Sector Report Health and Life Sciences Ghana. April, 2015

Transcription

1 Sector Report Health and Life Sciences Ghana April, 2015

2 Colophon This is a publication of: RVO.nl / Klantcontact Prinses Beatrixlaan 2 / 2595 AL den Haag P.O. Box / 2509 AC Den Haag T +31 (0) E intake@rvo.nl RVO.nl April 2015 Netherlands Enterprise Agency (RVO.nl) is a department of the Dutch Ministry of Economic Affairs that implements government policy for sustainability, innovation, and international business and cooperation. It is the contact point for businesses, educational institutions and government bodies for information and advice, financing, networking and regulatory matters. Corporate Social Responsibility The Dutch government supports CSR in international business and expects companies to operate according to the Guidelines of the Organisation for Economic Co-operation and Development (OECD), see also More information on CSR and international business can be found on (in Dutch) RVO.nl Although information provided by RVO.nl is based on reliable data, RVO.nl can not accept any liability for its accuracy. Pagina 2 van 23

3 Table of contents Colophon 2 1 Summary 4 2 Business Opportunities 8 3 Partners 15 4 Address Dutch foreign mission 16 5 Factsheet Health Sector Ghana 17 Pagina 3 van 23

4 1 Summary The health sector in Ghana is in transition from a mainly government managed public sector to greater diversity of health services providers. The public sector faces many challenges in terms of financing and the resulting diminishing quality of basic services. The National Health Insurance (NHIS) is a national service that finances the sector but while effective it faces serious challenges for financial sustainability and efficiency. In response to the continuing demand and willingness from the middle class and elite to pay competitive fees for quality health services, the opportunities for international investors in the health sector will continue to emerge. The construction of hospitals but also diagnostic centres and laboratory services are examples. While up till now the international commercial interest was mainly confined to construction and supply of equipment with some after sales management support, it is likely that in the near future health services management will become the focus of commercial interest as demands will emerge. Ghana is an African front runner in health service delivery. They are keen to welcome innovation and the prevailing entrepreneurial spirit of most Ghanaian professionals is a major accelerator for profitable business development by the private sector. Meanwhile the government keeps a keen eye open for equity and social justice. Ten years of National Health Insurance is for example an enviable track record for many other African countries. They look to Ghana for inspiration, example and leadership by embracing new technology and keeping up to date with global trends. History Ghana is since 1998 a development cooperation partner of The Netherlands. The Netherlands were actively engaged in the national health policy dialogue and supported the national health sector budget. Civil society and NGO s programs dealing with sexual and reproductive health and rights received Dutch funding. ORET and ORIO are popular instruments for the improvement of the health sector infrastructure. Ghana was the greatest recipient of ORET financing for a total funding of 573 million. Currently 3 Orio projects in the health sector are pending for a total value of 70 million. Our bilateral support was predominantly channelled via the government, but increasingly private parties emerge. As a result of this long and sustained engagement The Netherlands have a good reputation and a solid track record in Ghana. The donor-recipient relations are progressively phased out, to be replaced by equitable partnerships on the basis of mutually added value and willingness to pay. Ghana is, in the macroeconomic sense, a healthy country with a positive long term outlook. In the short term Ghana is facing economic instability due to fiscal and balance of payment deficits. This has delaying consequences for government payments and agreements. By improving its budgetary balance sheets the Ministry of Finance wants to get its house in order. Liquidity is therefore a transition challenge for the government in its efforts towards healthier public finances. The Government of Ghana is, for the time being, a less preferential business partner. The international Pagina 4 van 23

