PERFORMANCE AUDIT REPORT OF THE AUDITOR- … · Performance audit report of the Auditor-General on the generation and management of Internally ... 12 CHAPTER THREE ... and management

Performance audit report of the Auditor-General on the generation and management of Internally Generated Funds in public hospitals

PERFORMANCE AUDIT REPORT OF THE AUDITOR-

GENERAL ON THE GENERATION AND

MANAGEMENT OF INTERNALLY GENERATED

FUNDS IN PUBLIC HOSPITALS

Table of contents Pages

Transmittal letter …………………………………………. i

Executive summary ……………………………………….. iii

CHAPTER ONE ………………………………………. 1

Introduction ………………………………………………. 1

1.1 Reasons for the audit ………………………………... 1

1.2 Purpose and scope …………………………………… 2

1.3 Methods and implementation ……………………….. 3

CHAPTER TWO ………………………………………… 5

2.0 Descriptive chapter ……………………………………. 5

2.1 Historical background ………………………………… 5

2.2 Mandate ……………………………………………….. 7

2.3 Objectives ……………………………………………… 7

2.4 Funding ………………………………………………… 9

2.5 Organisational structure ……………………………….. 10

2.6 System description ……………………………………. 11

2.7 Key players and their activities ……………………….. 11

2.8 Current development ………………………………….. 12

CHAPTER THREE ………………………………………… 13

Findings ……………………………………………………... 13

3.1 Introduction ……………………………………………. 13

3.2 Challenges …………………………………………….. 14

3.2.1 Revenue defaulters ……………………………………. 14

3.2.2 Purchases not properly accounted for ………………… 15

3.2.3 Delays in re-imbursement of claims …………………… 19

3.2.4 Non-compliance with tariff structure by schemes ……… 20

Performance audit report of the Auditor-General on the generation and management of Internally Generated Funds in public hospitals

3.3 Inadequate and poor maintenance of existing

infrastructure …………………………………………. 23

3.4 Insufficient maintenance of equipment and machinery … 27

3.5 Summary and conclusion ……………………………… 30

CHAPTER FOUR ………………………………………….. 34

4.0 Recommendations ………………………………..…….. 34

4.1 Revenue defaulters ……………………………………. 34

4.2 Non-compliance with store procedures ………………… 35

4.3 Delays in reimbursement of claims ……………………… 35

4.4 Non-compliance with tariff structure by the schemes …… 36


infrastructure and machine ……………………………….. 37

APPENDICES ………………………………………………… 38

ABBREVIATIONS …………………………………………… 52

Performance audit report of the Auditor-General on the generation and management of i Internally Generated Funds in public hospitals

TRANSMITTAL LETTER

Ref. No. AG/01/109/Vol.2/32

Office of the Auditor-General

Ministries Block “O”

P. O. Box MB 96

Accra

Tel. (021) 662493

Fax (021) 662493

30 January 2011

Dear Madam Speaker,

PERFORMANCE AUDIT REPORT ON THE AUDITOR-

GENERAL ON GENERATION AND MANAGEMENT OF

INTERNALLY GENERATED FUNDS IN PUBLIC HOSPITALS

I have the honour to submit to you for presentation to Parliament my

performance audit report, in pursuance of Article 187(5) of the 1992

Constitution of the Republic of Ghana and Section 13(e) of the Audit

Service Act 2000, Act 584. The Audit Service Act mandates my office

to audit programmes and activities of public offices to ensure

economy, efficiency and effectiveness in the use of resources.

Performance auditing was introduced to the Ghana Audit Service in

2001, as part of a capacity building project funded by the European

Union. Officers who have been professionally trained in conducting

performance audits to internationally recognised standards prepared

this report. The team that carried out the audit comprised Ms.

Victoria Akordor, Assistant Director of Audit (Team Leader), Ms.

Mary Arthur, and Mr. Kplorm Dovlo, both Auditors, under the

supervision of Mr. Augustine R. K. Boadu, Deputy Auditor-General.

Performance audit report of the Auditor-General on the generation and management of ii Internally Generated Funds in public hospitals

In a rapidly changing society such as ours, there is a need for

performance auditing, since the inherent incentives for improvements

are limited in the public sector compared to the private one. The

performance audit process results in recommendations, which initiate

a process of renewal and change, leading to greater efficiency and

effectiveness in government administration. Depending on the extent

of coverage and complexity, it normally takes between six and 12

months to complete one performance audit, thus making it more

expensive than the traditional audits. Effective performance audits

can lead to better use of resources by public bodies and provide

support to democratic governments by bringing about accountability,

transparency, improved operations and better decision-making.

I would like to thank my staff for the preparation of this report and the

staff of the various hospitals for the assistance offered to my staff

during the period of the audit.

I trust that this report would meet the approval of Parliament.

Yours sincerely,

AUDITOR-GENERAL

THE RT. HON. SPEAKER

OFFICE OF PARLIAMENT

PARLIAMENT HOUSE

ACCRA

Performance audit report of the Auditor-General on the generation and management iii of Internally Generated Funds in public hospitals

PERFORMANCE AUDIT REPORT OF THE AUDITOR-

GENERAL ON THE GENERATION AND MANAGEMENT OF

INTERNALLY GENERATED FUNDS IN PUBLIC HOSPITALS

EXECUTIVE SUMMARY

Internally Generated Fund (IGF) is non-taxable revenue that is

generated through the activities of public hospitals as an additional

source of funding. The aim of introducing IGF into public hospitals in

1985 is to help alleviate financial difficulties confronting the health

sector in delivering quality health care.

2. Public hospitals have the legislative mandate (FAR 2004, L.I.

1802 part II) to collect and retain all IGF for its operations. IGF has

now become the major source of finance to public hospitals

constituting about 77% of total receipts. The audit set out to ascertain

whether the public hospitals are:

strengthening financial management and revenue generation

managing prudently resources available for the provision of

health service through the use of IGF, and

maintaining equipment and infrastructure to enhance

revenue generation.

3. The audit was carried out in four public hospitals comprising

Volta, Central and Greater Accra Regional hospitals and Korle-Bu

Teaching hospital. The audit covered the period 2005 to 2008.

Performance audit report of the Auditor-General on the generation and management iv of Internally Generated Funds in public hospitals

4. The audit team examined the generation, collection and

disbursement from IGF. All the hospitals the audit team visited have

shown an increase in revenue generation for the period reviewed.

Although revenue generated over the past four years has shown an

increased trend due to increase in patient attendance, improvement in

internal control systems and increase in tariffs, some difficulties have

to be overcome to run the hospitals smoothly as government

assistance and donor funds have dwindled over the review period.

