,820.00 0.00

Basic health equip / Cold Chain 1,146.00 500 500.00 646.00

Anti Snake & Rabies 2,538.00 1,500.00 1,500.00 1,038.00

Subtotal 112,552.00 7,428.00 - 10,400.00 4,000.00 71,799.00 15,941.00 109,568.00 2,984.00

Programme -

Nutrition and malaria project 6,650.00 100 6,550.00 6,650.00 0.00

Guinea worm eradication activities 3,000.00 203 1,000.00 1,203.00 1,797.00

Cumunicable diseases (pro-poor) 1,000.00 1,000.00 1,000.00 0.00

Screening Program ( general prostate and breast mammogram 1,000.00 1,000.00 1,000.00 0.00

Specialist outreach Services 1,500.00 500 500.00 1,000.00

Counterpart for WFP 500 200 200.00 300.00

MCH Campaigns 18,000.00 5,000.00 5,000.00 13,000.00

HIRD implementation 17,000.00 1,000.00 11,000.00 5,000.00 17,000.00 0.00

Regenerative Health & Nutrition 3,000.00 2,000.00 2,000.00 1,000.00

Labiofarm 2,000.00 1,000.00 1,000.00 1,000.00

Equipment maintenance and reagents 5,000.00 2,500.00 2,500.00 5,000.00 0.00

Productivity Improvement Initiatives 200 200 200.00 0.00 Strategic Initiative Fund

1,000.00 0.00 1,000.00 Emergency preparedness 5,000.00 300

800 1,100.00 3,900.00

Sub total 64,750.00 1,803.00 - 26,000.00 - 2,500.00 11,550.00 41,853.00 22,897.00

-

Exemption -

Buruli Ulcer 500 500 500.00 0.00

Refund of Medical exemptions 3,560.00 500 3,060.00 3,560.00 0.00

Piloting NHIS subsidies 500 500 500.00 0.00

Support to Finacially Distressed Schemes 5,000.00 5,000.00 5,000.00 0.00

Premium for poor people under NHIS 134,730.00 134,730.00 134,730.00 0.00

Sub total 144,290.00 - - 1,500.00 142,790.00 - - 144,290.00 0.00 Overseas conferences

500 400 400.00 100.00

Fellowship 2,000.00 300 1,500.00 1,800.00 200.00

Budget and PoW 100 100 100.00 0.00

46

Health Research 500 500 500.00 0.00

Sub total 3,000.00 800 - 2,000.00 - - - 2,800.00 200.00

Grand Total Item 3 306,199.00 10,031.00 0 39,900.00 146,790.00 74,299.00 27,491.00 298,511.00 7,688.00

Investment 0.00

Emergency and Essential Obstetric Care Equipment 18,493.00 4,000.00 2,000.00 2,000.00 6,629.00 3,864.00 18,493.00 0.00 Infrastructure

214,000.00 4,263.10 2,500.00 8,466.00 39,340.00 17,167.00 71,736.10 142,263.90 Transport and Ambulances

4,000.00 2,000.00 2,000.00 4,000.00 0.00 MIS & ICT

13,706.00 11,280.00 2,116.00 13,396.00 310.00 NHIS Reserve Fund

3,960.00 3,710.00 3,710.00 250.00

Total 254,159.00 8,263.10 2,500.00 12,466.00 56,330.00 8,629.00 23,147.00 111,335.10 142,823.90 Grand Total

921,135.00 268,509.10 2,500.00 52,866.00 235,430.00 112,630.00 50,638.00 722,573.10 198,561.90

47

48

2008 Donor Inflows

Revenue Table 1 Donor Funds for 2008 In 000 GH¢

Earmarked Donor Sector Support Health Fund Grant Loan Total Item 1 Item 2 Item 3 Item 4 Unallocated DFID 25,944 0 0 0 25,944 0 0 0 0 DANIDA 4,508 0 0 0 4,508 0 0 0 0 DUTCH 22,880 0 0 0 22,880 0 0 0 0 KUWAIT(TA for MCH) 0 0 138 0 138 0 0 0 0 BMH (Gusheigu) 0 0 2,208 1,380 3,588 0 0 0 1,148 BMH (Dist. Dental Fac) 0 0 773 0 773 0 0 0 0 UNICEF 0 0 6,624 0 6,624 0 0 0 0 6,624IDA(Regional HIV/AIDS) 0 0 3,680 0 3,680 0 0 0 0 AfDB((Trypon. Program) 0 0 1,380 0 1,380 0 0 0 0 AfDB(HSR III) 0 0 3,542 2,447 5,989 0 0 0 10,579 NDF (HSSP) 0 0 0 221 221 0 0 0 0 NDF(Health Serv. Rehab) 0 0 0 3,091 3,091 0 0 0 0 WFP 0 0 1,104 0 1,104 0 0 0 0 1,104WHO 0 0 7,259 0 7,259 0 0 0 0 7,259JICA 0 0 4,720 0 4,720 0 0 0 0 4,720USAID 0 0 23,368 0 23,368 0 0 0 0 23,368UNFPA(Reprodutive Hlth 0 0 2,208 0 2,208 0 0 0 0 2,208GAVI 0 0 1,720 0 1,720 0 0 0 0 1,720GLOBAL FUND 0 0 34,675 0 34,675 0 0 0 0 34,675BADEA 0 0 0 258 258 0 0 0 1,285 BELG (Clinical Lab Proj) 0 0 0 3,864 3,864 0 0 0 0 WORLD BANK - Malaria and Nutrition 0 0 0 4,600 4,600 0 0 0 0 World BANK - Health Insurance 0 0 0 2,116 2,116 0 0 0 0 OPEC - 2nd RHSP 0 0 0 1,960 1,960 0 0 0 1,074

49

SARG - Health Cent. Pro 0 0 0 460 460 0 0 0 0 460GRAND TOTAL 53,332 0 93,398 20,396 167,127 0 0 0 14,086 153,041Pipeline Agreements Tamale Teaching Hospital (ORET) 0 0 0 16,350 16,350 16,350 0 Other Sectors Dfid Multi-sector HIV 0 0 3,220 0 3,220 0 0 0 0 3,220Danida - HIV/AIDS NSF II Basket 0 0 184 0 184 0 0 0 0 184Danida - AIDS SWAp 0 0 1,656 0 1,656 0 0 0 0 1,656World Bank (Multi-Sector HIV/AIDS) 0 0 0 3,680 3,680 0 0 0 0 3,680UNFPA(Pop. & Devt) 0 0 1,288 0 1,288 0 0 1,288 0 0

9. PERFORMANCE ASSESSMENT FRAMEWORK

9.1. MILESTONES In 2008, the health sector will continue to consolidate its mutually reinforcing policies and priorities initiated in 2007. It will also continue with the unfinished agenda of high impact and rapid service delivery in addition to consolidating and strengthening the weak and fragmented health system. It will further enhance governance through sustainable financing. Specifically, these will be done through

(i) scaling up both programmes of regenerative health and nutrition and high impact rapid delivery to all regions;

(ii) further rationalizing salaries of health workers particularly through the implementation of initiatives that promote and augment workforce productivity; and

(iii) expanding the coverage of the National Health Insurance Scheme while being cognizant of issues of equity, efficiency and financial sustainability.