5 support base for the Government of Ghana via the traditional channels of ODA 1 partners and the development banks dwindles as Ghana reaches Lower Middle Income status. Opportunities in the emerging private sector are more promising, in spite of the fact that governmental control over the sector may impede rather than stimulate investments. In the wake of governmental ineptitude, corruption in all shapes and sizes becomes an increasing prominent feature that negatively affects the overall performance of the public sector. Business Climate Ghana s economic growth remained strong over the last decades. Ghana s growth is led by its political stability, its relatively liberal economic policies and rising primary commodity prices. Yet, the economic growth of the most recent years is more moderate. This economic success has been noticed by Dutch companies. The opportunities in the Ghanaian and regional market continue to attract trade and investment from The Netherlands. Trade and investment promotion are the core activities of this embassy. The West African region has strong growth figures and is seen by many Dutch companies as an interesting emerging market. Ghana is an attractive vantage point for international businesses with ambitions to expand in West Africa. Accra is a preferred hub for companies as it offers security, stability, adequate education and health facilities, an internationally trained work force at the academic level, and convenient flight connections to the major destinations in the region. Economic growth alone is not enough to lead Ghana to sustained higher levels of development. The government needs to transform its services, to manage the increasing complexities of a fast growing economy. The Ghanaian economy has grown steadily over the last ten years, in part due to high prices in primary commodities such as cocoa, timber and gold and since 2011 oil. The pace of growth in the Ghanaian economy moderated in 2012 reaching 8% compared to 15% in This trend continued, resulting in 7.3% in 2013, a 5% growth in 2014 and an estimated 3.7% in In order to counter this decreasing economic growth, the Government of Ghana will need to speed up reforms, including measures to budget more realistically and broaden its tax base by including the informal economy, which forms a large share of economic activities, in order to increase revenues. Projections for the next 5 to 10 years are rather positive; most probably Ghana will continue to grow as the main drivers underlying growth are likely to improve. However, the Ghanaian government needs to show its ability to tackle the countries energy issues and rising inflation. We expect that The Netherlands will remain among Ghana s first export destinations and that exports to Ghana from the Netherlands will continue to grow as fast as in recent years, with steadily increasing direct investments form the Dutch private sector in Ghana as well. The Netherlands is already among the top investors in Ghana. Organization of the public sector The Health Sector in Ghana is organized at three main levels: national, regional and district. Health interventions are packaged for each level and are delivered at the respective clinics and hospitals. These relate to the minimum benefit package and accreditation status of each facility as provided for under National Health Insurance law. At district level, the sub-district services incorporate the community health delivery. The health sector integrates prevention, promotion and curative services of 1 Official Development Assistance Pagina 5 van 23

6 health interventions. The Ministry of Health oversees as the policy guardian the quality and equity of access to the health services. It also manages the human resources. In response to the increasing demand for quality health services from the emerging middle class the private sector is expanding especially in the urban areas of the south. The Private Hospitals and Maternity Homes Board license and regulate health facilities and services in the private sector. Financing the public sector Ghana introduced 10 years ago the National Health Insurance Scheme (NHIS). While only 35% of the population is currently registered as paying subscribers, the scheme is regarded as an innovative tool for the financial management of the sector. The National Health Insurance Authority (NHIA) manages the system by receiving and channelling funds from both clients premiums and government levies and public resources. It processes claims for payments from the accredited health facilities (both public and private). With Ghana s cross-over to the lower middle income status, the ODA contributions from development partners are decreasing. Increasingly Ghana s health sector is looking for ways to sustain their services under their own steam by generating indigenous resources and managing these in the most efficient way. Financial resources flow of the health sector in Ghana Taxes, NHIL Budget Support Household Income GOG revenues Development Partners Premium NHIF Earmarked Support User Fees NHIA DMHIS Claims MOH Salaries Private Government & CHAG Health Services Providers GOG Government of Ghana NHIA Nat. Health Insurance Authority MOH Ministry of Health NHIL Nat. Health Insurance Levy DMHIS District Mutual Health Insurance Scheme NHIF Nat. Health Insurance Fund CHAG Church Health Association of Ghana Pagina 6 van 23