Challenges

Revenue defaulters

5. Total IGF generated over the four year period for the hospitals

amounted to GH¢56,069,100 with Korle-Bu generating the highest

and Ho the least. However a total amount of GH¢4,819,975

representing 7.95% was not realised due to defaulters.

Purchases not properly accounted for leading to leakage of store

items

6. Disbursement of IGF over the period is quite satisfactory as

payments for drug and non-drug consumables were made within laid

down rules and regulations. Total amount expended was

GH¢41,951,871.72.

7. We however noted that over 46 types of drug consumables and

non-drug consumables purchased for use were not duly accounted for

Performance audit report of the Auditor-General on the generation and management v of Internally Generated Funds in public hospitals

due to improper record keeping and negligence on the part of schedule

officers and supervisors.

Delays in reimbursement of claims

8. The audit revealed that it takes a year or more for scheme

mangers to fulfil their financial obligations to the hospitals. The total

amount owed as at 31 December 2008 was GH¢3.6 million.

9. The delay in reimbursement of claims has affected the four

public hospitals which are owing their creditors to the tune of GH¢2.9

million as at 31 December 2008.

Non-compliance with tariff structure

10. The audit team found that scheme managers at times failed to

comply with their tariff structure. Claims are also rejected on the

grounds of fraud and misunderstanding. Total amount rejected was

GH¢225,492.23.

Inadequate and poor maintenance of existing infrastructure

11. Korle-Bu and Ridge hospitals have infrastructure problems

while Ho and Cape Coast are operating under capacity. This problem

has resulted into overcrowding of health facilities especially in the

wards.

Performance audit report of the Auditor-General on the generation and management vi of Internally Generated Funds in public hospitals

Insufficient maintenance of equipment and machinery leading to

frequent breakdowns

12. All the four hospitals complained about broken down

equipment and machinery due to inadequate funds and lack of human

capacity.

13. Despite the difficulties what is generated should be

safeguarded and managed prudently to improve health care delivery.

There is the need to improve economy and efficiency in the collection

and disbursement of IGF.

The way forward

14. In light of the findings we recommend as follows:

Revenue defaulters

15. To increase revenue generation and improve revenue

collection, we recommend that management ensure that;

claims submitted to NHIS managers for re-imbursement

are validated before submission to avoid the incidence of

rejections on the grounds of fraud and other irregularities

staff debtors should not be given any new salary advance

until previous ones are settled

salary advances should be deducted from allowances given

to staff after the three month period given for refund

elapses, and

Performance audit report of the Auditor-General on the generation and management vii of Internally Generated Funds in public hospitals

for absconders and paupers, security men around the wards

should be vigilant to prevent them from absconding

without paying for services rendered.

Purchases not properly accounted for leading to leakage of store

items

16. To improve on efficient disbursement of IGF, we recommend

that hospital management should:

ensure that details of all items received into stores are

taken on ledger charge before issues are made

emergencies notwithstanding, every effort should be made

by the store keeper to enter all items purchased into store

records

plan its procurement ahead of time to avoid emergency

cases which are normally characterised with higher prices

and sub-standard items

procurement officer should ensure that items acquired and

paid for, are supplied in full, and

monitoring and Internal Audit unit should check store

items purchased into store ledgers to avoid instances of

understating and/or omitting store items from store ledgers.

Delays in reimbursement of claims

17. To quicken the reimbursement process we recommend that

hospital managements:

Performance audit report of the Auditor-General on the generation and management viii of Internally Generated Funds in public hospitals

ask for half the claims submitted pending thorough

evaluation of claims by scheme managers to avoid

instances of total cash shortages for day-to-day operations

and activities

computerise operations to speed up documentation process

to address cumbersome manual procedures, and

train personnel working on NHIS for requisite skills and

provide incentive package for any overtime work done to

motivate staff.

Non compliance with tariff structure by schemes

18. To avoid the incidence of schemes not paying the correct tariff,

we advise that management teams should:

have co-ordinators to represent them when Health

Authorities and NHIA are meeting to set tariffs. This will

give them the opportunity to justify the amount to be

charged, among others

insist on reviewing tariffs structure within the stipulated

six months by agreeing on a date with scheme management

prior to the beginning of each year, and

in consultation with National Health Authority change the

four week review period to suit their operational needs.

Performance audit report of the Auditor-General on the generation and management ix of Internally Generated Funds in public hospitals

Inadequate and poor maintenance of existing infrastructure and

machinery

19. To improve revenue generation and health care delivery,

management teams should:

put aside a percentage of total IGF, within a specified

period to improve the condition of existing infrastructure

have a proper maintenance schedule and follow it to the

letter, and seek the assistance of NGOs, Corporate Bodies

and other key players in the health sector to, at least, help

improve physical condition of existing infrastructure where

the cost implication is beyond them.

Performance audit report of the Auditor-General on the generation and management 1 of Internally Generated Funds in public hospitals

CHAPTER ONE

INTRODUCTION

1.1 Reasons for the audit

Government funding of public hospitals in Ghana has become

increasingly difficult, due to increase in population size and cost of

treatment. Accordingly, policy makers and researchers in the health

sector have looked to other countries to find new ways of organising

and paying for healthcare.

2. Internally Generated Funds (IGF) was therefore introduced in

1985 as an additional source of funding for public hospitals. IGF has

now become the major source of finance to public hospitals. Total

revenue accruing to the four hospitals (Korle-Bu Teaching Hospital,

Ridge Hospital, Central Regional Hospital and Volta Regional

Hospital) over the audit period was GH¢ 73,262,222.38 and out of

this, IGF‟s contribution is GH¢ 56,069,100.01 representing 77% of

the total income.

3. Over the years, huge financial supports have been given to

hospitals to enable them provide quality health care services to

citizens. In the last four years, about 15% of the national budget has


been allocated yearly to the health sector to provide high quality and

affordable health care service to all Ghanaians.

4. However, the Auditor-General‟s Report on the Public Accounts

of Ghana (Ministries, Departments and Agencies) 2005 in respect of

public health institutions identified the following lapses:

non-compliance to procurement procedures

improper record keeping

IGF not properly accounted for

indebtedness of Institutions and National Health Insurance

Scheme to public hospitals , and

embezzlement of drug revenue. The lapses impact

negatively on the generation of revenue of the hospitals.

1.2 Purpose and scope

5. The purpose of the audit was to ascertain whether public

hospitals are:

strengthening financial management and revenue generation

prudently managing resources available for the provision of

health service through the use of IGF, and

maintaining equipment and infrastructure to enhance

revenue generation.