These will be complemented by additional initiatives to be vigorously pursued in the following areas:

(a) promotion of safe food and access to water with the object of reducing food and water borne diseases;

(b) enhancement of the quality and coverage of clinical care including referrals, revamping of hospitals and mortuaries, development of clinical protocols, provision of infrastructure and equipment to laboratories, pharmacies and theatres;

(c) expansion of middle level training programmes targeted at the training of medical assistants, midwives, and health assistants for the sub-districts while enhancing workforce productivity with improved HMIS; and

(d) strengthening of inter-sector collaboration.

9.2. INDICATORS AND TARGETS The table below shows the indicators and targets for measuring and assessing performance of the health sector in 2008.

50

51

9.3.

Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

GOAL ONE: Ensure that children survive and grow to become healthy and productive adults that reproduce without risk of injuries or death and age healthily

1 IMR 71 (2001) N/A 64 53

2 U5MR 111 (2001) N/A 105 90

3 MMR Survey to provide baseline N/A N/A3 To be determined after the baseline

4 U5 prevalence of low weight for age 18% (MICS 2006) N/A 16% 12%

5 Total Fertility Rate 4.4 N/A 4.3 4.2

GOAL TWO: Reduce the excess risk and burden of morbidity, disability, and mortality especially in the poor and marginalized groups

6 HIV+ prevalence among pregnant women 15-24 years 3.2 <4.0 <4.0 <4.0

7 Incidence of Guinea worm 4,136 <3,500 <3,500 <1500

GOAL THREE: Reduce inequalities in access to health services and health outcomes

8 Equity Index: Poverty (U5 Mortality Rate) 1.18 (118:100)

N/A 1.18

1.18

9 Equity Index: Geography (services) (Supervised deliveries) 1: 2.05 (WR 26.5: CR 54.3) N/A 1: 2.05 1:1.8

10 Equity Index: Geography (resources) (Nurses: Population) 1: 4.14 (Upper West: 1: 44,317 to Total population 1: 10,700)

N/A 1:3.5 1:2.5

11a Equity Index: NHIS Gender (Female/Male card holder ratio)

Not currently measured but will be captured in 2008.

N/A N/A To be set once baseline is developed.

11b Equity Index: NHIS poverty (Ratio lowest quintile to whole population who hold NHIS cards)

Baseline to be developed from District MICS 2007

N/A N/A To be set once baseline is developed

3 The non-applicable status is due to the baseline currently being collected, therefore at this stage a target cannot be set.

52

Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

Thematic Area 1: Healthy Lifestyle and Healthy Environment4

12 % of households with sanitary facilities 18%(MICS 2006) N/A 70

85%

13 % of households with access to improved source of drinking water

74% (DHS 2003)

N/A 78 90%

14 Obesity in adult population 25.3% (DHS 2003women age 15-49 with BMI ≥25.0)

N/A 25%5 20%

Thematic Area 2: Provision of Health, Reproduction and Nutrition Services

15 % children 0-5 months exclusively breastfed 54% (MICS / DHS) N/A 60% 74.4%

16 % deliveries attended by a trained health worker 45% 59% 60% 70%

17 Contraceptive Prevalence Rate (CPR) (For modern methods)

0.19 (DHS 2003)

0.27 0.28 0.35

18 Antenatal care coverage 69.4 (DHS 2003) 95% 95% 99%

19 % of U5s sleeping under ITN 35% 60% 60%

80%

4 The targets set in this thematic area are desired targets; they are not within the health sector’s remit and therefore the sector cannot be held accountable 5 The target is not ambitious due to the RHNP is not expected to have an impact for a few years

53

Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

20 % of children fully immunised by age one 84% (This is for Penta3) 90% 92%

94%

21 HIV+ clients receiving ARV therapy 7,388 25,000 38,000 71,000

22 Outpatients attendance per capita (OPD) 0.53 (OPD) 0.60 0.60 1.2

23 Institutional maternal mortality rate 2.19/1000 1.75/10001.80/1000 1.5/1,000

24 TB treatment success rate 72.30% 85% 80% 85%

25 % population live within 8km of health infrastructure Baseline not set N/A To be set once baseline is determined.

To be set once baseline is determined.

26a Doctor: population ratio 1:10, 641 26b Nurse: population ratio 1: 1,587

27 % total MTEF expenditure on health 15%

15.5% 15.5% 16%

28 % non-wage GOG recurrent budget allocated to district level and below

48%

>40% >40% >40%

29 Per capita expenditure on health 21.45 24.64 39.11 67.32

30 Budget execution rate (by source, by line item and by level) For GOG: (Item 1 – 100%, Item 2 – 100%, Item 3 – 74%, Item 4 – 109%) HIPC – 94% Donor – 71.9%

31 % of annual budget allocations to items 2 and 3 (GOG and HF) disbursed to BMCs by the end of June

For Item 2 – 50% of budget released by end June.

32 % of population with valid NHIS membership card 25% 55% 65% 80%

54

Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

33 Proportion of claims settled within 4 weeks Not currently measured, will develop baseline once ICT is in place

N/A To bedeveloped once baseline is set.

To be developed once baseline is set.

34 % of IGF from NHIS 45% N/A 55% 70%

Monitoring and reporting on the performance of the health sector in 2008 will be approached from three main angles. Firstly, a year on year tracking of progress based on the sector-wide indicators will be undertaken. In 2008 steps will be taken to continue to refine some of the indicators which are being introduced for the first time in the Five Year POW. Tracking these indicators will require significant agreement on the definitions and criteria for data collection and efforts will be made to work on these during the year. District coverage surveys will be undertaken to validate data from the routine data collection system. The second approach will be through the Intra and inter agency performance hearing system. Guidelines will be provided to all agencies on the mechanism for the performance hearings and efforts will be made to improve the structured participation of all stakeholders. The third approach will be the Annual Review activities which will include in-depth reviews and the independent review exercise.

9.4. RISKS AND ASSUMPTIONS The major risks to the successful implementation of the POW are outlined as follows:

• Budget execution (predictability, timeliness and adherence)

o Approved budget is not fully released. The sector would continue to dialogue and review plans and programmes

o Funds for the implementation of programmes and activities are released late. Reprioritisation of plans and programmes

• The continuing unresolved HR management challenges which can lead to industrial unrests. Continue to dialogue with the stakeholders and ensure industrial harmony exists at all levels

• Unusually large disasters that will require mass shifts of resources. In 2008 this is very real as a result of the following:

o Hosting of Ghana 2008. Work with Local organising Committee to put in place emergency measures to prevent any disaster before, during and after the Ghana 2008 football tournament Possibilities of Epidemic outbreaks. Ensure there is a National Epidemic Response Plan

o Impending elections during 2008. Work with various stakeholders to minimise violence during and after elections

• Performance of the economy o Inflation. Keep reviewing plans and programmes to keep expenditure

within budget limits o Energy and utilities. Efficient utilisation of resources and reprioritise plans

and programmes

The successful implementation of the programme of work is based on the assumption that all the programmes and activities outlined will translate into verifiable outcomes that will lead to the attainment of the set objectives. It also assumes the following:

• The health problems and challenges defined and for which programmes have been designed are valid.