7 Health sector transition: challenges and opportunities The health sector is in transition from a predominant government (public) health services network towards a more diversified and decentralized system. The public health system is an extension from its socialist past, when government was the sole provider. It becomes increasingly difficult to sustain this system on the limited available public funds. Since the review and subsequent hike of salaries of civil servants in 2009, the government resources for the sector are disproportionately allocated to salaries (70-65% 2 of current government expenditures). The financial spaces for other recurrent expenditures and capital investments are seriously restricted as a result. This reflects the overall environment of public finances in Ghana. In order to relieve the pressure on the public health budget, the government encourages private sector initiatives 3 to actively engage. The sector is therefore in transition towards more diversified service delivery, with opportunities for commercial health services entrepreneurs. The other sides of these dynamics are serious equity challenges. The poor are exclusively dependent on the constrained public health services and CHAG 4 hospitals. Also access and affordability differences between regions will be more pronounced. The NHIA was created as the pivotal financing channel for the health sector. The NHIA does not have the monopoly as other insurance entrepreneurs are welcome to enter the market. Next to premiums NHIA receives government funding for its mandate to implement the national insurance law. For example young people below 18 years, those > 60 years and the poor are assured of free health care. While the architecture of the national insurance is solid, its functioning is below par. The processing of claims is notoriously slow. Hospitals and clinics can wait sometimes up till 4-6 months for their refund. This negatively affects the (financial) management and in turn the overall performance of the health facilities as suppliers of, for example, drugs and support services demand prompt payment. As a result, informal payments, under the counter transactions and other out-of-pocket expenditures are next to regular user fees common for patients and their attending relatives. The private sector as the functional counterpart fills in the gaps of the public services. Their business case is built on the preparedness and willingness of the emerging middle class to pay for quality assured health services. The health profile of Ghana is also changing, as many diseases are life style dependent. In the past poverty diseases were most common. Most patients suffered from communicable diseases and diseases related to poor hygiene and sanitation. But in the wake of increasing wealth, other disease patterns emerge. Non-communicable diseases such as hypertension, cardiovascular diseases, diabetes, cancer, road traffic accident and obesity are, among others, now becoming frequent occurrences in hospitals and clinics. The transition towards greater wealth is accompanied by changing disease patterns. Unfortunately the current health services are neither prepared nor experienced to deal with the prevention, treatment and rehabilitation of non-communicable diseases. 2 Development Partners meeting with the President, 13 March President s Speech State of the Nation 25 February CHAG Christian Health Association of Ghana Pagina 7 van 23

8 2 Business Opportunities The dynamic transition of Ghana s health sector offers opportunities for commercial entrepreneurship and engagement. Opportunities emerge over time and are mentioned as follows: A. status-quo (current) B. beyond the horizon C. beyond convention Some of these opportunities are obvious as they connect with ongoing or anticipated tenders. The context for these openings is here and now : A. status-quo (current). Other less clear chances relate to future potentials: B. beyond the horizon. The context is mainly determined by the ambitions and commitments of Ghana health sector (both public and private) and their ability and preparedness to invest into new developments. Finally there are options that do not (yet) feature on any formal strategy agenda but that may crop up over time. These potentials are determined by the anticipated local demand for products and services in the future: C. beyond convention. The ability to read and appreciate the dreams and aspirations of Ghana s middle class and elite consumers is crucial for early birds entrepreneurs. A. Status-quo (current) A.1 Public Sector Given the current dominance of the health sector by government actors, the majority of current business opportunities arise from public tenders. As part of the transition, the government is currently re-appraising its responsibility and commitment. Given the government s budgetary constraints it is understandable that they scan the international solidarity arena for grants or concessionary loans. With the retreating donor community these financing options become increasingly scarce. The counterpart financing by Ghana of soft loans become protracted undertakings with increasingly uncertain outcomes. In line with the shrinking public resources for health, business cases proposed by the government beyond the obvious international tenders must be regarded with great caution. The few opportunities for commercial engagement within the short term are supported by international funding or banks (for example ORIO, Nordic Fund, WB grants etc.) Ministry of Health Medical education and training (Nuffic/NICHE) Infrastructural projects Construction of hospitals and clinics. Diagnostic and laboratory facilities and referrals (histopathology). Pagina 8 van 23

