HEALTH SUMMITHEALTH SUMMIT1919thth – 23 – 23rd rd November 2007November 2007

DRAFT FIVE-YEAR CIP III DRAFT FIVE-YEAR CIP III (2007 – 2011) (2007 – 2011)

PREPARED BY

POLICY, PLANNING, MONITORING & EVALUATION (PPME) DIRECTORATE, MOH

IN COLLABORATION WITH

MAP CONSULT LIMITED &INTEGRITAS

Review of CIP II - Projects

LevelsNumber of ProjectsPlanned

Number Completed2002-2006***

NumberOngoing as

at31st Dec 2006

Sub District - CHPS 100 26 7Sub District - Health Centers 95 50 15District Hospitals 42 22 18District Health Administrations** 229 42 9Regional Hospital Projects 6 5 7Reg. Health Administration Projects 53 17 44Specialist Institutions Projects * 3 3 3Regional Maintenance Workshops 4 0 0Training Institutions 19 10 9Statutory Bodies 5 3 6Teaching Hospital Projects 16 1 15National Projects 15 0 5

* Psychiatric Hospitals

** Includes Accommodation projects in regions

*** Projects completed during the period under review include projects from CIP I and previous periods

Infrastructure

Review of CIP II - Projects

Transport Purchases

Item No.

Planned Actual

% Achieved

Double Cabin Pick-ups 450 324 78 Single Cabin 40 0 0 Saloon Cars 300 1650* 560

Motorcycles 5000 751 15 Bicycles 7300 1000 14 Ambulance FWD 66 0 0 Ambulance 44 50 114 Station Wagon 52 52 100 Blood Collection Van 5 0 0 Medium Size Bus 35 10 28 Mini Bus 15 10 67 Stores Truck 20 13 65 Water Tanker 11 0 0

*: Includes cars financed under a special arrangement with a revolving fund for health sector staff,

outside the CIP II.

Review of CIP II - Projects

Equipment

Overall, the achievements for equipment included:

• the equipping of a large number of Health Centers, District Hospitals (including new ones such as Begoro & Sogakope) and Regional Hospitals (including new ones such as Sunyani, Ho & Cape Coast);

• the extension of Physiotherapy services; and

• a number of completed projects at KBTH and KATH.

Review of CIP II - Financials

Actual CIP II Financial Performance (US$'000)

2002 ACTUAL

2003 ACTUAL

2004 ACTUAL

2005 ACTUAL

2006 ACTUAL

TOTAL

GoG MTEF

750 1,115 1,320 2,152 2,691 8,027

GoG HIPC 6,880 5,541 13,577 0 27,477 53,476

Ext Aid 8,108 3,123 13,462 18,659 12,395 55,746

Earmarked Funds

3,458 18,766 33,161 60,071 45,936 161,392

IGF 202 1,414 231 12,955 14,802

NHIS 0 0 0 18,831 18,831

TOTAL 19,196 28,545 61,519 80,881 120,286 312,274

Review of CIP II - Lessons• Resources

Actual expenditure exceeded the $126 million forecast by $186 million.Attributable to improved data capture (from comprehensive budgeting) new funding sources, and increased external aid

• ProjectsAbout 30% achievement against plan in completed projects for Infrastructure and Transport and a lot are still ongoing.

CIP III (2007 – 2011) POLICY FRAMEWORK

CIP III is to respond to the strategic objectives of 5Y POW:- Promoting healthy lifestyle and healthy environment;- Increasing access to quality health, reproduction and nutrition services;- Strengthening health system capacity; and,- Ensuring good governance and sustainable financing.

Four key components of CIP III:

– Civil works (infrastructure);– Medical equipment;– Transport; and– Information and Communication Technology (ICT). 7

CIP III - KEY CHALLENGES 1• The increasing demand for health services in response to the NHIS and the

need to scale up achievement of health related MDGs;

• Rapid urbanisation with its attendant pressures on limited health facilities

• Inadequate emergency and epidemic preparedness of health facilities & the increasing demand to expand the NAS 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.