• The estimated budget is approved for disbursement

55

• The budget estimated is adequate for all financial requirements for the implementation of the POW

• The approved budget is disbursed in a timely manner and rationally utilised • The budget earmarked for the POW is executed to the level where programmes and

activities are not adversely affected. • All BMCs have the minimum required capacities including requisite staff in the

utilisation of resources for the activities outlined • All collaborators play their expected roles in the implementation process • Procurement plan is adhered to • There is no force majeure

56

10. ANNEXES

57

Annex 1: CAPITAL INVESTMENT PLAN

58

59

Table 1: Agency/BMC Allocations

ITEM AGENCY/TITLE OF PROJECT 2008 BUDGET PROVISION

GH(¢)

% OF 2008 TOTAL

BUDGET A GHANA HEALTH SERVICE

1 Selected CHPS, HC, DH, DHNT, RHMT & staff accommodation projects with high level of completion and sunk cost that can be completed in 2008 9,193,614.98

2 Sunyani Regional Hospital staff accommodation project 5,500,500.00 3 Reconstruction/rehabilitation of sub-district facilities destroyed by floods in 3 northern regions 1,200,000.00 4 Matching Fund for BADEA Projects - Rehabilitation of Bolgatanga Regional Hospital 2,371,440.00 5 Matching Fund for ADB III/NDF Projects 12,590,746.16 6 Matching Fund for OPEC II Projects (21 No. Health Centres) 370,812.52 7 Matching Fund for OPEC II Projects (3 No. District Hospitals) 985,003.48 8 Procurement of Equipment & Transport 12,855,543.00

9 Sub-Total 45,067,660.14 42.32

B TRAINING SCHOOLS

1 Allocation for selected projects in CHNTS, SOH, HATS, Nursing & Midwifery training institutions with high sunk cost that can be completed in 2008 2,189,800.00

2 Construction of Offices & Lecture Halls for the Ghana College of Physicians and Surgeons at Ridge, Accra 350,000.00

3 Sub-Total 2,539,800.00 2.38

C TEACHING HOSPITALS 1 KORLE BU TEACHING HOSPITAL i Refurbishment of the Medical Block 2,000,000.00 ii Refurbishment of the Maternity Block 700,000.00 iii Preparatory works for Urology Department 500,000.00 iv Surgical Medical Emergency 80,000.00 v Drug Addiction Rehab. Centre 270,000.00 vi Plastic Surgery 354,457.00

vii Sub-Total 3,904,457.00 3.67 2 KOMFO ANOKYE TEACHING HOSPITAL i Completion of Maternity and Children’s' Block 2,000,000.00 ii Completion of Doctors' Flats 318,000.00 iii Purchase of ICT/Computers 232,701.00 iv Refurbishment of Wards 78,375.00 v Completion of Office Complex/Resource Dev. Centre 285,000.00

60

vi National Accident & Emergency Centre 8,689,620.60 vii Sub-Total 11,603,696.60 10.90

3 TAMALE TEACHING HSPITAL i Major Rehabilitation and Upgrading of Tamale Teaching Hospital 17,125,500.00 ii Sub-Total 17,325,500.00 16.08

D STATUTORY BODIES/SUBVENTED ORG. 1 Construction of Offices and Laboratories for Food and Drugs Board 1,750,000.00 2 Office Complex and Training Centre for National Ambulance Service in Accra 401,896.00 3 Construction of Offices for the Nurses and Midwives Council 605,599.22 4 Investment Requirement for CSRIPM & TAMD 737,005.00 5 Investment Requirement for Pharmacy Council 32,000.00

6 Completion of office accommodation and construction of staff accommodation for Medical and dental Council 120,000.00

7 National Health Insurance Council/Infrastructure, ICT & Reserve Fund (Excluding KATH A+E & others) 18,605,189.70

8 Sub-Total 22,251,689.92 20.90

E MOH HEADQUARTERS/NATIONAL 1 Transport and Ambulances 4,000,000.003 Sub-Total 4,000,000.00 3.76

F GRAND TOTAL 106,492,803.65

61

Table 2: Allocations per Expenditure Priorities

ITEM PRIORITY LEVEL/TITLE OF PROJECT 2008 BUDGET PROVISION

GH(¢)

% OF 2008 TOTAL

BUDGET

A. MATCHING FUNDS & OTHER COMMITMENTS

1 Matching Fund for BADEA Projects - Rehabilitation of Bolgatanga Regional Hospital 2,371,440.00

2 Matching Fund for ADB III/NDF Projects 12,590,746.16 3 Matching Fund for OPEC II Projects (21 No. Health Centres) 370,812.52 4 Matching Fund for OPEC II Projects (3 No. District Hospitals) 985,003.48 5 Major Rehabilitation and Upgrading of Tamale Teaching Hospital 17,125,500.00 6 2007 Outstanding Bills 1,693,200.00

7 Sub-Total 33,443,502.16 31.40

B. PROJECTS PROCURED UNDER ICB WITH LEGAL CONSEQUENCES FOR DELAYED PAYMENTS

1 National Accident & Emergency Centre at KATH 8,689,620.60 2 Construction of Offices and Laboratories for Food and Drugs Board 1,750,000.00 3 Construction of Offices for the Nurses and Midwives Council 605,599.22 4 Sunyani Regional Hospital staff accommodation project 5,500,500.00

5 Construction of Offices & Lecture Halls for the Ghana College of Physicians and Surgeons at Ridge, Accra 350,000.00

6 Sub-Total 16,895,719.82 15.87

C. ONGOING PROJECS WITH HIGH LEVEL OF COMPLETION & COLOSSAL SUNK COSTS

1 Refurbishment of the KBTH Medical Block 2,000,000.00 2 Refurbishment of the KBTH Maternity Block 700,000.00 3 Preparatory works for KBTH Urology Department 500,000.00

62

4 KBTH Surgical Medical Emergency 80,000.00 5 KBTH Drug Addiction Rehab. Centre 270,000.00 6 KBTH Plastic Surgery 354,457.00 7 Completion of KATH Maternity and Children’s Block 2,000,000.00 8 Completion of Doctors' Flats at KATH 318,000.00 9 Refurbishment of Wards at KATH 78,375.00

10 Completion of KATH Office Complex/Resource Dev. Centre 285,000.00

11 Office Complex and Training Centre for National Ambulance Service in Accra 401,896.00

12 Investment Requirement for CSRIPM & TAMD 737,005.00 13 Investment Requirement for Pharmacy Council 32,000.00

14 Completion of office accommodation and construction of staff accommodation for Medical and dental Council 120,000.00

15 Sub-Total 7,876,733.00 7.40

D. ONGOING INVESTMENTS THAT RESPOND TO POW PRIORITIES & MDG'S

1 Selected CHPS, HC, DH, DHNT, RHMT & staff accommodation projects with high level of completion and sunk cost that can be completed in 2008