9 Ghana Health Services (GHS) Drugs Drug procurement and pharmaceutical supplies management. Quality assurance at port of entry Equipment Digital hospital equipment ICT Hospital management Hospital waste management Diagnostic imaging and digital imaging Advanced laboratory Advanced life support and monitoring systems Emergency response and Ambulance services Rehabilitation and physiotherapy National Health Insurance Authority Health Insurance (NHIS) Claims management (processing and payments) ICT links between NHIS and health sector in general Production of bio-certified identity cards Capacity building of NHIA to efficiently manage the NHIS using business/commercial principles without compromising the social objects of the NHIS. A.2 Private Sector Private health facilities complement the public sector. As the days of free health care in the public hospitals are over, the costs are becoming increasing less of a barrier. The added values of private facilities are quality and convenience. The private sector is thus gaining popularity. There is a growing middle class that prefers to use private health facilities and can afford it. The NHIS works with private health facilities by way of contracting private facilities to provide services to NHIS clients in order to achieve a high coverage. The current inefficiency of the NHIS claim-processing is however a serious barrier for many private facilities, that have to rely more on direct payments or other commercial insurance schemes. International competition is stiff with new players (notably from Asia) entering the market with cheap often low quality products. The awareness and demand for high quality is increasing especially in the high end of the market. Products and services from The Netherlands have a good reputation in that respect. Furthermore the commercial track record of Dutch commercial partnerships in Ghana is a positive branding. The emerging market for pharmaceutical products depends heavily on imports rather than local production. Producing generic pharmaceuticals is also a valid business case for export to surrounding markets in other West African countries. Other opportunities merit further exploration: Commercial health insurance Hospitals and clinics. Maternity homes. Elderly and residential care. Pagina 9 van 23

10 B. Beyond the horizon Occupational health and rehabilitation/physiotherapy. Dialysis centres 5 Multidisciplinary cancer treatment centres First Aid and (air)ambulance services. Diagnostic services (X-Ray, MRI, CT, advanced laboratory including histopathology) Services for maintenance and repairs of medical equipment Mortuary services/funeral homes B1 Public Sector Over time the operational mandate of government for the management of the public health sector will continue to change. The relevance of the ministry of health for the sector will therefore diminish for its operational management responsibility and will increase in terms of quality and equity assurance of the health sector. These new aspects attract less commercial interest, except for ad hoc health system consultants. The actual management of the public hospitals, via GHS and CHAG, will increasingly become less dependent on the unreliable and insufficient funding from the government. The NHIA will face similar challenges, when the contributions from government are not keeping up with the costs of health care 6. It is likely that GHS and CHAG will have to find ways and means to increase their efficiency and effectiveness. GenKey 7 and Nearshoring 8 are Dutch companies with excellent ICT track records in Ghana to introduce and to service new technologies. The Dutch company GenKey is a good example of how to introduce innovation in Ghana. Their biometric identification technology for NHIS clients is now standard to avoid misuse. It saves costs and increases efficiency. GenKey is also active in voter registration for the elections. Management of public hospitals and clinics that aim for greater efficiency and better cost containment can benefit from technological innovations that are increasingly becoming available. Cutting costs requires looking at reducing operational expenses. Green power generation (i.e. solar, gasifier, biogas) are options for cutting costs. 5 Kidney disease is a growing problem in Ghana (MOH estimates 8,000 cases of renal failure [MOH, ]). About 10 per cent of all hospital admissions in the country are now said to be kidney-related in Ghana. Korle-Bu handled in ,121 kidney-related cases. In 2011 that number shot up to 2,687 cases a 31 per cent increase. Yet dialysis centres are only found in Korle Bu and Konfo Anokye Teaching hospitals. Recently however, the police hospital and the central regional hospital Accra have dialysis centres. 6 This is a phenomenon that is seen in most countries around the world that went through such transition, including The Netherlands. Several developed countries are still searching for sustainable solutions (USA-Obamacare) Pagina 10 van 23

