Health sector report Ghana 2014

Sector Report

Health and Life Sciences Ghana March, 2014

Embassy of the Kingdom of the Netherlands in Ghana |

Pagina 2 van 23

Colophone

This is a publication of:

RVO.nl / Klantcontact

Prinses Beatrixlaan 2 / 2595 AL den Haag

P.O. Box 93144 / 2509 AC Den Haag

T +31 (0)88 0424242

E [email protected]

www.rvo.nl

© RVO.nl | March 2014

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 http://www.oecdguidelines.nl/. More information on CSR and

international business can be found on http://www.rvo.nl/onderwerpen/internationaal-

ondernemen/mvo (in Dutch).

© 2014 RVO.nl Although information provided by RVO.nl is based on reliable data, RVO.nl can not accept any liability for its accuracy.

http://www.oecdguidelines.nl/

http://www.rvo.nl/onderwerpen/internationaal-ondernemen/mvo

http://www.rvo.nl/onderwerpen/internationaal-ondernemen/mvo


Pagina 3 van 23

Table of contents

Colophone—2

1 Summary—4

2 Business Opportunities—8

3 Partners—15

4 Address Dutch foreign mission—16

5 Factsheet Health Sector Ghana—17


Pagina 4 van 23

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 5 van 23

support base for the Government of Ghana via the traditional channels of ODA1

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. 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 2011. The government of Ghana and the IMF project 7 to 8% growth for the

coming years. In order to achieve this, 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 positive; most probably Ghana will continue

to grow as the main drivers underlying growth are likely to improve.. 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 6 van 23

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 - 2014

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

Earmarked Support

Budget Support

Premium

Household

Income

GOG

revenues

Development

Partners

NHIA

DMHIS

Government & CHAG

MOH

Health Services Providers

Private

Taxes, NHIL

NHIF

Claims

User Fees

Salaries


Pagina 7 van 23

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 initiatives3 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 CHAG4 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.

2 Development Partners’ meeting with the President, 13 March 2014. 3 President’s Speech “State of the Nation” 25 February 2014

4 CHAG – Christian Health Association of Ghana

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.


Pagina 8 van 23

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:

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).

A. status-quo (current)

B. beyond the horizon

C. beyond convention


Pagina 9 van 23

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 10 van 23

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.

Occupational health and rehabilitation/physiotherapy.

Dialysis centres5

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

B. Beyond the horizon

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 care6. It is

likely that GHS and CHAG will have to find ways and

means to increase their efficiency and effectiveness.

GenKey7 and Nearshoring

8 are Dutch companies with

excellent ICT track records in Ghana to introduce and

to service new technologies.

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, 14-03-14]). About 10 per cent of all hospital admissions in the country are now said to be

kidney-related in Ghana. Korle-Bu handled in 2010 2,121 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). 7 http://www.genkey.com/

8 http://www.nearshoring.nl/

http://www.genkey.com/

http://www.nearshoring.nl/


Pagina 11 van 23

An interactive e-communication system between health facilities

provides opportunities for the exchange of clinical, managerial

and financial information. The setting-up is a large and expensive

undertaking that involves different hospitals. These hospitals will

become more or less independent management units. Thus the

added value in terms of cost saving, higher staff satisfaction,

professional growth and better health outputs must be

demonstrated before large investments become bankable

propositions.

The Netherlands will finance in 2014 a feasibility study by IICD to

explore the ground work for such undertaking for the hospitals of

Northern Ghana with Tamale Teaching Hospital as the hub.

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 http://healthmarketinnovations.org/program/movercado

http://healthmarketinnovations.org/program/movercado


Pagina 12 van 23

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 13 van 23

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

Africa10

. 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 FIFA11

, 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:

http://www.hartmann-international.com/Articles/2/Opening-of-a-new-branch-of-clinic-in-

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

http://www.hartmann-international.com/Articles/2/Opening-of-a-new-branch-of-clinic-in-Kenya.aspx

http://www.hartmann-international.com/Articles/2/Opening-of-a-new-branch-of-clinic-in-Kenya.aspx


Pagina 14 van 23

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 Detox centres and services (alcohol

& drugs)

Top sport centre for surgery and

rehabilitation

Specialized addiction clinics

Weight loss centres and services Viral treatment centres (hepatitis)