9,193,614.98

2 Reconstruction/rehabilitation of sub-district facilities destroyed by floods in 3 northern regions

1,200,000.00

3 National Health Insurance Infrastructure & Reserve Fund (Excluding NHIC ICT & KATH A+E) 7,325,,189.70

4 Sub-Total 17,718,804.68 16.64

E NURSING TRAINING INSTITUTIONS PROJECTS

63

1 Allocation for selected projects in CHNTS, SOH, HATS, Nursing & Midwifery training institutions with high sunk cost that can be completed in 2008

2,189,800.00

2 Sub-Total 2,189,800.00 2.06

F EQUIPMENT, TRANSPORT & ICT

1 Purchase of ICT/Computers for KATH 232,701.00 2 ICT requirements for NHIC 11,280,000.00

3 GHS Procurement of Equipment & Transport for Districts 12,855,543.00

4 National Transport and Ambulances 4,000,000.00

5 Sub-Total 28,368,244.00 26.64

G GRAND TOTAL 106,492,803.65

2008 CAPITAL INVESTMENT BUDGET

SOURCE OF FUNDING (GH¢) TITLE OF PROJECT

COST TO COMPLETION

GH(¢)

2008 BUDGET

PROVISION GH(¢) GOG DONOR EARMARKED HHIS HIPC I

CY/BMC ALLOCATIONS

HEALTH SERVICE CHPS, HC, DH, DHNT, RHMT commodation projects with high ompletion and sunk cost that can eted in 2008

13,458,530.98 9,193,614.98 0.00 1,926,200.00 1,147,539.98 4,840,000.00 1,27

Regional Hospital staff dation project 9,000,000.00 5,500,500.00 2,000,000.00 3,500,500.00

ction/rehabilitation of sub-cilities destroyed by floods in 3 gions

2,000,000.00 1,200,000.00 1,200,000.00 0.00 0.00 0.00 0.00

Fund for BADEA Projects - ation of Bolgatanga Regional 2,404,450.00 2,371,440.00 1,086,640.00 0.00 1,284,800.00 0.00 0.00

Fund for ADB III/NDF Projects 25,156,117.00 12,590,746.16 2,011,772.78 0.00 10,578,973.38 0.00 0.00 Fund for OPEC II Projects (21 h Centres) 1,824,664.16 370,812.52 89,992.52 0.00 280,820.00 0.00 0.00

Fund for OPEC II Projects (3 ct Hospitals) 3,106,860.59 985,003.48 191,643.48 0.00 793,360.00 0.00 0.00

nt (Emergency & Essential Care) 25,000,000.00 12,855,543.00 0.00 4,000,000.00 3,864,000.00 2,000,000.00 0.00 2,99

l 81,950,622.73 45,067,660.14 6,580,048.78 5,926,200.00 21,449,993.36 6,840,000.00 0.00 4,27% of 2008 Investment Budget 42.32 79.63 47.54 52.32 20.86 0.00 4

NG SCHOOLS

n for selected projects in SOH, HATS, Nursing & training institutions with high that can be completed in 2008 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00 ion of Offices & Lecture Halls

hana College of Physicians and at Ridge, Accra 350,000.00 350,000.00 0.00 350,000.00 0.00 0.00 0.00 l 8,982,189.50 2,539,800.00 0.00 2,539,800.00 0.00 0.00 0.00 % of 2008 Investment Budget 2.38 0.00 20.37 0.00 0.00 0.00 0

NG HOSPITALS BU TEACHING HOSPITAL ment of the Medical Block 2,000,000.00 2,000,000.00 0.00 0.00 2,000,000.00 0.00 0.00 ment of the Maternity Block 700,000.00 700,000.00 0.00 0.00 0.00 0.00 0.00 70ry works for Urology nt 500,000.00 500,000.00 0.00 0.00 0.00 0.00 0.00 50

Medical Emergency 80,000.00 80,000.00 0.00 0.00 0.00 0.00 0.00 8iction Rehab. Centre 270,000.00 270,000.00 0.00 0.00 0.00 0.00 0.00 27rgery 354,457.00 354,457.00 0.00 0.00 0.00 0.00 0.00 35l 3,904,457.00 3,904,457.00 0.00 0.00 2,000,000.00 0.00 0.00 1,90% of 2008 Investment Budget 3.67 0.00 0.00 4.88 0.00 0.00 2

ANOKYE TEACHING AL on of Maternity and Childrens'

2,000,000.00 2,000,000.00 0.00 0.00 0.00 2,000,000.00 0.00 on of Doctors' Flats 318,000.00 318,000.00 0.00 0.00 0.00 0.00 0.00 31of ICT/Computers 232,701.00 232,701.00 0.00 0.00 0.00 0.00 0.00 23ment of Wards 250,000.00 78,375.00 0.00 0.00 0.00 0.00 0.00 7on of Office Complex/Resource re 4,000,000.00 285,000.00 0.00 0.00 0.00 0.00 0.00 28

Accident & Emergency Centre 8,689,620.60 8,689,620.60 0.00 0.00 0.00 5,344,810.30 3,344,810.30 l 15,490,321.60 11,603,696.60 0.00 0.00 0.00 7,344,810.30 3,344,810.30 91% of 2008 Investment Budget 10.90 0.00 0.00 0.00 22.40 100.00 1

E TEACHING HSPITAL

habilitation and Upgrading of eaching Hospital 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00 l 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00 % of 2008 Investment Budget 16.08 9.39 0.00 39.88 0.00 0.00 0

ORY BODIES/SUBVENTED

ion of Offices and Laboratories and Drugs Board 1,750,000.00 1,750,000.00 0.00 0.00 1,200,000.00 0.00 0.00 55mplex and Training Centre for

Ambulance Service in Accra 521,896.00 401,896.00 401,896.00 0.00 0.00 0.00 0.00

ion of Offices for the Nurses wives Council 757,600.00 605,599.22 505,555.22 0.00 0.00 0.00 0.00 10nt Requirement for CSRIPM &

737,005.00 737,005.00 0.00 0.00 0.00 0.00 0.00 73nt Requirement for Pharmacy

32,000.00 32,000.00 0.00 0.00 0.00 0.00 0.00 3on of office accommodation and on of staff accommodation for nd dental Council 250,000.00 120,000.00 0.00 0.00 0.00 0.00 0.00 12

Health Insurance nfrastructure, ICT & Reserve cluding KATH A+E & others) 29,445,189.70 18,605,189.70 0.00 0.00 0.00 18,605,189.70 0.00 l 33,493,690.70 22,251,689.92 907,451.22 0.00 1,200,000.00 18,605,189.70 0.00 1,53% of 2008 Investment Budget 20.90 10.98 0.00 2.93 56.74 0.00 1

EADQUARTERS/NATIONAL , Motor Bikes and Ambulances 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00 l 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00 % of 2008 Investment Budget 3.76 0.00 32.09 0.00 0.00 0.00 0

TOTAL 233,096,781.52 106,492,803.65 8,263,000.00 12,466,000.00 40,999,993.36 32,790,000.00 3,344,810.30 8,62

ATIONS BY EXPENDITURE PRIORITIES

ING FUNDS & OTHER TMENTS Fund for BADEA Projects -

ation of Bolgatanga Regional 2,404,450.00 2,371,440.00 1,086,640.00 0.00 1,284,800.00 0.00 0.00