11 The current ICT mobile communication revolution in Ghana will determine the landscape for a long time to come. Already the coverage of mobile telephone services and internet, including mobile money and communication platforms are among the highest in the continent. In line with the ambition of the Ghana people to be the front runner for Africa, the health sector can take advantage of e-health and telemedicine innovations and applications. By linking departments in a hospital via ICT, the overall efficiency increases. Several ICT hospital management systems have so far been introduced in Ghana. Regrettably most hospital managers are inexperienced in this field. They invest in commercial ICT systems on a rather intuitive and opportunistic basis. The subsequent fragmentation of different ICT management systems in various hospitals does not contribute to the potential synergy between facilities. Big efficiency gains for health facilities can be obtained when the NHIA is electronically linked with the accredited facilities. The current delays of claims processing result in spiralling of costs: late receipt of funds means late payment for suppliers, who increase their prices in anticipation of such late payments. By removing the hard copy paper trail the human factor and related informal and under the counter payments are reduced. Moreover by reducing the inefficiencies, the credibility and acceptability of the NHIS will increase. Overall the value chain will become more transparent and will result in better health outcomes. Ghana Health Services (GHS) Digitalization of diagnosis, treatment, monitoring, management and record keeping. Standardized ICT hospital management with compatible links with NHIA, MOH etal. Setting up mobile phone based patient- and client communications MOVERCADO 9. Telemedicine through e-connections between hospitals. Management of hospital waste. On site oxygen concentration for ambient air Power generation solutions o Gasifier (on hospital waste) o Biogas o Solar 9 Pagina 11 van 23

12 National Health Insurance Authority (NHIA) Setting up NHIS electronic network with accredited facilities Facilitate premium payments and client registration Digital automation of registration, claims and processing Link up with health facilities e-network B2 Private Sector It is likely that the current economic growth and related wealth of the middle and upper class will continue. Thus opportunities for private health initiatives will continue to emerge especially in urban areas. Many private hospitals operate under the charismatic leadership of a Ghanaian medical specialist. Such leadership is not always connected with effective entrepreneurship. The envisioned potential and profit due to unrealistic planning and revenue forecasting, may not materialize. The defaulting on bank loans may increasingly occur. It is likely that the commercial stakeholders of such hospitals/clinics will search for international managers that can nurse the facility back to health. Mobile telephone based health communications for patients and clients are new and represent a greatly appreciated added commercial value for reaching out to patients and clients. For example selling insurance or other health related products for hard to reach people are some of the innovative and commercially viable opportunities (ref. Movercado ). In response to the continuing demand and willingness from the middle class and elite to pay competitive fees for quality health services, the opportunities for international investors in the health sector will continue to emerge. The construction of hospitals but also diagnostic centres and laboratory services are examples. While up till now the international commercial interest was mainly confined to construction and supply of equipment with some after sales management support, it is likely that in the near future hospital management will become the focus of commercial interest as demands will emerge. Similar trends can be observed in the hospitality business (hotels, resorts etc.). In the wake of increasing numbers of private health providers, the client base for hospital- and medical equipment is expanding with more interesting parties that value and are prepared to pay for good and prompt service. The maintenance contracts with GHS were often the source of frustration and little profits. When each piece of equipment is regarded by commercial health sector operators as a potential money maker, the commercial basis for maintenance work improves. As a side product of the current track record of the NHIS/NHIA, we will see more people who can afford health insurance at higher rates but with better and more reliable benefits. They represent an emerging market for commercial insurance companies. Ghana serves as the regional hub for pharmaceutical manufacturing and distribution to the over 300 million people who live within the Economic Community of West African States (ECOWAS). There is still room for lots of growth in Ghana's pharmaceutical manufacturing. Even with production rates as they are, factories in Ghana are not operating at full capacity. Because of their high quality, Ghana s pharmaceutical exports to other countries in the region are valued. Ghana has many advantages for investors, such as a sound structure in place and access to a large and in-need market. Pagina 12 van 23