6. The audit was carried out in four public hospitals comprising

Volta, Central and Greater Accra Regional hospitals and Korle-Bu

Teaching hospital. The audit covered the period 2005 to 2008. Korle-

Bu was chosen because it is a teaching hospital. Volta and Central

regional hospitals were chosen because they were built in 1995 with

new infrastructure and equipment with the opportunity to generate

more revenue. Greater Accra Regional Hospital (Ridge) was chosen

because of the increasing number of patients visiting the facility over

the years.

1.3 Methods and implementation

7. The audit team used interviews, review of documents and

physical inspection to collect data for our detailed examination.

Interviews

8. We interviewed key officials for all the hospitals visited. The

interviewees were officials either involved in decision-making or

policy implementation as regards the generation and management of

IGF. The interviews were to enable us understand the processes and

procedures involved in the management of IGF. Refer to Appendix „1‟

for details of key persons interviewed.


Documentary review

9. The rationale for the documentary review was to enable us to

have an insight into the legal mandate for IGF as well as to understand

the system description and activities of the audit object. Refer to

Appendix „2‟ for details of documents reviewed.

Physical inspections

10. The team inspected the Out Patients Department (OPD) and the

wards of the four hospitals visited to ascertain the condition and

adequacy of infrastructure and equipment used in health care delivery.

We also inspected some of the projects undertaken with funds from

IGF.


CHAPTER TWO

DESCRIPTIVE CHAPTER

2.1 Historical background

11. Internally Generated Fund (IGF) is non-taxable revenue that is

generated through the activities of public hospitals. Public hospitals

have the legislative approval to collect and retain all IGF. Revenue is

generated through the following activities:

Medicine

General Surgery and Anaesthesia

Paediatrics

Obstetrics and Gynaecology

Dental Services

Psychiatry

Accident and emergency services

Ear, Nose and Throat

Ophthalmology

Dermatology

12. The concept of IGF was introduced in 1985 when it became

necessary to find additional sources of funding to support the


activities and operations of public hospitals. Basically, the major

sources of IGF are cash received from patients for services rendered.

13. The National Health Insurance scheme (NHIS) was introduced

in 2005 to enable citizens have access to health care by paying a

premium yearly. After rendering healthcare services to insured

patients, management of public hospitals submit claims to scheme

managers of the NHIS for re-imbursement.

14. Public hospitals are in six categories:

i. Teaching hospitals

ii. Regional hospitals

iii. Municipal and District hospitals

iv. Poly Clinics

v. Health Centres, and

vi. Health Post

15. Teaching hospitals provide all services ranging from primary1

to tertiary2, while the regional hospitals, municipal and district

1 The care a patient receives at first contact with the Health care system.

2 Treatment given in a health care centre that includes highly trained specialists and often

advanced technology


hospitals and Polyclinics provide primary and secondary3 services,

Health centres and Health posts provide only primary services.

2.2 Mandate

16. Regulation 18 of Financial Administration Regulations 2004

(LI1802) gives Public hospitals the legislative approval to collect and

retain all IGF.

2.3 Objectives

17. The objectives of the public hospitals in relation to IGF are to:

strengthen financial management to improve revenue

generation and collection

manage prudently resources generated for the provision of

quality health care, and

maintain equipment and infrastructure used in generating

revenue.

2.3.1 Functions

18. For the purposes of achieving their objectives, public hospitals

are to determine charges and fees with the Minister‟s approval and are

tasked with the:

3 Treatment by specialists to whom a patient had been referred by primary health care

providers


management and administration of health resources

receipt, custody and the judicious disbursement of public

funds, and

keeping accurate financial management and accounting

information in acceptable formats for audit and decision

making purposes.

2.3.2 Vision

19. The vision of a public hospital is that of a society in which

preventable diseases and avoidable deaths are kept to the barest

minimum and everywhere every citizen has access to a quality driven,

result oriented, close to clients, focused and affordable health service

run by a well motivated work force.

2.3.3 Mission

20. The Mission of a public hospital is to work in collaboration

with all partners in the Health sector to ensure that every individual,

household and community is adequately informed about health and

has equitable access to high quality health and related intervention.


2.4 Funding

21. Public Hospitals receive revenue from three main sources,

namely Government of Ghana budgetary support, Donor Pool Fund

and IGF. Table 1 shows the sources of funds and amount generated

for the period 2005 to 2008 for the four hospitals visited. Total income

for the four hospitals amounted to GH¢ 74 million. Figure 1 also

shows IGF as a major source of funding for the hospitals, contributing

about 77% of total incomes.

Table 1: Source of funds and amount generated

Year/Source

of fund

IGF

GH¢

DPF

GH¢

GOG

GH¢

Amount

GH¢

2005 9,794,340.22 3,566,040.02 7,992,795.56 21,353,175.80

2006 11,172,519.50 1,284,959.87 3,537,947.07 15,995,426.44

2007 15,436,028.10 0 794,881.95 16,230,910.05

2008 19,666,212.19 0 704,053.88 20,370,266.07

Total 56,069,100 4,850,997 13,029,678 73,949,778.36

Source: Annual reports from 2005 to 2008 of the four hospitals visited


Figure 1: Funding for public hospitals for the four-year period

Source: GASgraph

2.5 Organisational structure

22. The organizational structure for Public Hospitals can be found

at Appendix „3‟.

2.6 Systems description

23. The processes involved in the generation and management of

IGF in public hospitals are grouped into four stages, as follows:


The detailed system description is shown as a flow chart at Appendix

„4‟.

2.7 Key players and their activities

Key Players Activities

MOH Formulates policy for the health sector

including fees and charges

GOG Provides budgetary support

GHS Implements policy decisions taken by MOH

NHIS Pays on behalf of insured patients

Council of Teaching

Hospitals

Take decisions for teaching hospitals

Donors Gives financial and technical support to

hospitals

2.8 Current development

24. Following the passage of the National Health Insurance Law,

Act 650 and LI 1809, the NHIS was introduced into public hospitals

Planning and Budgeting

Procurement of Drugs and Non-drugs

consumables

Revenue Generation and Collection

Expenditure/ Usage of IGF


in 2005. The introduction of the National Health Insurance Scheme

has increased hospital attendance especially for maternal health

delivery. As at 31 December 2008, the number of insured patients is

about 80% of total attendance4. This has implications on IGF as

increased attendance means an opportunity to generate more revenue.

25. Effective 1 July 2008, free maternal delivery policy has been

extended to all pregnant women and cost is borne by government. In

Korle-Bu 18,033 women had been seen under this programme as at

the end of December 2008.

26. Some public hospitals like Korle-Bu Teaching Hospital have

instituted a pilot project where banks are contracted to collect daily

receipts on behalf of the hospitals in order to minimise the risk of

carrying cash to bank.