Cosmetic and reconstructive surgery Geriatric care


Pagina 15 van 23

3 Partners

1. Afisah Zakariah, MD, MPH, PhD

Director, PPME

Ministry of Health

P.O. Box M-44

Accra, Ghana

[email protected]

2. Dr. Ebenezer Appiah-Denkyira

Director General of the Ghana Health Service

ACCRA/GHANA

[email protected]

3. Dr Maureen M. Martey

Private Sector Unit

Ministry of Health

ACCRA/GHANA

Tel: +233244369807

Office: +23321680350

[email protected]

4. Mr. Sylvester Mensah

CEO, National Health Insurance Authority

PMB, Ministries Accra, Ghana

[email protected]

5. Dr. Baaba Selby

PMB, Ministries, Accra

Director of Claims

NHIA

[email protected]

6. Dr. Docia Saka

Registrar

Health Facility Regulatory Agency

Ministries Post Office

P.O.Box MB 534

Accra

Tel: 0302900995

If applicable, list details of relevant trade fairs, exhibitions, events, journals, etc.


Pagina 16 van 23

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. +233 302 214 361

F. +233 302 772 655

I. www.ghana.nlembassy.org

http://www.ghana.nlembassy.org/


Pagina 17 van 23

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 1 3.0 731,201

1 - 4 10.8 2,674,205

5 – 9 12.7 3,128,952

10 - 14 11.8 2,916,040

15 - 19 10.6 2,609,989

20 - 24 9.4 2,323,491

Total < 25 years 58.3 14,363,878


Pagina 18 van 23

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, 2014. Table 1A: Health Financing Statistiscs,

2010

Source, MOH - Ghana

Per Capita OPD Attendance in the Public Sector Facilities by Regions

Table 2: OPD per capita by region, 2006-2011 , Source GHS

Year\ Region AR WR NR BAR CR VR UER UWR ER GAR Ghana

2006 0.59 0.57 0.3 0.91 0.5 0.41 0.55 0.46 0.65 0.47 0.55 2007 0.72 0.72 0.31 1.02 0.7 0.51 0.69 0.65 0.94 0.6 0.69 2008 0.73 0.86 0.49 1.3 0.68 0.73 1.01 0.7 0.97 0.51 0.77 2009 0.89 0.69 0.53 1.15 0.71 0.69 1.37 0.72 0.95 0.51 0.81 2010 0.96 1.12 0.64 1.19 0.75 0.64 1.45 0.88 1.01 0.59 0.92 2011 1.17 1.35 0.62 1.48 0.79 0.87 1.40 1.06 1.18 0.64 1.05 2012 0.96 1.44 0.70 1.63 1.00 1.01 1.99 1.12 1.38 0.95 1.14

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 12th May 2014 are as indicated in table below.

Region Hospitals Health

Centre Clinics CHPS

Western 29 59 114 182

Central 27 61 54 168

Greater

Accra

84 21 238 78

Eastern 33 82 117 400

Volta 29 146 71 157

Ashanti 89 141 151 67

Brong

Ahafo

30 84 114 168

Northern 15 83 0 146

Upper

east

7 40 48 178

Upper

West

9 65 11 166

National 352 785 918 1710

Republic of Ghana 2010

Population 24,658,823

Exchange Rate (GH¢:US$) 1.4738

Total GDP in GH¢ 43,388,000,000

Total GDP in US$ 29,439,544,036

Total Health Expenditure (THE) in GH¢ 1,421,749,293.80

Total Health Expenditure (THE) in US$ 964,682,652.87

THE per capita in GH¢ 57.66

THE per capita in US$ 39.12


Pagina 19 van 23

Table 3: Distribution of Private Health Facilities by Regions

Region Clinic Hospital Maternity Home Total

Greater Accra 194 37 44 275

Volta 11 5 10 26

Eastern 31 7 30 68

Central 26 5 19 50

Western 55 12 26 93

Ashanti 87 42 68 197

Brong Ahafo 28 7 31 66

Northern 15 2 7 24

Upper East 22 2 5 29

UpperWest 5 0 1 6

Total 474 119 241 834 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 2010.