CIP III - KEY CHALLENGES 2

• Inadequate funds for the backlog of capital investments contributing to the several uncompleted/abandoned projects as well as outstanding payments and huge commitments on maintenance contracts;

• 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;

CIP III – Policy Thrust

The focus of the CIP III is derived from the Strategic Objective 3 of the HS POW (2007-

2011) which aims at:

strengthening health system capacity to expand, manage and sustain high coverage of services

CIP III – Over-arching Principles

Under the CIP III, a cautious approach to infrastructure development will be pursued in order to keep the project and recurrent cost implications of investments within the resource envelope for the period.

Specific attention will be paid to the completion of existing projects while transport and equipment renewal and Planned Preventive Maintenance plans will be vigorously pursued. ICT will be deployed to improve health information systems.

Objectives of CIP III Components

• Increase geographical access to well maintained health facilities and health enhancing infrastructure with emphasis on deprived and peri-urban areas;

• Provision of training institutions to respond to the human resource requirements of the sector;

• Maintain and Provide health facilities with functional equipment;

• Increase vehicle availability for service delivery and supervision;

• Generate and use evidence for decision making, programme development, resource allocation and management through research, statistics, information management and deployment of ICT

CIP III Resource Envelope

Methodology

3 alternative methods considered for projecting resource envelope• Projections from 2007 Budget;• Projections from 2006 actual expenditures; and • Projections based on proportion of total sector revenue.

Projections from 2006 actual expenditures selected as the preferredforecast method, and from this method two scenarios wereDeveloped - the High Case and the Low Case.

Total resources projected for the CIP III Period• The High Case Scenario - $510.9 million • The Low Case Scenario - $361.9 million (see tables below)

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CIP III Resource Envelope (contd.)Limitations in Forecast Models• Some uncertainties over the NHIF’s future investment plans.

• Models do not include revenue from financial credits, grants and earmarked funds, as these are difficult to predict.

• At time of planning 2007 Half-year actual investment expenditure was not available to validate the budgeted allocations for 2007.

• The current energy crisis could impact on the capital projections in the following ways:

1) More government funds could be channeled into solving the energy crisis.

2) Expected general slowdown in economic activity which will impact on the amount of income for the NHIF.

3) Less IGF for investment, since a higher proportion of it may be used for fuel to run generators in the major hospitals. 14

CIP III Resource Envelope (contd.)

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Projected Resource Envelope (High Case)

SOURCE

2006 ACTUAL

2007 BUDGET

2008 BUDGET

2009 FORECAST

2010 FORECAST

2011 FORECAST

TOTAL

  $'000 $'000 $'000 $'000 $'000 $'000 $'000

IGF 2,691 3,580 4,559 5,187 5,810 6,391 25,526

GoG MTEF 12,955 8,420 10,669 11,243 11,805 12,513 54,651

HIPC 27,478 12,565 11,970 10,660 10,127 10,329 55,651

Health Fund/ Budget Support

12,395 13,486 14,255 0 0 0 27,742

Earmarked Funds, Grants and Financial Credits

45,936 22,841 37,765 22,659 17,937 14,349 115,551

NHIS 18,831 28,473 34,926 44,925 56,157 67,388 231,869

TOTAL 120,286 89,366 114,144 94,674 101,835 110,970 510,989

CIP III Resource Envelope (contd.)