4 Bio-Statistics Unit of the four hospital visited


CHAPTER THREE

FINDINGS

3.1 Introduction

27. The audit revealed that revenue generated over the past four

years had shown an increasing trend for all the hospitals visited. Table

2 shows the total amount collected over the four year period of GH¢

56.0 million.

Table 2: IGF Generated by the four hospitals in nominal terms

Year Ridge

(GH¢)

Ho

(GH¢)

Cape

Coast

(GH¢)

Korle-Bu

(GH¢)

Total

(GH¢)

%

Change

2005 1,165,961 741,337 838,199 7,048,843 9,794,340 -

2006 1,796,398 887,622 1,115,374 7,373,125 11,172,520 14%

2007 2,607,870 1,308,544 1,323,758 10,195,855 15,436,028 38%

2008 3,520,067 1,565,461 2,136,206 12,444,477 19,666,212 27%

Total 9,090,296 4,502,964 5,413,538 37,062,301 56,069,100

Source: Annual reports of the hospitals visited

28. From Table 2, all the hospitals visited showed increases in

yearly revenue generations. IGF increased by 14% in 2006 over 2005.

In 2007 the increment was 38% over 2006. This figure dropped

slightly to 27% in 2008.


29. The reasons for the increase in revenue were attributed to the

increase in patient attendance, improvement in internal control

systems and increasing tariffs. Refer to Appendix „5‟ for details.

30. Despite the increase in revenue from 2007 to 2008, the

hospitals could have collected more IGF if they had not been hindered

by the following challenges:

revenue defaulters

non-compliance with store procedure

delays in re-imbursement of claims, and

non-compliance with tariff structure by the schemes.

3.2 Challenges

3.2.1 Revenue defaulters

31. Even though revenue generation has shown an increase in trend

from 2005 to 2008, examination of patient bills and ledgers revealed

that there is a revenue loss because of absconders, staff defaulters

(salary advance) NHIS rejections, and paupers who could not pay

their bills. Table 3 indicates an amount of GH ¢4.8 million for which

services have been provided but revenue was not realised.


Table 3: Income not realised as at 31 December 2008

Hospital/category Ridge

(GH¢)

Ho

(GH¢)

Cape

Coast

(GH¢)

Korle-Bu

(GH¢)

Total

(GH¢)

Paupers/Absconders 9,262 73,003 - 574,054 656,319

Staff 28,587 74,841 17,407 136,708 257,543

NHIS 941,609 197,486 - 2,516,415 3,655,511

Corporate Bodies 42,039 208,563 - 0 250,602

Total 1,021,496 553,894 17,407 3,227,178 4,819,975

Source: Patient bills and ledgers

32. Revenue generated but not collected is loss of revenue which

affects health care delivery. The Central Regional Hospital in Cape

Coast did not have any data on Paupers/Absconders, NHIS rejections

and payment by corporate bodies because it did not keep a ledger for

them.

3.2.2 Non-drug consumables Purchases not properly accounted

for

33. Non–drug consumables comprise all items with the exception

of drugs used in health care delivery. During the review period, a total

amount of GH¢ 27,979,714 representing 49% of IGF revenue was

disbursed on non-drug consumables for the four hospitals visited as

shown in Table 4.


Table 4: Expenditure on non-drug consumables from IGF

Year Ridge

(GH¢)

Ho

(GH¢)

Cape

Coast

(GH¢)

Korle-Bu

(GH¢)

Total Amt

(GH¢)

2005 790,404 507,392 92,742 4,882,642 6,273,180

2006 1,289,267 621,519 184,304 5,182706 7,277,798

2007 2,112,939 910,344 291,206 6,351,116 9,665,606

2008 2,367,281 201,188 297,088 1,897,574 4,763,130

Total 6,559,891 2,240,443 865,340 18,314,040 27,979,714

Source: Annual reports from 2005 to 2008

34. Stores regulations chapter V (70) requires that all items bought

should be taken on ledger charge or in a cost book and issued out only

under approved requisition.

35. However we could not reconcile payments for non-drug

consumables with store records for 2008 as the items bought were not

recorded in the store ledgers. Total amount of items not routed

through store for Ridge hospital amounted to GH¢30,914.50 while

that of Korle-Bu was GH¢41,343.95. See Appendix 6 for details.

36. The problem was attributed to emergency buying and sending

the items to the user departments directly without passing them

through stores.


37. Failure to route the items purchased through store could result

in non-delivery of the items and misappropriation of the amounts

involved.

Drug consumables

38. Public hospitals are required to keep a revolving fund for drugs

into which all receipts are paid and all drugs purchases are made from

this account. A mark up of between 5% to 20% margin is put on drugs

purchased depending on the type of drug involved. This is to cater for

administration expenses and frequent increase in drug prices due to

inflation. Monies generated from the sale of drugs are to be used

solely for the purchase of drugs and drug related expenditure.

39. For the four year period examined, the total amount disbursed

on drugs and drug related expenses by the four hospitals from IGF

amounted to about GH¢14 million. The details are shown in Table 5.


Table 5: Expenditure on drugs

Year Ridge (GH¢) Ho (GH¢) Cape Coast

(GH¢)

Korle-Bu

(GH¢)

Total Amt.

(GH¢)

2005 294,149 153,399 256,287 2,242,784 2,946,618

2006 474,389 158,767 294,796 2,190,418 3,118,369

2007 458,034 146,588 424,682 2,302,331 3,331,636

2008 538754 1,147,319 612,821 2,276,641 4,575,534

Total 1,765,326 1,606,072 1,588,586 9,012,174 13,972,157

Source: Annual reports

40. Drugs purchased must be entered into their respective store

ledgers with the quantity and store receipt voucher number clearly

stated in accordance with stores regulations. We however noted in

some instances that 48 different types of drugs purchased were not

recorded in relevant store ledgers in the records of Cape Coast and

Ridge Hospitals. See Appendix 7 for details.

41. The anomalies were attributed to delivery of drugs in

instalments by suppliers, ineffective supervision by the internal audit

unit in charge of monitoring and negligence on the part of store

officers responsible for store management. These lapses could result

in loss of revenue to the hospitals, which revenue could have been

used to maintain or improve upon infrastructure for the hospital.


3.2.3 Delays in re-imbursement of claims

42. The agreement between the hospitals and the NHIS schemes is

that hospitals should be paid within four weeks after submission of

claims. The audit revealed however that the hospitals were not re-

imbursed on time. It took between two to six months or more for

scheme managers to settle their indebtedness to the hospitals, thus

hampering revenue generation. As at 31 December 2008, the NHIS

owed GH¢3.6 million to the four hospitals as shown in Table 3.