Fund for ADB III/NDF Projects 25,156,117.00 12,590,746.16 2,011,772.78 0.00 10,578,973.38 0.00 0.00 Fund for OPEC II Projects (21 h Centres) 1,824,664.16 370,812.52 89,992.52 0.00 280,820.00 0.00 0.00 Fund for OPEC II Projects (3 ct Hospitals) 3,106,860.59 985,003.48 191,643.48 0.00 793,360.00 0.00 0.00

habilitation and Upgrading of eaching Hospital 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00 l 91,267,591.75 33,443,502.16 4,155,548.78 0.00 29,287,953.38 0.00 0.00 % of 2008 Investment Budget 31.40 50.29 0.00 71.43 0.00 0.00 0

TS PROCURED UNDER H LEGAL

QUENCES FOR DELAYED NTS Accident & Emergency Centre

8,689,620.60 8,689,620.60 0.00 0.00 0.00 5,344,810.30 3,344,810.30

ion of Offices and Laboratories and Drugs Board 1,750,000.00 1,750,000.00 0.00 0.00 1,200,000.00 0.00 0.00 55

ion of Offices for the Nurses wives Council 757,600.00 605,599.22 505,555.22 0.00 0.00 0.00 0.00 10Regional Hospital staff dation project 9,000,000.00 5,500,500.00 2,000,000.00 0.00 3,500,500.00 0.00 0.00 ion of Offices & Lecture Halls

hana College of Physicians and at Ridge, Accra 350,000.00 350,000.00 0.00 350,000.00 0.00 0.00 0.00 l 20,547,220.60 16,895,719.82 2,505,555.22 350,000.00 4,700,500.00 5,344,810.30 3,344,810.30 65% of 2008 Investment Budget 15.87 30.32 2.81 11.46 16.30 100.00 7

NG PROJECS WITH HIGH OF COMPLETION & HUGE OSTS ment of the KBTH Medical

2,000,000.00 2,000,000.00 0.00 2,000,000.00 0.00 0.00 ment of the KBTH Maternity

700,000.00 700,000.00 0.00 0.00 0.00 0.00 0.00 70ry works for KBTH Urology nt 500,000.00 500,000.00 0.00 0.00 0.00 0.00 0.00 50rgical Medical Emergency 80,000.00 80,000.00 0.00 0.00 0.00 0.00 0.00 8ug Addiction Rehab. Centre 270,000.00 270,000.00 0.00 0.00 0.00 0.00 0.00 27astic Surgery 354,457.00 354,457.00 0.00 0.00 0.00 0.00 0.00 35on of KATH Maternity and Block 2,000,000.00 2,000,000.00 0.00 0.00 2,000,000.00 0.00

on of Doctors' Flats at KATH 318,000.00 318,000.00 0.00 0.00 0.00 0.00 0.00 31ment of Wards at KATH 250,000.00 78,375.00 0.00 0.00 0.00 0.00 0.00 7

on of KATH Office Resource Dev. Centre 4,000,000.00 285,000.00 0.00 0.00 0.00 0.00 0.00 28mplex and Training Centre for

Ambulance Service in Accra 521,896.00 401,896.00 401,896.00 0.00 0.00 0.00 0.00 nt Requirement for CSRIPM &

737,005.00 737,005.00 0.00 0.00 0.00 0.00 0.00 73nt Requirement for Pharmacy

32,000.00 32,000.00 0.00 0.00 0.00 0.00 0.00 3on of office accommodation and on of staff accommodation for nd dental Council 250,000.00 120,000.00 0.00 0.00 0.00 0.00 0.00 12l 12,013,358.00 7,876,733.00 401,896.00 0.00 2,000,000.00 2,000,000.00 0.00 3,47% of 2008 Investment Budget 7.40 4.86 0.00 4.88 6.10 0.00 4

NG INVESTMENTS THAT

D TO POW PRIORITIES &

CHPS, HC, DH, DHNT, RHMT commodation projects with high ompletion and sunk cost that can eted in 2008 13,458,530.98 9,193,614.98 0.00 1,926,200.00 1,147,539.98 4,840,000.00 0.00 1,27

ction/rehabilitation of sub-cilities destroyed by floods in 3 gions 2,000,000.00 1,200,000.00 1,200,000.00 0.00 0.00 0.00 0.00

Health Insurance Infrastructure e Fund (Excluding NHIC ICT & +E) 17,855,189.70 7,325,189.70 7,325,189.70 l 33,313,720.68 17,718,804.68 1,200,000.00 1,926,200.00 1,147,539.98 12,165,189.70 0.00 1,27% of 2008 Investment Budget 16.64 14.52 15.45 2.80 37.10 0.00 1

G TRAINING

UTIONS PROJECTS n for selected projects in SOH, HATS, Nursing & training institutions with high that can be completed in 2008 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00 l 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00 % of 2008 Investment Budget 2.06 0.00 17.57 0.00 0.00 0.00 0

MENT, TRANSPORT & ICT of ICT/Computers for KATH 232,701.00 232,701.00 0.00 0.00 0.00 0.00 0.00 23rements for NHIC 11,590,000.00 11,280,000.00 11,280,000.00 ent of Equipment 25,000,000.00 12,855,543.00 0.00 4,000,000.00 3,864,000.00 2,000,000.00 0.00 2,99, Motor Bikes and Ambulances 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00 l 67,322,701.00 28,368,244.00 0.00 8,000,000.00 3,864,000.00 13,280,000.00 0.00 3,22% of 2008 Investment Budget 26.64 0.00 64.17 9.42 40.50 0.00 3

TOTAL 233,096,781.52 106,492,803.65 8,263,000.00 12,466,000.00 40,999,993.36 32,790,000.00 3,344,810.30 8,62

70

Ministry of Health 2008 Fellowship Year FOREIGN

Course/Programme Country Long ShortUnit Cost (£) Number

Total Cost

1 Cert.Accident & Emerg.ency U K √ 8,000 1 8,000

2 Cert.Intensive Care U K √ 8,000 1 8,000

3 Msc Emergency Medicine U K √ 20,000 1 20,000

4 MSc Advance Trauma U K √ 20,000 1 20,000

5 MSc Control of Infectious U K √ 20,000 1 20,000

Diseases/Epidemiology

6 Msc Nutrition & Dietetics U K √ 20,000 1 20,000

7 Msc Health Financing U K √ 20,000 1 20,000

Economics & Insurance

8 MSc Health Mgt Infor.Sys. U K √ 20,000 1 20,000

9 MSc Opthalmic Nursing UK √ 20,000 1 20,000

10 MSc Com'ty Pschiatry UK √ 20,000 1 20,000

ToTal 10 176,000

REMARKS

Total cost for 2007 foreign programmes =£176,000

Cedi equivalent =¢2,816,000,000 Local Programmes

1 MSc Clinical Pharmacy Ghana √ 1,500 3 4,500

2 MPH Health Promotion Ghana √ 1,500 6 9,000

and Education

3 MPH Reproductive Health Ghana √ 1,500 6 9,000

4 MSc Environmental Sci. Ghana √ 1,500 1 1,500

Annex 2: FELLOWSHIP PLAN

71

5 MPH Ghana √ 4,000 10 40,000

6 MA HRM Ghana √ 2,000 2 4,000

7 MSc Health Planning and Ghana √ 1,500 4 6,000

Management

8 MBA HRM Ghana √ 4,500 3 13,500

9 EX.MA. GOV.&LEAD. Ghana √ 2,000 2 4,000

10 EX.MA.PUB.ADM.. Ghana √ 2,000 1 2,000

11 PG DIP.EDU Ghana √ 500 30 15,000

12 B.ED HLTH SCI.EDU. Ghana √ 1,000 40 40,000

13 BSc Infor.Com. Ghana √ 1,500 1 1,500

Sci.& Tech.

