Effects of the Global Economic Crisis on Health: Ghana's Experience

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1 Effects of the Global Economic Crisis on Health: Ghana's Experience Felix Ankomah Asante Ama Pokuaa Fenny November 16-19, 2009

2 OUTLINE Introduction Economic Situation and Global Crisis Ghana- Background Information Economic Situation Vulnerability to the Effect of Global Crises Effects of Global Crisis on Health Health Financing Health care availability and quality Effects of Global Crisis on Social Justice Conclusions

3 INTRODUCTION Global economic crisis became quite visible in the latter part of 2008, following soon after huge price hikes in fuel and food. The main channels being through trade, foreign direct investment and remittances. In Ghana, the picture is quite abysmal with remittances declining; export growth slowing down; foreign direct investment expected to shrink this year by 20 percent, and some commodity prices having slumped as a result of a slowdown in global demand. It is quite early to assess the direct impact of the global economic and financial crisis on households in Ghana, but the indirect impact could be potentially large.

4 GHANA BACKGROUND INFORMATION Economic growth: 7.3% in 2008 Human Development Index: Ghana ranks 135 out of 177 countries. Political stability: five consecutive democratic elections. Progress towards MDGs: Good progress: Net primary school enrolment (MDG 2) rose from 79% in 2006/07 to 89% in 2007/08 Gender Parity (MDG 3): for every 100 boys there are 96 girls Poverty has fallen from 52% in 1991/92 to 28 % in 2005/2006 HIV/AIDS: HIV prevalence stabilising at about 2%

5 ECONOMIC SITUATION Ghana s economy has experienced increasing growth rates in the past seven years, averaging 5.9 percent per annum, from 2002 to The economy could have performed even better in the last three years but for the effect of the huge hikes in crude oil price rises, the energy shocks and the global economic downturn. Presently, Ghana is very vulnerable to deterioration in the external environment with a current account deficit of 22 percent of GDP and 1.8 months of international reserves. The situation has also worsened with the steep depreciation of the cedi against the three major currencies (US Dollar, the British Pound and the Euro).

6 VULNERABILITY TO THE EFFECT OF GLOBAL CRISES Main channels of Ghana s vulnerability to the global economic crisis include: Very high current account deficit Very high budget deficit Aid dependency Export dependency Declining remittances High inflation and Exchange rate depreciation.

7 EFFECTS OF GLOBAL CRISIS ON HEALTH Global Financial Crises Declining export revenues- lower capital inflows Less Aid Difficulty to finance budget and current account deficit Fewer Remittances Further depreciation of exchange rate Effect on Health: Declining expenditure on health Reduced consumption of basic goods such as education and good quality food Changes in living conditions, lifestyles and behaviours Negative health outcomes Imports are more expensive Upward pressures on fuel and food prices

8 HEALTH FINANCING NHIS Ghana is currently operating under a National Health Insurance Scheme (NHIS) which is designed to offer affordable medical care, especially to the poor and the vulnerable. There have been major strides in expanding access to health care under the NHIS. Over ten million people almost half the population are entitled to free medical treatment for a number of common ailments. However, only around a third of these are contributing to the scheme financially raising issues of financial sustainability of the scheme. The NHIS is heavily reliant on tax funding for percent of its revenue.

9 HEALTH FINANCING AID Donor funding plays a significant role in health sector financing. Total external assistance for 2008 (US$162 million) has been the highest in 8 years. (No clear evidence as yet of declining Aid to the sector).

10 HEALTH FINANCING REMITTANCES Remittances are a huge income flow for Ghana, roughly equivalent to 30 percent of its exports. Ghana has seen a marked increase in remittances inflows over the last decade, from $449 million in 1999 to $1.8 billion and $1.9 billion in 2007 and 2008 respectively. Remittances have slowed down, but have not dramatically decreased yet. Remittances into Ghana declined by 14.2 percent from the fourth quarter of 2007 to the fourth quarter of 2008 (Ackah, Bortei Dorku Aryeetey & Aryeetey, 2009). At the start of 2009, economists were projecting a 20 percent plunge in remittances from Ghanaians working abroad.

11 HEALTH CARE AVAILABILITY AND QUALITY (1) Global crisis may mean a reduction in family income and affect the use of health services. The most common effect is for households to lower their demand for private care with a consequent transfer of demand to the public sector. Overall quality of services may also decline if public services are compromised and not adequately equipped to cope with the rising numbers. Households are taking the opportunity to visit government hospitals or health centres to benefit from the insurance scheme (Asante and Aikins,2008). However, there is no clear evidence whether the global crisis will push more people to enrol into the NHIS as remittances or private incomes fall.

12 HEALTH CARE AVAILABILITY AND QUALITY (2) There is evidence that since the NHIS was expanded from 2006, OPD use for the population as a whole has increased.

13 EFFECTS OF GLOBAL CRISIS ON SOCIAL JUSTICE Ghana embraces social protection as a mitigation strategy. Coverage of various protection schemes have been extended. The key components of Ghana s social safety nets include the ff: Livelihood Empowerment against Poverty (LEAP) - conditional cash transfer programme targeting the extreme poor, the elderly and the disabled. The National Health Insurance System (NHIS) covers 12.3 million Ghanaians. Capitation grant for all children in Government basic schools to offset education costs. The School Feeding Programme which provides meals for some 500,000 schoolchildren throughout the country and provides a market for farmer produce. The National Youth Employment Programme which aims to provide training and employment opportunities for the youth.

14 CONCLUSION Currently, there is very little concrete evidence to ascertain the impact of the crisis on health outcomes. The government aims to expand social protection cover to safeguard the health of its people. Spending in all these intervention areas can positively influence health, provided that health impact is carefully reviewed and understood. The outlook for 2009 and beyond appears to be promising. Rising prices of Ghana s key commodities (gold and cocoa) in the international market will generate much needed foreign exchange enabling the country to counter the effects of the global crisis.

15 CONCLUSION (CONT.) There are also opportunities in key sectors such as oil & gas and the related oil services industry as well as the telecoms sector. Also, the emergence of large scale projects in agriculture such as rice farming aimed to diversify Ghana s revenue portfolio. In all, the global crisis presents an opportunity for streamlining and harmonising government programmes to yield maximum results in the most efficient manner.

16 THANK YOU

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