43. According to the Director General of Ghana Health Service,

total debt owed by the Scheme to all public hospitals amounted to

GH¢ 36.0 million as at 31 December 2008 and therefore called for a

review of the Scheme to enable it function smoothly.5

44. Even though the Scheme managers were blamed for the

situation, the hospitals were partly to blame for the delays in

payments. The hospitals lacked personnel to cope with the workload.

There were long processes of documentation and cumbersome

procedures as work was done manually. These conditions made it

difficult for the hospitals to meet the two week deadline for

submission of claims at the end of each month.

5 Daily Graphic of 15 January 2009


45. Since the hospitals were not paid promptly, they in turn owed

their creditors for drugs and non-drug items supplied to them. The

hospitals indicated that suppliers threatened to stop supplies until the

hospitals made good their indebtedness. As at 31 December 2008, the

four hospitals owed their creditors GH¢2.9 million. Table 6 shows the

details of the hospitals indebtedness.

Table 6: Amount owed by four hospitals to creditors

Hospital GH¢

Ridge Hospital, Accra 221,570.17

Volta Regional Hospital, Ho 896,101.00

Central Regional Hospital, Cape Coast 115,373.79

Korle-Bu Teaching Hospital, Accra 1,680,216.99

Total 2,913,261.95

Source: Creditors Ledger

46. Since the hospitals treat between 70% and 80% insured

patients, physical cash was locked up with the schemes which affected

the smooth running of day to day operations.

3.2.4 Non-compliance with tariff structure by schemes

47. Under the NHIS, tariffs are set by the National Health

Insurance Council in consultation with Health Authorities with inputs


from the various public hospitals. The tariffs are supposed to be

reviewed by the National Health Insurance Authority every six

months to reflect current trends in the economy.

48. We noted during the audit that as at December 2007, the

National Health Insurance Schemes were still using 2004 approved

tariffs because tariffs had not been reviewed since 2004, even though

prices of drugs and other non-drug consumables had gone up. In April

2008 a new tariff known as Ghana Diagnosis Related Group (G-

Drugs) charges had replaced the “Fee for service” used previously. As

at December 2008 this new tariff was still in use although tariffs are to

be reviewed every six months. The hospitals also complained of the

rejection of claims by the scheme managers submitted by them

although patients have been treated and discharged. As at December

2008, GH¢ 225,492.23 was rejected by scheme managers as shown in

Table 7.

Table 7: Rejected claims by NHIS

Hospital Rejected claims by NHIS (GH¢)

Ridge Hospital, Accra 15,382.66

Volta Regional Hospital, Ho 16,219.82

Central Regional Hospital, Cape Coast 0

Korle-Bu Teaching Hospital, Accra 193,889.75

Total 225,492.23 Source: GAS Analysis of Annual reports.


49. We noted further that claims are sometimes rejected by scheme

managers on the grounds that the services provided by the hospitals

are not covered in the tariff list being used by the Schemes and in

other instances, claims are sometimes rejected on suspicion of fraud

perpetuated by hospital staff.

50. An interview with management of Ho Regional Hospital

revealed that Scheme managers reject claims on the grounds that

Regional Hospitals should treat referral cases only and therefore not

reimburse hospitals for treating patients who were not referred from

Primary Health Centres. However the Hospitals are of the view that it

is not prudent to turn away a sick person who calls for help.

51. This problem arose because the NHIA did not consult the

Hospitals before setting tariffs thereby not considering the cost

involved in rendering services. According to the Hospital

Management Committee, tariffs are set by the National Health

Insurance Authority without their inputs.

52. Rejection of genuine claims submitted and payment of lower

tariffs for services provided will result in low revenue generation and

loss of revenue to the hospital. Another consequence identified is that


insured patients are denied access to certain drugs if prices quoted by

the Schemes are far below the market price, thus hindering equitable

access to Health.

53. The inability of the hospitals to robustly collect revenue is

making it difficult for them to maintain the equipment and

infrastructure used in generating the revenue. This condition had led

to inadequate and poor maintenance of existing structure and

insufficient maintenance of equipment and machinery.


infrastructure

54. One major objective of public hospitals is to maintain

infrastructure to enhance quality, efficient, accessible and affordable

health care services. To achieve these objectives, hospitals are

mandated to retain all IGF collected which should be used for all costs

related to the running of the hospitals including capital projects not

exceeding GH¢ 50,000.

55. Even though the hospital were using part of IGF collected for

infrastructure development, we noted during the audit that there was

the need to increase the allocation, especially in the case of Ridge and

Korle-Bu hospitals where the physical conditions of some of the


structures needed attention. An increasing number of patients had not

been met by a corresponding increase in infrastructure.

Case Example 1

56. Picture 1 shows a congested ward at Korle-Bu Teaching

Hospital while Picture 2 shows the maternity ward of Ridge Hospital

with patients lying on the floor in the corridor. Ho and Cape Coast

Regional hospitals however had excess health facility as they are

operating under capacity due to lack of health professionals needed

for its operations.

The maternity ward of Ridge hospital has a bed capacity of 37. Pregnant women

that delivered in 2005 at Ridge hospital were 2,878. This number increased to

6,049 in 2007 but bed capacity was not increased. This condition has resulted in

pregnant women sometimes using the floor and benches as their beds.


Picture 1 Picture 2

Source: Korle-Bu photos Source: GAS photos

Case Example 2

57. Pictures 3 and 4 respectively show the maternity ward of Volta

Regional Hospital, Ho and the OPD at Cape Coast Hospitals as a good

model. The management of the hospitals explained that it was difficult

maintaining existing health infrastructures let alone expanding the

The OPD and Wards of Central Regional Hospital (Cape Coast) and

Volta Regional Hospital (Ho) were kept in a neat and orderly fashion

without congestion. These were ideal cases.


infrastructure as they relied mostly on IGF for operating the hospitals.

They also complained of dwindling GoG and DPF which IGF

supplements, as detailed in Table 1 on page 6.

Picture 3 Picture 4

Source: GAS photos on field inspection at Ho and Cape Coast Regional Hospitals

58. Table 8 shows that over the review period, Ridge and Central

Regional hospitals spent 1.36 and 1.44% of IGF respectively on

infrastructure while Volta Regional Hospitals spent 0.41% on

maintenance of existing infrastructure. Korle-Bu spent the highest of

3.00% on infrastructure. Between the four hospitals IGF spent on

maintenance averaged 1.55%.