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Projected Resource Envelope (Low Case)

SOURCE

2006 ACTUAL

2007 BUDGET

2008 BUDGET

2009 FORECAST

2010 FORECAST

2011 FORECAST

TOTAL

  $'000 $'000 $'000 $'000 $'000 $'000 $'000

IGF 2,691 2,685 3,419 3,890 4,357 4,793 19,145

GoG MTEF 12,955 6,315 8,002 8,432 8,854 9,385 40,988

HIPC 27,478 12,565 11,970 10,660 10,127 10,329 55,651

Health Fund/ Budget Support

12,395 0 0 0 0 0 0

Earmarked Funds, Grants and Financial Credits

45,936 22,841 37,765 0 0 0 60,606

NHIS 18,831 22,779 27,940 35,940 44,925 53,910 185,495

TOTAL 120,286 67,185 89,097 58,923 68,263 78,418 361,885

CIP III Expenditure Distribution High Case

LEVELS 

SUMMARY COST IN US$ (2007-2011)

CIVIL WORKS

TRANSPORT EQUIPMENT ICT Total% of Total

Sub-District 18,827,391 10,286,000 8,460,000 735,000 38,308,391 7.51

District 11,818,152 19,842,000 59,595,000 1,438,400 92,693,552 18.18

Regional 44,615,326 4,157,333 5,710,000 1,468,000 55,950,659 10.97

Specialized Institutions 625,000 0 140,000 0 765,000 0.15

Training Schools 14,175,543 5,566,667 0 0 19,742,210 3.87

Tertiary 95,498,370 1,845,493 45,223,903 4,000,000 146,567,766 28.74

GHS HQ 2,857,609 15,352,667 0 0 18,210,275 3.57

Statutory Bodies/Sub-vented Organizations 34,730,435 6,310,093 0 65,102,000 106,142,528 20.81

MOH/GHS - National 8,477,391 1,228,667 20,914,295 1,000,000 31,620,353 6.20

TOTAL 231,625,217 64,588,920 140,043,198 73,743,400 510,000,735  

% of Total 45.42% 12.66% 27.46% 14.46%    

             

TOTAL ESTIMATED CAPITAL EXPENDITURE         510,000,735  

NB:- Data sources for Equipment and ICT do not provide sufficient detail to allow a breakdown into all 9 categories above

CIP III Expenditure Distribution Low Case

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LEVELS 

SUMMARY COST IN US$ (2007-2011)

CIVIL WORKS

TRANSPORT EQUIPMENT ICT Total% of Total

Sub-District 13,452,391 2,571,500 5,240,000 0 21,263,891 5.88

District 11,644,239 6,090,500 17,960,000 0 35,694,739 9.87

Regional 42,375,109 2,388,833 4,620,000 0 49,383,942 13.65

Specialized Institutions 277,174 0 140,000 0 417,174 0.12

Training Schools 12,545,109 542,167 0 0 13,087,275 3.62

Tertiary 95,226,630 461,373 12,710,859 0 108,398,863 29.97

GHS HQ 1,026,087 2,208,167 0 0 3,234,254 0.89

Statutory Bodies/Sub-vented Organizations

34,154,348 1,577,523 0 65,102,000 100,833,871 27.88

MOH/GHS - National 8,477,391 307,167 20,564,295 0 29,348,853 8.11

TOTAL 219,178,478 16,147,230 61,235,154 65,102,000 361,662,863

% of Total 60.60% 4.46% 16.93% 18.00%  

TOTAL ESTIMATED CAPITAL EXPENDITURE       361,662,863

NB:- Data sources for Equipment and ICT do not provide sufficient detail to allow a breakdown into all 9 categories above

CIP III Infra Targets – High CaseSummary of Civil Works

 

New and Ongoing

Rehabilitation UpgradeTOTAL

NO.

CHPS 107 0 0 107

Health Centre 33 7 4 44

District Hospital 18 10 5 33

Regional Hospital 1 3 1 5

Regional Health Administration 35 17 3 55

Specialized Institutions 3 1 0 4

Tertiary 9 4 0 13

National - (GHS HQ/Training Institutions/Regulatory Bodies) 17 2 0 19

TOTAL 223 44 13 280

CIP III Infra Targets – Low CaseSummary of Civil Works

 

New and Ongoing

Rehabilitation UpgradeTOTAL

NO.