13 Opportunities for the private sector: Mobile telephone based communication platforms for (social) marketing Private health facilities Private health insurance Commercial centres of excellence Commercial diagnostic centres Specialized centres like diabetes care, physical rehabilitation and physiotherapy Production of micronutrients and food enrichment components Pharmaceutical manufacturing and export of generic medicines Production and export of medicinal plants and homeopathic ingredients. Production and export of non-medicinal pharmaceutical preparations (starch etc) C. Beyond convention Examining the dynamics of the Ghanaian health market guided by the economic and disease trends, we can explore the types of health related services that have been successfully introduced in developed countries. It is probably just a matter of time before the demand of these services will become stronger. Non communicable diseases will increase like cardio-vascular diseases, cancer and diabetes. Life styles will change also. With more free time on their hands, people will adapt life styles with more emphasis on entertainment and sport. Getting and staying in shape are important preoccupations of a young and wealthy population. Sports and fitness will become increasingly popular. Sport injuries are part of any game. Opportunities for sports related rehabilitation can be worthwhile opportunities as part of investments in sport and fitness facilities. Sports have always been and will continue to be important parts of Ghanaian life. Soccer is the main driver. It is also an important export product with many West African soccer players engaged in the major football leagues of Europe, Asia and Americas. These players are also major investors in Ghana. West African players with injuries are treated in sophisticated but western sport rehabilitation centres. There is no such centre for the treatment and management of top sport injuries in West Africa 10. A top world class sport health treatment and rehabilitation centre in Ghana can be a profitable undertaking when players have the option to recuperate at home while receiving the same quality of care as in Spain or Switzerland. It is worthwhile to explore the willingness of top Ghanaian soccer players to invest in such centre. It would be very wise to put such centre in the hands of real health professionals supported by credible commercial management. Big shots from the GFA, CAF, UEFA and FIFA 11, should be avoided, as they tend to focus on other matters than sport medicine and footballers well-being. 10 An example in Kenya for its top athletes: Kenya.aspx 11 GFA- Ghana Football Association; CAF Coalition of African Football Association; UEFA- Union of European Football Association; FIFA Fédération Internationale de Football Association Pagina 13 van 23

14 It is likely that alcohol consumption will increase. The proportion of alcoholics in leading positions is likely to rise. Also the consumption of hard drugs (notably cocaine and heroin) will increase. With the entertainment sector becoming commercially mature, dance/music and festival related use of synthetic drugs is likely to expand. Commercial sex will increase in size and complexity. This may well result in the sexually transmitted infections like HIV and Hepatitis. These viral infections are also transmitted via injecting drug use. We see similar patterns also in Brazil, SE Asia and South Africa. Obesity is the unfortunate rising trend that can be seen in almost all transition countries. Changes in the diet and more sedentary lifestyles contribute. In response to obesity a market will emerge for slimming clinics. Also the demand for cosmetic surgery is likely to emerge as well. With the improving socioeconomic conditions the overall life expectancy will further increase. As a result we will see more elderly people who will depend on specialized services. This will result in the increasing demand for geriatric prevention, treatment and care. There are currently only very limited provisions for those services. Based on the above considerations (under beyond convention ) the following opportunities are of course based to some extent on speculation. But these scenarios cannot be ignored in a comprehensive market scan: Sport medicine and rehabilitation Top sport centre for surgery and rehabilitation Weight loss centres and services Cosmetic and reconstructive surgery Detox centres and services (alcohol & drugs) Specialized addiction clinics Viral treatment centres (hepatitis) Geriatric care Pagina 14 van 23

15 3 Partners 1. Afisah Zakariah, MD, MPH, PhD Director, PPME Ministry of Health P.O. Box M-44 Accra, Ghana 2. Dr. Ebenezer Appiah-Denkyira Director General of the Ghana Health Service ACCRA/GHANA 3. Dr Maureen M. Martey Private Sector Unit Ministry of Health ACCRA/GHANA Tel: Office: Mr. Sylvester Mensah CEO, National Health Insurance Authority PMB, Ministries Accra, Ghana 5. Dr. Baaba Selby PMB, Ministries, Accra Director of Claims NHIA 6. Dr. Docia Saka Registrar Health Facility Regulatory Agency Ministries Post Office P.O.Box MB 534 Accra Tel: If applicable, list details of relevant trade fairs, exhibitions, events, journals, etc. Pagina 15 van 23

16 4 Address Dutch foreign mission The Embassy of the Kingdom of The Netherlands, 89, Liberation Road Ako Adjei Interchange, P.O. Box 1647 CT Accra, Ghana T F I. Pagina 16 van 23