Table 8: Amounts spent on maintenance of existing infrastructure

Hospitals IGF

(GH¢)

Amount spent on

maintenance GH¢

Expenditure/

IGF

Ridge 9,090,295.64 123,314.39 1.36%

Volta Regional 4,502,964.48 18,452.90 0.41%

Central Regional 5,413,538.63 78,181.34 1.44%

Korle-Bu 37,062,301.26 1,112,683.27 3.00%

Total 56,069,099.75 1,332,631.90 6.21%

Source: Annual Reports

59. The effect of this situation was that health authorities were

forced to turn away patients due to inadequate infrastructure. If these

patients had been treated, it would have contributed to increase the

amount of IGF generated.

3.4 Insufficient maintenance of equipment and machinery

60. Equipment and machinery are important tools used by hospitals

to generate revenue to deliver quality health care. Public Hospitals are

to maintain equipment and machinery which should be carried out

either regularly or on quarterly basis by the Estate department.

61. Each of the four hospitals visited had a maintenance schedule

for equipment and infrastructure but these schedules were not

followed by the Estate department.


62. In an interview with head of the Estate department, inadequate

technical expertise and insufficient funds from the finance department

were found to be the reasons for their inability to follow the

maintenance schedule.

63. We noted that out of the total IGF generated, only about

GH¢1.6 million representing 2.87% was used to maintain equipment

and machinery leading to the frequent breakdown of machines. Table

9 shows that Volta Regional Hospital spent the highest of 22.09%

while Ridge Hospital spent the lowest of 1.56% on maintenance of

equipment.

Table 9: Percentage of monies spent on maintenance of equipment and

machinery

Hospitals IGF(GH¢) Amount spent on

maintenance (GH¢)

% of IGF

(GH¢)

Ridge 9,090,295.64 141,008.40 1.56%

Volta

Regional

4,502,964.48 994,810.37 22.09%

Central

Regional

5,413,538.63 361,025.12 6.67%

Korle-Bu 37,062,301.26 994,810.37 2.68%

Source: Annual Reports


64. Picture 5 shows broken down incubators at Ridge hospital

while Picture 6 shows a broken down sterilizer at the Volta Regional

hospital in Ho. More IGF could have been generated through the

provision of services with the equipment had they been in good

condition.

Picture 5 Picture 6

Source: GAS photos

65. The effect of the above is that the equipments have broken

down and the hospitals must find cash to replace them since they have

been “Over-used”.


3.5 Summary and conclusions

66. IGF was introduced into public hospitals in 1985 to help

alleviate financial difficulties confronting the health sector in

delivering quality health care. All the hospitals the audit team visited

have shown an increase in revenue generation in real terms. They also

attest to the fact that IGF which constitutes 77% of total revenue is

now their backbone in health care financing.

67. Generating revenue is not the problem as there is always a sick

person to be attended to. However, collecting what is generated at

times creates a problem. The hospitals cannot recover an amount of

GH¢4.4 million generated as income over the four year period

because of absconders, paupers, NHIS rejected claims and staff

defaulters. Revenue generated but not collected results in unavailable

revenue for health care delivery, developing infrastructure and

maintaining equipment and machinery.

68. The management and disbursement of IGF over the period was

quite satisfactory as payments for drug consumables and non-drug

consumables were effected within laid down rules and regulations.

We however noted that some drug consumables and non-drug

consumables purchased were not properly accounted for due to


improper record keeping and negligence on the part of schedule

officers and supervisors. This is due to emergency buying, delivery of

drugs and non-drugs in instalments and items sent to user departments

without passing them through stores. This could result in leakages and

waste of resources leading to poor health delivery.

69. Major challenges facing the hospitals has to do with NHIS and

overcrowding of health facilities. All the hospitals complained of

delays in reimbursement of claims submitted on behalf of insured

patients and unwillingness to comply with tariff structure. These

activities have impacted negatively on revenue generation. As at 31

December 2008, NHIS managers were owing the four public hospitals

GH¢3.6 million and an amount of GH¢ 36.0 million to all public

hospitals.

70. There is little or no co-ordination between the hospitals and the

scheme managers when it comes to setting tariffs, resulting into

conflict between the hospital authorities and scheme managers as to

how much and when to pay. Delays in reimbursement are causing

operational difficulties as creditors for drugs and non-drugs items

have threatened to stop supplying items to them on credit. The

hospital owed creditors GH¢ 2.9 million for the period.


71. Health facilities at Korle-Bu and Ridge hospitals are over

stretched resulting in overcrowding of OPD and the wards. Most of

the infrastructure were built in the early 1900s when the population

size was small and therefore could contain patients. The introduction

of NHIS has drastically increased patient attendance especially for

maternal deliveries. Pregnant women are forced to lie on benches due

to inadequate space and lack of beds. However, purchase and

maintenance of equipment is a major problem for all hospitals.

Between 1% and 22% of IGF is used on infrastructure and

maintenance of equipment and machinery.

72. The effect is that the hospitals cannot deliver on their mandate

leading to inadequate revenue generation.

73. To some extent public hospitals are strengthening financial and

revenue generation because there has been an increase in revenue

generation over the period reviewed but structures should be put in

place to improve economy and efficiency in the management of the

revenue.

74. The maintenance of equipment and infrastructure should be

enhanced to improve revenue generation. Currently only 2.87% of


IGF collected is spent on maintenance of equipment and

infrastructure.


CHAPTER FOUR

RECOMMENDATIONS

4.1 Revenue defaulters

75. To increase revenue generation and improve revenue

collection, we recommend that management teams should ensure that:

claims submitted to NHIS managers for re-imbursement

are validated before submission to avoid the incidence of

claims being rejected on the grounds of fraud and other

irregularities.

staff debtors should not be given any new salary advance

until previous ones are settled.

salary advances should be deducted from allowances given

to staff after the three-month period given for refund

elapses, and

security men around the wards should be extra vigilant to

prevent patients from absconding without paying for

services rendered.


4.2 Non – compliance with store procedures

76. To improve compliance with store procedures, we recommend

that hospital management teams should:

ensure that details of all items received into stores are

taken on ledger charge before issues are made

emergencies notwithstanding, every effort should be made

by the store keeper to enter all items purchased into store

records

plan its procurement ahead of time to avoid emergency

cases which are normally characterised with higher prices

and sub-standard items

ensure that items acquired and paid for, are supplied in

full.

4.3 Delays in Reimbursement of claims

77. To quicken the reimbursement process we recommend that

hospital management teams should:

ask for half of the claims submitted pending thorough

evaluation of claims by Scheme managers to avoid

instances of total cash shortages for day-to-day operations

and activities,


computerise operations to speed up their documentation

process to address cumbersome manual procedures, and

train personnel working on NHIS in requisite skills and

provide incentive package for any overtime work done to

motivate staff to work within the specified two weeks

period as specified within the agreement with NHA.