14 Msc Nursing Ghana √ 3,000 5 15,000 15 Mphil Nursing Ghana √ 3,000 4 12,000 16 Mphil Clinical Psychology Ghana √ 3,000 2 6,000 17 Allied Health Ghana √ 500 30 15,000

Total 150 198,000 REMARKS

Total cost for 2007 Local programmes =£198,000

Cedi equivalent =¢3,168,,000,000 Total cost for 2007programmes for continuing students =£568,500 Cedi equivalent =¢9,016,000,000 Grand Total= ¢9,016,000,000 +¢3,168,000,000+¢2,816,000,000=(¢15,000,000,000)

72

T RIES

VALUE Gh¢ (000) % FREQ. FUNDING SOURCE

START DATE

COMPLETION DATE

PROCUREMENT METHOD

T

Annex 3: PROCUREMENT PLAN

PROCUREMENCATEGO

PHADrugs &Consu

EPI Vaccines

EPI S

Contraceptives

TB drProcurPsychotr

Printing &

HIV/AI

Malar

ITNs Basic health equip / Cold Chain

Anti Snake & Rabies

INVESTMENT EmerEquipEquipReagents 5,

Capital pr

SERVICES

Procur

Financial Audit Nutrition and MalariaProject

TOTAL

RMACEUTICALS HF Gh¢ (000)

IGF Gh¢(000)

GOG Gh¢(000)

Budgetary Support Gh¢ 000)

Total Available Gh¢ (000)

Gap Gh¢ (000)

Nondrug mables 36,660

10.61 1

36,660.00 36,660.00 0.00 NOV. 2007 MAY,2008 ICB

20,607 5.96 1 15,598.75 1500.00 1,900.00 18,998.75 1,608.72 NOV,2007 SEPT, 2008 UN AGENCY

TATIONERY 13,149 13,149.00 NOV,2007 SEPT, 2008 SHOPPING/NCB

3,986 1.15 2 500.00 1,400.00 1,900.00 2,086.00 NOV,2007 SEPT, 2008 UN AGENCY

ugs 450 0.13 2 450 450.00 0.00 FEB. 2008 AUG. 2008 UN AGENCY

ement of opic drugs 450

0.13 2 450 450.00 0.00 NOV. 2007 MAY,2008 UN AGENCY

Publication 940 0.27 1

440.00 500 940.00 0.00 JAN. 2008 JUNE ,2008 SHOPPING/NCB

DS 14,838 4.29 2 10,967.74 1,200 12,167.74 2,670.26 JAN. 2008 SEPT, 2008 ICB

ia/ACT 8,402 2.43 1 500 500.00 7,902.00 MAR. 2008 SEPT, 2008 ICB

5,820 1.68 3,000 3,001.68 2,818.32 JAN. 2008 SEPT, 2008 ICB

1,146 0.33 1 500 500.00 646.00 NOV. 2007 AUG, 2008 UN AGENCY

2,538 0.73 1 1,500 1,500.00 1,038.00 FEB. 2008 AUG. 2008 ICB

gency Obstetric ment 16,340

4.73 1

3,864.00

9,340.00

4,000.00 2,000 19,204.00 -2,864.00 JAN. 2008 AUG. 2008 ICB

ment Maintenance & 000

1.45 1

2,500.00 2,500 5,000.00 0.00 JUNE. 2006 SEPT, 2008

CONTRACSECURED

ojects 214,000 61.93 1

17,240.00

12,200.00 8,466 37,906.00 176,094.00 FEB. 2008 SEPT, 2008 ICB

ement Audit 60 0.02 1 - 60.00 NOV. 2007 MAY,2008 ICB

150 0.04 1 - 150.00 NOV. 2007 MAY,2008 ICB

1,022

0.30 1

1,022.00 1,022.00 -0.50 JAN. 2008 AUG. 2008 ICB

345,557.97

100.00 31,452.49

66,181.68

18,200.00 24,366.00 140,200.17

205,357.80

Annex 4: NATIONAL HEALTH INSURANCE ALLOCATION FORMULA

GENERAL ASSUMPTIONS FOR THE 2008 ALLOCATION Budgetary Allocation On the basis of MOFEP projections for 2008, the National Health Insurance Fund is expected to realize an amount of GH¢235.42 million in the year 2008. This amount represents an increase of 33.83% over last year’s budgetary allocation of GH¢175.91 million. The projected budgetary receipt of GH¢235.42 million is expected from the two main sources; namely the NHIL and SSNIT contributions. Registration Coverage Council set a target of 55% coverage for 2007. Current (September 2007) registration figures indicate that 55% of the population had been registered. Based on available statistics, a registration target of 65% has been set for 2008. The allocation of the Fund is therefore based on the assumption that 65% of the population of Ghana will access benefits under the scheme in 2008. Number Of Schemes As at the end of October 2007, one hundred and forty-three (143) schemes were fully operational. Provision has been made to cover five (5) more schemes whose establishment began in 2007 and are expected to be operational in 2008. The allocation of the Fund is therefore based on the assumption that one hundred and forty-six (148) schemes will be operating in 2008. Per Head Subsidy An amount of ¢120,000 (GH¢12.00) was paid as subsidy per head to the exempt group members and SSNIT contributors in the year 2007. However, given the rising cost of medical bills which is evident from the bills submitted by service providers and the Review of the Medicines List and Tariff Structure, it has been proposed to increase the subsidy from GH¢12.00 to GH¢14.00 per person for 2008. This figure looks even lower given the fact that figures received from the various schemes as at the end of October 2007 indicate an average national per capital cost of an encounter with a health service provider to be ¢93,000.00 (GH¢9.30GP),. It is assumed that on average a person makes two encounters with health service providers in a year. These two encounters per a person per year give a resulting average national per capital cost of ¢186,000 (GH¢18.60GP) Investment Income For 2007 It is expected that an amount of One hundred and Forty-One million, Eight hundred and Nine Thousand, Six hundred and Twenty-Four Ghana Cedis, Fifty-Four Ghana Pesewas (GH¢141,809,624.54) will remain in investment at the end of 2007.

The expected investment income from the above investment is estimated at GH¢21.22 million. This will not be available for allocation as it will be retained in the investment account to grow the Fund. As a result, the total inflow to the NHIF in 2008, is estimated to be GH¢256.64 million.

73

DETERMINATION OF ALLOCATION OF FUNDS

Based on the above stated main objectives of the fund, the following criteria as described by Act 650 shall be applied;

• SUBSIDIES FOR THE EXEMPT GROUPS AND SSNIT CONTRIBUTORS

The law (Act 650) proposes subsidies to DMHIS to cover the health care cost of those exempted by law. The exempt groups are;

a) Indigents b) Under 18 years of age with both parents or guardians as contributors c) Under 18 years with community approved single parents d) Pensioners under the SSNIT Scheme e) Aged (70 years of age and above).