CHPS 10 0 0 10

Health Centre 32 2 3 37

District Hospital 13 10 4 27

Regional Hospital 0 2 1 3

Regional Health Administration 26 14 3 43

Specialized Institutions 1 1 0 2

Tertiary 8 3 0 11

National - (GHS HQ/Training Institutions/Regulatory Bodies) 13 1 0 14

TOTAL 103 33 11 147

CIP III Targets – Equipment, Transport and ICT

• Equipment – Maintain existing stock with priority to MDG 5 (Low Case), Provide additional equipment to fill gaps and complete all initiated projects (High Case)

• Transport – High Case includes purchase of 1,692 Double Cabin Pick Ups, and 181 ambulances, among others

• ICT – High Case provides NHIS & DHMS ICT requirements and at least minimum ICT infrastructure for 30 Sub-Districts, 40 DHMT, 40 District Hospitals, and all Regional Hospitals and RHMTLow Case restricted to NHIS & DHMS ICT requirements

Strategic Activities under CIP III (Infrastructure)

1. Deploying the Investment Planning Model and the SAM framework in the development of annual Capital Investment Plans;

2. Preparation of detailed annual investment plans by agencies/regions/districts;

3. Design & implement a framework for routine progress and expenditure tracking system for capital investments; and

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

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Strategic Activities under CIP III (Equip. & Transport)

1. Improve planned preventive maintenance and management systems;

2. Mobilise resources to support the replacement of obsolete equipment and to implement medium term vehicle replacement plan targeting over aged vehicles particularly in the deprived districts;

3. Prioritize provision of equipment that improve quality and make hospitals sustainable entities

4. Improve efficiency through the development of skills of staff

Strategic Activities under CIP III (ICT)

1. Develop and implement a strategic plan for the development of an integrated and consolidated National Health Information System including a link between financial management and service delivery information;

2. Scale up the district-wide system for informationmanagement to ensure the availability, accurate and reliable routine service-based data.

3. Implement the Health Sector ICT policy and strategy

Estimated Recurrent cost Implications of CIPIII

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Total per Annum 11,549,81

4  Total over the planning period (5 yrs)

57,749,070

High Case Recurrent Cost Projection

Low Case Recurrent Cost Projection

Total per Annum 3,062,049  

Total over the planning period (5 yrs)

15,310,246

Managing & Monitoring Implementation of the Plan

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Requirements for the successful implementation of the Plan:

• Predictability in funding

• A planning, budgeting and approval process that can be applied to all proposed new projects

• Deployment of the HS Planning model as an inclusive mechanism for project definition and programming,

• Procedures and formats for progress and expenditure monitoring that will include local validation of the data reported; and

• A realistic plan for assessing and increasing the human resource capacity of the various participating entities to implement the required activities.

Acknowledgements

The CIP III team wishes to thank all those who facilitated, participated and contributed to this plan, as well as the organizations they represent, for their generous and open discussions, comments and important inputs.

The team is particularly grateful to DANIDA for providing technical assistance.

CIP Team Members

• Dr. E. Addai - Director PPME, MOH• Mr. J.G.K. Abankwa- Head, CIMU, MOH• Mr. Ben. Nkansah - Project Analyst, CIMU, MOH• Dr. N. Adjabu - Head, CEU, GHS• Mr, Sylvester Ziniel - Quantity Surveyor, EMU, GHS• Mr. Hassan Ligbe - Fleet Engineer, GHS• Alhaji Saaka Dumba - Transport Manager, MOH• Mr. P.K. Mensah - Consultant, Map consult Ltd.• Mr. Phillip Cobbina - Consultant, Map consult Ltd.• Mrs. Julie Asante - Consultant, Integritas• Mr. Edem Adzaku - Consultant, Integritas

Thank you for your relentless support and facilitation.

Thank You

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