4.4 Non-compliance with tariff structure by the schemes

78. To avoid the incidence of schemes not paying the correct tariff,

we advise management teams to:

have co-ordinators to represent them when Health

Authorities and NHIA are meeting to set tariffs. This will

give them the opportunity to justify the amount to be

charged among others.

insist on reviewing tariffs structure within the stipulated

six months by agreeing on a date with scheme management

prior to the beginning of each year.


in consultation with National Health Authority change the

six week review period to suit their operational needs.


infrastructure and machinery

79. To improve revenue generation and health care delivery,

management teams should:

put aside a percentage of total IGF, within a specified

period to improve the condition of existing infrastructure

have a proper maintenance schedule which should be

followed to the letter, and

seek the assistance of NGOs, Corporate Bodies and other

key players in the health sector to help improve the physical

condition of existing infrastructure.


APPENDICES

Appendix ‘1’

Interviewees at the various hospitals include:

Medical Superintendent

Hospital Administrator

Head, Finance and Accounts

Head, Internal Audit

Head, Pharmacy Unit

DIRECTOR of Nursing Services

HEAD of procurement

Monitoring team

Five revenue collectors

Schedule officer of NHIS

Patients (Insured and Uninsured).


Appendix ‘2’

Documents reviewed

Document Reason

Budget Estimates (2005-2008) Whether activities are

budgeted for.

Annual report (2005-2008) Confirm financial figures

Financial Administration

Regulation 2004 (LI 1802)

Mandate for IGF

Financial Administration Act, 2003

(Act 654)

Administration of IGF

Ministry of Health accounting,

treasury and financial reporting

rules and instructions

Whether rules and

regulations regarding

collection and disbursement

of IGF are being followed

Ghana Health Service and Teaching

Hospitals Act 1996 Act 525

If laid down procedures of

collection and disbursement

of IGF are being adhered to

Revenue and expenditure records

2005-2008

Whether revenue and

expenditure targets have

been achieved

Ministry of Health finance

handbook

Rules regarding financing of

Health Institutions

Bank reconciliation statements

(2005-2007)

Check if amount generated

has been banked and

accounted for

Patient Bills ledgers/ Books To verify how much has

been generated compared to

amount realised.

Directives and instructions on

operation of IGF

Rules regarding the

operation of IGF

Per

form

an

ce a

ud

it r

epo

rt o

f th

e A

ud

ito

r-G

ener

al

on

th

e g

ener

ati

on

an

d m

an

ag

emen

t

40

o

f In

tern

all

y G

ener

ate

d F

un

ds

in p

ub

lic

ho

spit

als

Ap

pen

dix

‘3’

Org

an

ogra

m

Reg

ional

Hosp

ital

Min

istr

y o

f H

ealt

h

Counci

l of

Ghan

a H

ealt

h

Ser

vic

e

Counci

l fo

r

Tea

chin

g

Hosp

ital

s

Tea

chin

g

Hosp

ital

Chie

f

Ex

ecuti

ve/

Med

ical

super

inte

nden

t H

osp

ital

Man

agem

ent

Tea

m

Inte

rnal

Audit

Hea

d

Nurs

ing

H

ead, A

dm

in &

sup

port

ser

vic

es

Hea

d F

inan

ce &

Acc

ounts

Hea

d C

linic

al

Ser

vic

es

Per

form

an

ce a

ud

it r

epo

rt o

f th

e A

ud

ito

r-G

ener

al

on

th

e g

ener

ati

on

an

d m

an

ag

emen

t

41

o

f In

tern

all

y G

ener

ate

d F

un

ds

in p

ub

lic

ho

spit

als

Ap

pen

dix

‘4’

Sy

stem

s d

escr

ipti

on

of

gen

era

tio

n a

nd

ma

na

gem

ent

of

IGF

Pro

cure

men

t &

Sto

res

Pla

nn

ing &

Bu

dget

R

even

ue

Gen

erat

ion

Exp

end

itu

re

Pre

par

atio

n o

f an

nu

al

esti

mat

es (

Fee

s &

Ch

arges

)

Pre

par

atio

n o

f an

nu

al

esti

mat

es (

Fee

s &

Ch

arges

)

Pre

par

atio

n o

f an

nu

al

esti

mat

es (

Fee

s &

Ch

arges

)

Ap

pro

val

an

d

auth

ori

zati

on o

f fe

es

and

ch

arges

by M

OH

and

GH

S

Acq

uis

itio

n o

f val

ue

bo

oks

En

try o

f val

ue

bo

oks

in

sto

ck r

egis

ter

Issu

e o

f val

ue

bo

oks

to r

even

ue

coll

ecto

rs u

pon

req

ues

t b

y t

he

mo

nit

ori

ng u

nit

Pay

men

t to

cah

ier

by

reven

ue

coll

ecto

rs

Ret

urn

of

use

d v

alu

e

bo

oks

to m

on

ito

rin

g u

nit

En

try o

f co

llec

tio

ns

into

reven

ue

cash

bo

ok b

y c

ash

ier

Lo

dg

men

t o

f co

llec

tio

ns

to b

ank b

y c

ash

ier

Bal

anci

ng o

f ca

sh b

oo

k

Pre

par

atio

n o

f B

ank

reco

nci

liat

ion

sta

tem

ents

Au

tho

riza

tio

n a

nd a

pp

roval

for

pu

rch

ase

by T

end

er

com

mit

tee

Rec

eip

t an

d p

urc

has

e

item

s in

to s

tore

s

Saf

ety a

nd

sec

uri

ty o

f

sto

re i

tem

s

En

try o

f st

ore

ite

ms

into

sto

re l

edger

s

Req

uis

itio

n f

or

sto

re

item

s

Au

tho

rity

an

d a

pp

roval

for

use

of

sto

re i

tem

s

Au

tho

rity

an

d a

pp

roval

for

spen

din

g

Pre

par

atio

n o

f p

aym

ent

vo

uch

ers

(P.V

)

Rec

ord

ing o

f P

.V‟s

in

to

exp

end

itu

re c

ash

boo

k

Bal

anci

ng o

f ex

pen

dit

ure

cash

bo

ok

Pre

par

atio

n o

f b

ank

reco

nci

liat

ion

sta

tem

ents


42

Appendix ‘5’

Factors accounting for increasing revenue

a. Increase in patient attendance

Table A1 gives details on patient attendance for the period.