Premiums of contributors to the SSNIT Pension Scheme are to be paid from the NHIF by virtue of the payment of 2.5% of their SSNIT contribution to the NHIF. The calculation of the subsidy below for each category of the exempt is based on certain assumptions indicated in the explanatory notes under 7.0

SUBSIDY DISTRIBUTION TABLE FOR 2008

*Ghana’s Population as at 2000 was about 20m

Category Estimated Total Number

% of Population

Estimated Registered Number for 2008

Amount per Person GH ¢

Total Amount GH¢

Remarks

Indigent 940,000 4.70 799,000 14.00 11.19m 10% on 20m population less the Aged and children population {i.e. 10% of 20m-(0.6m-10m) =0.94m. An amount of GH¢11.19m has been allocated to meet the premium of 85% of the aged estimated to be registered for 2008

Under 18 years

10,000,000 50.00 7,500,000 14.00 105.00m Children Under 18 years of age are estimated to constitute about 50% of the country’s population. 75% of this population is estimated to be registered for 2008. An amount of GH¢105.00m is allocated to meet their contributions to HISs.

SSNIT Pensioners

70,000 0.35 63,000 14.00 0.88m 90% of the 70,000 estimated SSNIT Pensioners are estimated to be registered for 2008. A total amount of GH¢0.88m has been allocated for their premium.

Aged (70 years & above)

600,000 3.00 510,000 14.00 7.14m Based on the estimated 3% of the aged population, a total amount of GH¢7.14 has been allocated to meet the premium of 85% of the aged estimated to be registered for 2008

SSNIT Contributors

800,000 4.00 680,000 14.00 9.52m. An amount of GH¢9.5.2m has been allocated to meet the premium of 85% of SSNIT contributors expected to be registered.

Total 12,410,000

9,552,000 GH¢14 133.73m

74

OTHER MANDATORY AND ADMINISTRATIVE COMMITMENTS OF THE NATIONAL HEALTH INSURANCE COUNCIL Disbursement will be made in 2008 for the following other mandatory and administrative expenditures;

a) Council Secretariat Operations b) Support to Service Providers c) Health Service Investment d) Support to Financially Distressed Schemes (Reinsurance) e) Administrative and Logistical Support to the Schemes f) Headquarters Building g) MIS & ICT Solution h) Investment

OTHER MANDATORY AND ADMINISTRATIVE COMMITMENTS OF 2008 ALLOCATION TABLE

ITEM AMOUNT % 0F

FUND REMARKS

Council Secretariat Operations

10.49 million 4.46 2008 Budget

Support to Service Providers and MOH Programs

10.05 million 4.27 i. To enable Service Providers respond to health insurance requirements, a provision is made as seed loan of GH¢30,000 for drug stock for each district hospital payable in 6 months. GH¢4.05 ii. Support for M O H health preventive programs GH¢6.00m

Health Service Investment

36.32 million 15.43 Investment to be made in: i. Training of Health Assistants GH¢23.50m ii. KATH’s rehabilitation GH¢12.84m

Support to Financially Distressed Schemes (Reinsurance)

5.00 million 2.12 Average support of GH¢100,000 each for estimated 50 Schemes.

Administrative and Logistical Support to the Schemes

21.81 million 9.26 i. To provide for Motor bikes, bicycles and Outboard motors. GH¢310,000 ii. To provide Administrative Support of an average of GH¢70,348.80 to each scheme. (GH¢10.42m) iii. To settle outstanding bills-Stationery and software cost (Contingent Liability) GH¢3.00m iv. Provision to cover allowance/cost for 700 service personnel for the schemes: GH¢432,000 v. Pre-Financing of New I D cards GH¢5.00m vi. To undertake capacity building of the schemes. (GH¢1m) Vii. To undertake adverts/publicity of schemes(GH¢1.66m)

Headquarters Building 3 million 1.27 For the construction of Headquarters building MIS & ICT Solution 11.28 million 4.79 An amount of $24m (GH¢22.56m) is needed for the

installation of Integrated MIS Solution, IT Infrastructure, PABX etc. (these are all nationwide in character) The amount of GH¢11.28m provided represents the other 50% of the installation cost which is expected to be paid in 2008.

Investment 3.73 million Investments for 2008 Total

101.68 million

75

SUMMARY OF PROPOSED ALLOCATION OF FUNDS FOR 2008 Proposed Allocation of Funds To Various Activities

ACTIVITY ALLOCATION GH ¢

(%)

Subsidy for Exempt Groups 133.73 million

56.80

Council’s Operations 10.49 million

4.46

Service Providers Support

10.05 million

4.27

Health Service Investment

36.34 million

15.44

Support to Financially Distressed Schemes (Reinsurance)

5.00 million

2.12

Administration/Logistics 21.82 million

9.27

Headquarters Building

3.00 million

1.27

MIS & ICT Solution

11.28 million

4.79

Investment

3.71 million

1.57

Total

235.43 million

100

COMPARATIVE YEARS FUNDS ALLOCATION ANALYSIS 2008 2007

ACTIVITY ALLOCATION GH ¢

(%)

ALLOCATION 2007 GH¢

(%)

VARIANCE GH¢

Subsidy for Exempt Groups 133.73 million

56.80

90.02 million

51.27

43.71m

Council’s Operations 10.49 million

4.46

7.90 million

2.59m

Service Providers Support

10.05 million

4.27

10.05 million

0

Health Service Investment

36.34 million

15.44

29.33 million

7.01m

Support to Financially Distressed Schemes (Reinsurance)

5.00 million

2.12

5.00 million

0

Administration/Logistics 21.81 million

9.26

17.67 million

4.14m

Headquarters Building

3.00 million

1.27

2.00 million

1.00m

MIS & ICT Solution

11.28 million

4.79

11.28 million

0

Investment

3.71 million

1.57

2.65 million

1.06m

Total

235.43 million

100 175.91 million

59.51m

76

Subsidy’s variables:

a) Indigent b) Under 18 years c) SSNIT Pensioners d) Aged

e) SSNIT Contributors Allocation Formula Allocation = (a + b + c + d + e) x GH¢14+Admin Cost

PROPOSED ALLOCATION OF FUNDS TO VARIOUS EXPENDITURE ITEMS

Expenditure Item

Council Secretariat & Zonal Offices

ReserveFund GH¢

Secretariat Building

GH¢

DMHIS GH¢

Service Providers GH¢

Total GH¢

Personal Emolument

2.17m - - 5.41m - 7.54m

Administration Exp.