17 5 Factsheet Health Sector Ghana FACTSHEET HEALTH SECTOR REPUBLIC OF GHANA 2014 Demography: The 2010 population census puts Ghana s population at 24,658,823 with a population growth rate of 2.5% per year. Males constitute 12,024,845 and females 12,633,978. The rural population is 12,545,229 (50,9%) and that of urban population is 12,113,594 (49,1%). The regional distribution is shown below. Regional Distribution of Ghana s population (2010 pop. census) Region Population Western 2,376,021 Central 2,201,863 Greater Accra 4,010,054 Volta 2,118,252 Eastern 2,633,154 Ashanti 4,780,380 Brong Ahafo 2,310,983 Northern 2,479,461 Upper East 1,046,545 Upper West 702,110 Age in years % of total population Age groups Less than , ,674, ,128, ,916, ,609, ,323,491 Total < 25 years ,363,878 Pagina 17 van 23

18 Public Health Facilities The distribution of public health facilities by regions in Ghana are presented on table below: Table 1: Distribution of Public Health Facilities in Ghana, Table 1A: Health Financing Statistiscs, Region Hospitals Health Centre Clinics CHPS Western Central Greater Accra Eastern Volta Ashanti Brong Ahafo Northern Upper east Upper West National Republic of Ghana 2010 Population 24,658,823 Exchange Rate (GH :US$) Total GDP in GH 43,388,000,000 Total GDP in US$ 29,439,544,036 Total Health Expenditure (THE) in GH 1,421,749, Total Health Expenditure (THE) in US$ 964,682, THE per capita in GH THE per capita in US$ Source, MOH - Ghana Per Capita OPD Attendance in the Public Sector Facilities by Regions Table 2: OPD per capita by region, , Source GHS Year\ Region AR WR NR BAR CR VR UER UWR ER GAR Ghana Private Health Facilities The private health sector in Ghana is a large and important actor in the market for health related goods and services. While nearly all health experts acknowledge that the private sector is a major provider of health services, available estimates on the size of the private sector vary widely and are outdated. The Health Facility Regulatory Agency, an agency of the MOH is a body responsible for accrediting and maintaining records of private sector hospitals, clinics, and maternity homes. Requested information provided by the Health Facility Regulatory Agency on accredited private health facilities in Ghana by 12 th May 2014 are as indicated in table below. Pagina 18 van 23

19 Table 3: Distribution of Private Health Facilities by Regions Region Clinic Hospital Maternity Home Total Greater Accra Volta Eastern Central Western Ashanti Brong Ahafo Northern Upper East UpperWest Total Source: Ghana Private Hospital and Maternity Home Boards of the MOH Human Resources. Public Sector Health Workforce: In the public sector health workforce grew from 42,193 in 2007 to 57,038 in 2011, (increase of 26%). Health worker / population density trends have improved from 1.88 health workers/per 1,000 pop in 2007, to 2.11 in 2009, but dropped back to 1.9 in Nurses Table 4: Nurse/ Population Ratios from (1 nurse per population) Year : Ratio: 1:1,497 1:1,489 1:1,240 1:1,251 Table 5: Distribution of Nurses by Region, AR WR NR BAR CR VR UER UWR ER GAR Ghana Total no. of nurses 2,325 1,422 1,191 1,214 1,373 1, ,994 3,698 16, Total no. of nurses 2,397 1,376 1,194 1,207 1,370 1, ,914 3,846 16, Total no. of nurses 3,096 1,712 1,645 1,562 1,655 1,733 1, ,259 4,502 20, Total no. of nurses 3,253 1,739 1,640 1,645 1,873 1,789 1, ,219 4,649 20, Pop. / 1 nurse 1,550 1,422 1,601 1,470 1,250 1, , , Pagina 19 van 23