Nurses

Table 4: Nurse/ Population Ratios from 2009-2012(1 nurse per population)

Table 5: Distribution of Nurses by Region, 2009-2012 AR WR NR BAR CR VR UER UWR ER GAR Ghana

Total no.

of nurses

2009

2,325 1,422 1,191 1,214 1,373 1,533 892 586 1,994 3,698 16,228

Total no.

of nurses

2010

2,397 1,376 1,194 1,207 1,370 1,477 904 583 1,914 3,846 16,268

Total no.

of nurses

2011

3,096 1,712 1,645 1,562 1,655 1,733 1,142 725 2,259 4,502 20,031

Total no.

of nurses

2012

3,253 1,739 1,640 1,645 1,873 1,789 1,152 775 2,219 4,649 20,734

Pop. / 1

nurse

2012

1,550 1,422 1,601 1,470 1,250 1,244 930 941 1,237 917 1,251

Year : 2009 2010 2011 2012

Ratio: 1:1,497 1:1,489 1:1,240 1:1,251


Pagina 20 van 23

Doctors Table 6: Doctor Pop Ratio 2006-2012 (1 doctor per population)

Table 7: Distribution of Doctors by Region, 2009-2012.

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

2009

606 276 279 341 291 381 197 153 478 792 3,794

Total no.

of

midwifes

2010

630 277 299 356 284 353 190 145 462 784 3,780

Total no.

of

midwifes

2011

754 279 298 370 308 358 198 147 489 833 4,034

Total no.

of

midwifes

2012

779 277 274 352 294 303 190 131 451 812 3,863

WIFA12

/1

midwife

2012

1,553 2,142 2,300 1,649 1,911 1,763 1,354 1,336 1,461 1,260 1,611

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

Year 2006 2007 2008 2009 2010 2011 2012

Ratio: 1:15,423 1:13,683 1:13,499 1:11,649 1:11,698 1:10,217 1:10,452

AR WR NR BAR CR VR UER UWR ER GAR Ghana

No. of docs. 2009 600 80 50 140 87 78 34 17 157 839 2,082

No. of docs. 2010 562 91 72 141 88 80 29 14 155 876 2,108

No. of docs. 2011 630 91 117 145 106 91 27 18 165 1,085 2,475

No. of docs. 2012 519 89 137 154 104 90 27 18 139 1,204 2,481

Pop. / 1 doc. 2012 9,715 27,775 19,163 15,705 22,505 24,728 39,697 40,502 19,748 3,540 10,452


Pagina 21 van 23

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

2012 2011 2010

Source of Fund Amount (GHC Mn) % Amount (GHC

Mn) %

Amount (GHC

Mn) %

GoG 1,750.48 60.17 771 53.5 474 42.6

IGF/NHI Claims 427.04 14.68 367 25.5 286 25.7

NHIF 434.6 14.94 23 1.6 28 2.5

Program – Donor 181.6 6.24 139 9.6 190 17.1

Sector Budget Support 109.25 3.76 105 7.3 60 5.4

F/Credits 6.36 0.22 36 2.5 72 6.5

HIPC/Fund 4 0.4

TOTAL 2,909.33 100 1,441 100 1,113 100

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)

Source of Fund Amount

Share

(%)

GOG 1,208,823.01 28.2

IGF 1,363,622.80 31.9

Donor 781,262.00 18.3

Total Discretionary 3,353,707.81 78.4

NHIF 926,610.51 21.6

Overall 4,280,318.32 100.0

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 2012. 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 2013.


Pagina 22 van 23

Table 11: Progress towards Abuja Target (2009 – 2014)

2009 2010 2011 2012 2013 2014

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, (2009 – 2014)

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

2005 - 2010

International Funds 360,479,692.54 52.97 178,932,270.64 18.55 -50.36

Private Funds 118,661,796.53 17.44 122,831,726.54 12.73 +3.51

Public Funds 201,408,758.71 29.59 662,918,655.69 68.72 +229.14

Total 680,550,247.78 100.00 964,682,652.87 100.00 +41.75

This is a publication of:

Netherlands Enterprise Agency (RVO.nl)

P.O. Box 93144 2509 AC The Hague

www.rvo.nl

Documents

Health sector report Ghana 2014