4.09m - - 8.83m - 12.92m

Service 1.68m - - 120.48m 23.55m 145.71m Capital Expenditure 2.29m - 3.00m 11.59m 12.84m 29.72m Total 10.19m - 3.00m 146.31m 36.39m 195.89m % of Total Budgetary Amount

4.60% - 1.53% 73.27% 18.58% 100%

EXPLANATORY NOTES SUBSIDY

• Indigents Indigents as described by law are people who are very poor. The Ghana Living Standard Survey puts the poverty rate in Ghana at 40%. It must be stated that most of those considered very poor can not afford the annual highly subsidized premium of ¢72,000.00. Without relevant statistical data certain assumptions were made in arriving at a proportion of the population who would be considered indigents. Ghana’s population as at 2000 was about 20 million. To estimate the indigent population, there is the need to avoid double counting, considering the fact that certain population groups are already covered under the DMHISs. Consequently, 600,000 people constituting the aged population (i.e. 3% of 20 million) and another 10,000,000 representing the population of those less than 18 years (i.e. 50% of 20 million) are subtracted from the total population. The remaining population will be 9.4 million (viz 20 million less 10.6 million). It is assumed that 10% of the net population of 9.4 million would constitute the indigent population and hence the indigent population estimated to be 940,000. 85% of indigents (i.e.799,000 indigents) are estimated to be covered under the scheme in 2008. An amount of GH¢12.00 is allocated as premium for each indigent and hence, a

77

total amount of GH¢11.19 million (i.e. GH¢14.00 x 799,000) will be required as subsidy to DMHISs for the indigents in 2008.

• Children under 18 years The law prescribes that those under 18 years be catered for by government. The 2000 population Census estimated the population strength of this category to be 10 million. It is estimated that 60% of this number will be covered under the scheme in 2008. A provision of GH¢101.69 million (i.e. ¢14.00 x 7,500,000) has been made to cover the premium of the 7,500,000 under 18 years estimated to be covered under the scheme in 2008.

• SSNIT Pensioners From data available at SSNIT the number of SSNIT pensioners is estimated to be 70,000. It is estimated that 90% of this number (i.e.63, 000) will be covered under the scheme in 2008. An amount of GH¢0.88 million (i.e. GH¢14.00 x 63,000) is allocated to cover the premium of the 63,000 SSNIT pensioners expected to be covered under the scheme in 2008.

• The Aged Those considered to be the aged population are those of 70 years and above. The 2000 population Census estimated that the aged population is 3% of the total population of the country (i.e. 600,000). Considering the fact that the aged suffer a number of chronic diseases such as hypertension, diabetes, cancers, heart diseases etc, and the fact that they are economically vulnerable makes them a very important population group to be considered in the development of the health insurance formula. It is expected that 85% of the aged (i.e. 510,000) will be covered under the scheme in 2008. An estimated amount of GH¢7.14 million (i.e. GH¢14.00 x 510,000) is allocated for the premium of the 510,000 aged expected to be covered under the scheme in 2008.

• SSNIT Contributors From data available at SSNIT, the total number of SSNIT contributors is estimated at 800,000 for 2008. SSNIT contributors are automatically covered under the law because of their 2.5% monthly contribution to the NHIF. It is estimated that 680,000 SSNIT contributors representing 85% of the total number of SSNIT contributors will be covered under the scheme in 2008. An amount of GH¢9.52 million (i.e. 680,000 x GH¢14.00) is therefore allocated to cover their premium to the DMHIS in 2008.

COUNCIL HEADQUARTERS & REGIONAL/ ZONAL OFFICES OPERATIONS The Council has directed that expenditure on its Secretariat should not exceed 5% (in line with international best practices) of total revenue to the Council. A total of GH¢10.49 million has been earmarked for the activities of the Secretariat of the NHIC (Including the 10 number Regional/Zonal Offices. Expenditure on the Council’s operations covers both recurrent and capital cost. The Council’s budget represents about 4.49% of total expected receipts for the year 2008. SUPPORT TO SERVICE PROVIDERS The Act enjoins Council to facilitate access of the population to basic health services. To enable health care providers deliver quality care and to improve access to health

78

services, GH¢10.05 million has been allocated for this purpose. The amount is expected to be given as seed loan to district hospitals for drug stock and will be payable over a 6 month period. i. Each hospital will be granted a loan of GH¢30,000.00 ii. Support for Preventive Programs GH¢6.00m HEALTH SERVICE INVESTMENT As support to the Ministry of Health to expand health services in the country an amount of GH¢36.34 million is provided for health service investment. The investment to be made in: i. Training of Health Assistants GH¢23.50m. ii. KATH’s rehabilitation GH¢12.84m. REINSURANCE ALLOCATION For DMHIS that are financially distressed Act 650 mandates the Council to provide them with the necessary assistance to enable them adjust their economic position to make them viable and sustainable provided they operate under sound management and financial practices. It is estimated that 50 Schemes will be financially distressed in 2008. It is estimated that schemes that will be distressed will need an average amount of ¢1 billion each to enable them adjust their financial situation. A total amount of GH¢5.00 million (50 x GH¢100,000.00) has therefore been set aside to enable the Council fulfill this mandate. It is recognized that all 148 DMHIS have a possibility of being financially distress; however, a worse case scenario of 50 distressed cases in the year is used. ADMINISTRATIVE AND LOGISTICS SUPPORT FOR SCHEMES To ensure an effective administration of the schemes, the schemes need to be assisted to build their administrative and logistical capacity on continuous basis to meet expanding responsibilities. A total amount of GH¢21.81 million will be required by Council to provide administrative and logistical support to the Schemes. The following are expected to be covered under this budget: i. Provision of motor bikes, bicycles and Outboard motors: GH¢0.310m. ii. Provision of an average administrative support of GH¢70,348.80 to each scheme: GH¢10.41m (GH¢70,348.80 x 148)

The GH¢70,348.80 per scheme is expected to cover the following: • salaries of staff - GH¢40,348.80 ; and • general administrative expenses - GH¢30,000.00

iii. Provision to cover allowance/cost for 700 service personnel for the schemes: GH¢0.432m. vi. To settle outstanding bills-Stationery and software cost (Contingent Liability) GH¢3.00m v. Pre-Financing of New I D cards GH¢5.00m vi. Capacity building of the schemes through training: GH¢1m. vii. Adverts/publicity of schemes: GH¢1.66m

79

HEADQUARTERS BUILDING The National Health Insurance Council Secretariat which is housed in a refurbished bungalow is not large enough to accommodate further staff and thus putting constraints on the employment staff. Most of the key positions as well as other supporting staff positions at the Secretariat are yet to be filled and therefore the need for adequate office space. There is space for the expansion of the Headquarters building. A budget of GH¢3.00 million is allocated for the project in 2008. Council wishes to undertake the expansion with dispatch; however some administrative procedures must be followed, especially to comply with the provisions of the Public Procurement Act, 2003. The project is expected to start at the beginning of 2008. MIS & ICT SOLUTION ICT solutions are required to facilitate the day to day operations of the Headquarters and the Schemes. The business activities will be performed to ensure that:

There is effective communication between the Schemes, the Headquarters and Service Providers for data collection and analysis, which is critical for meeting the objectives of the Council;

Managing risk, controlling fraud and ensuring financial sustainability; and Addressing the portability requirement.

A total amount of $24m (GH¢22.56 million) is needed for the installation of Integrated MIS Solution, IT Infrastructure, PABX (VOIP Solution) etc. (these are all nationwide in character). An amount of GH¢11.28 million represents the other 50% of the total installation cost is expected to be paid in 2008 and has therefore been provided for this year.

80