20 Doctors Table 6: Doctor Pop Ratio (1 doctor per population) Year Ratio: 1:15,423 1:13,683 1:13,499 1:11,649 1:11,698 1:10,217 1:10,452 Table 7: Distribution of Doctors by Region, AR WR NR BAR CR VR UER UWR ER GAR Ghana No. of docs ,082 No. of docs ,108 No. of docs ,085 2,475 No. of docs ,204 2,481 Pop. / 1 doc ,715 27,775 19,163 15,705 22,505 24,728 39,697 40,502 19,748 3,540 10,452 Source HR MoH Midwives Table 8: Distribution of Midwives by region AR WR NR BAR CR VR UER UWR ER GAR Ghana Total no. of midwifes , Total no. of midwifes , Total no. of midwifes , Total no. of midwifes , WIFA 12 /1 midwife 1,553 2,142 2,300 1,649 1,911 1,763 1,354 1,336 1,461 1,260 1, Source HR, MoH Pharmacists According to the Registrar of the Pharmacy Council, there are 2,327 pharmacists on the register as at May 30, 2013 out of which 1,652 are working in the country with the remaining 675 working in the Diaspora. This brings the ratio of one pharmacist to 14,528 persons which is far below the World Health Organization s (WHO) recommendation of one pharmacist to 2,000 persons. 12 Women in Fertile Age Group Pagina 20 van 23

21 Funding trends in the public health sector The Table below depicts proportional share of the various sources of funds. Table 9: proportional share of the various sources of funds to the Ghana health sector (Public Sector) by years Source of Fund Amount (GHC Mn) % Amount (GHC Mn) % Amount (GHC GoG 1, IGF/NHI Claims NHIF Program Donor Sector Budget Support F/Credits HIPC/Fund TOTAL 2, , , Mn) % Government Budget For 2014 The approved health sector budget for 2014, set out in the 2014 Budget Statement, indicates a total for the sector of GH 4,280,318,322. This comprises the discretionary budget: GOG, Donor and IGF plus the statutory allocation which constitutes funds from NHIF. Table 10: 2014 Health Sector (Public Sector) Resource Envelope by source of fund (in GH 000) Share Source of Fund Amount (%) GOG 1,208, IGF 1,363, Donor 781, Total Discretionary 3,353, NHIF 926, Overall 4,280, Source: 2014 Budget Statement Appendix Table 10 represents the total budget approved for the public health sector for 2014 which is GH 4.28 billion, consisting both discretionary and statutory. The total discretionary funds approved for the sector is GH 3.35 billion; representing a 78.4% share of the total health sector budget. This includes funding from GOG (28.2%), IGF (31.9%) and Donor contributions (18.3%). The statutory budget constitutes funds from NHIF which represents a 21.6% share of the sector s envelope. The health sector share of the total government budget has increased in nominal terms from 2009 to 2014 but declined marginally in In 2014, it depicts a 1.0% increase from last year. However, tracking progress towards Abuja target indicates that the proportion of the domestic budget allocated to the health sector has fallen by 0.7% from Pagina 21 van 23

22 Table 11: Progress towards Abuja Target ( ) Abuja Target 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% Health Share of Total Government Budget 9.8% 11.1% 11.6% 10.7% 12.5% 13.5% Health Share of Domestic Resources 7.9% 7.6% 8.4% 6.5% 11.1% 10.4% Source: Ghana Budget Statement, ( ) Significant proportion of the budget from GOG will likely be in jeopardy due to fiscal and macro-economic challenges this year and reduced ODA contributions. Internally Generated Funds (IGF) constitutes the largest source and this is mainly from out of pocket payments. Health Expenditure According to the 2005 and 2010 National Health Accounts, Total Health Expenditure (THE) showed a drop of international funding while public fund allocations increased. However most of the public expenditures are absorbed by salaries (approx. 65%) and capital investments (approx. 20%) leaving little fiscal space for operational expenses for service delivery. Table 12 : Total Health Expenditure Percentage Change among Financing Sources, 2005 & 2010 Financing Sources 2005 (US$) % 2010 (US$) % % Change International Funds 360,479, ,932, Private Funds 118,661, ,831, Public Funds 201,408, ,918, Total 680,550, ,682, Pagina 22 van 23

23 This is a publication of: Netherlands Enterprise Agency (RVO.nl) P.O. Box AC The Hague