Table A1: Patient attendance records

Years Ridge Ho Cape

Coast

Korle-Bu Total %

Change

2005 91,727 50,005 90,123 339,580 571,435 -

2006 96,163 44,696 76,533 280,975 498,367 12.79%

2007 131,541 39,843 94,893 296,339 562,616 12.89%

2008 244,413 48,359 101,579 323,752 718,103 27.64%

Total 563,844 182,903 363,128 1,240,646 2,350,521

Source: Biostatistics unit of the four hospitals

On the whole there is an increase in patient attendance even though

year 2006 shows a slight decrease from year 2005 with the exception

of Ridge hospital.

b. Improvement in internal control systems

Through interviews and documents examined, the audit found that

internal control systems and monitoring measures were intensified.


43

For example revenue collectors are checked by monitoring units

before payments are made to cashiers at the close of the day. This is to

ensure arithmetic accuracy and to detect omissions and mis-

statements. Revenue collectors and cashiers were made to pay for any

cash shortages detected against them. Also inspection of receipts

issued to patients by doctors before treatment is given and preparation

of departmental accounts has contributed to the increase in revenue.

c. Increase in tariffs

Another contributing factor to increase in revenue is as a result of

increase in tariffs even though tariffs are not renewed regularly within

the stipulated six months period.


44

Appendix 6 (a)

Ridge Hospital

Non-Drugs items not received into stores

Date Item Quantity Amount (GH¢)

26/3/08 Raid Insecticide Spray 12 ctns 504.00

" Air Refreshner 6 ctns 180.00

" Toilet Roll 150 ctns 450.00

30/4/08 Haz-Tab 45g 60 tins 270.00

" Haz-Tab Granules 10 tins 360.00

18/6/08 Detergent 3 drums 726.00

21/5/08 UPS 5 pcs 1,925.00

29/5/08 Disposable gloves 410 pkts 1,722.00

11/2/2008 Impression Material 10 pcs 120.00

2/4/2008 Bleach Parazone 7 drums 1,400.00

5/3/2008 CAT Vacutainer 4.5ml 3000 pcs 840.00

" CIT Vacutainer 4.5ml 3000 pcs 810.00

15/2/2008 Dustbin 5 pcs 422.30

12/2/2008 Mosquito spray 10 ctns 420.00

" Air Refreshner 6 ctns 180.00

12/2/2008 Bleach 10 drums 2,000.00

19/3/2008 Disposable gloves 240 pkts 1,416.00

5/2/2008 Aug 2144 Disinfectant 2 drums 16,650.00

2/1/2008 Coartem Tab 80 519.20

30,914.50


45

Appendix 6(b)

Korle-Bu Teaching Hospital

Stationery not routed through stores Date Item Quantity PV No. SRA Amount

24/01/07 Hp 45 Cartridge 30pcs 502530 389679 897.00

Inkjet Colour 78 30pcs " " 1,207.50

Epson Ribbon LQ - 680 40pcs " " 552.00

Toner Cartridge 13A 10pcs " " 920.00

Toner Cartridge 12A 6pcs " " 552.00

23/01/07 Toner Cartridge 2 502956 304.00

23/1/07 Cartridge 3 502910

Computer Mouse 1 "

248.00

1/2/2007 Laserjet Hp 1200 Tonner 2 508047 340.00

Ipod Nano 2 " 240.00

Deskjet 840 Cartridge B/W 2 " 70.00

Deskjet 840 Cartridge

Coloured

2 " 122.00

Giant Staple Machine 1 " 85.00

30/1/07 Computer Hard Drive 1 508001 460.00

Ipod Nano 3 " 450.00

30/1/07 1320 Toner Cartridge 4 502589 480.00

A4 Paper 61 boxes " 114.00

30/1/07 Heavy Duty Staple 4 502997 348.00

Toner Cartridge 05949A 4 " 520.00

A4 Paper 3 boxes " 286.50

25/1/07 Hp Laserjet 15A Toner 3 502998 360.00

15/3/07 12 Inch Fan 2 508906 340.00

10/7/2007 Computer Hard Drive 2 765099 250.00

13/2/07 Lexmark Cartridge 1 508081 250.00

22/3/07 Fax Films Px 432 2 508956 360.00

16/2/07 Ipod Nano 1 508260 410.00

9/5/2007 UPS Batteries 5 630153 36.00

7/2/2008 X-Ray Request Forms 6000pcs 981096 1,461.00


46

Discharge Forms 30,000pcs " 349.50

Daily Treatment 30,000pcs " 349.50

Chart 500 " 1,300.00

30/4/08 Foolscap Notebooks 400 545373 1,941.75

12/3/2008 USB Pen drives 2 981629 300.00

Electronic Calculators Ds-

8900

5 " 260.00

Toner 2100 2 " 380.00

3/4/2008 Toner Cartridge 3 1052563 345.00

2/6/2008 Hp Laserjet P300 Toner 3 844048 585.00


47

Date Non-drug item Quantity Amount

(GH¢)

25/05/07 Hp Laserjet Cartridge 4 480.00

A4 Paper 5 95.00

12/6/2007 Deskjet 5150-Hp57

cartridge

4 204.00

Giant Stapler 1 85.00

9/7/2007 1320 Tonner Cartridge 4 500.00

Arch files 20 70.00

A4 Paper 5 105.00

3/7/2007 1320 Tonner Cartridge 4 520.00

A4 Paper 4 112.00

Arch files 20 70.00

16/08/07 Casio Calculator 10 320.00

Computer Printer Toner 4 680.00

1/2/2007 Heavy Duty Staple Machine 4 340.00

4 480.00

3 285.00

10/4/2007 Arch files 3 285.00

Stabilizers 4 300.00

Giant Staple Machine 2 190.00

11/4/2007 Shredder 1 400.00

7/4/2007 Hp Laserjet 1320 2 264.00

2/2/2007 Laserjet Hp 1200 series

Tonner

2 340.00

Ipod Nano 2 240.00

Deskjet 840c Cartridge 2 70.00

Deskjet 840 Cartridge (Hp

6625A Coloured

2 122.00

Giant Staple Machine 1 85.00


48

8/5/2007 A4 Paper 5 boxes 92.50

Tonner Cartridge 1320 4 500.00

Envelope (Big Size) 2 pkts 14.00

Envelope (Small Size) 2 pkts 7.50

30/3/07 Epson Ribbon 2180 60pcs 924.60

Cannon Tonner 1600 6pcs 483.00

Tonner Cartridge 12A 5pcs 420.00

Tonner Cartridge 13A 10pcs 816.50

29/01/07 Hp Laserjet 15A Tonner 3pcs 360.00

Tonner Cartridge 1320 1pc 120.00

1/3/2007 No. 57 & 58 Deskjet

Cartridge

2pcs 135.00

6/2/2008 Hp 1320 (49A) 4 540.00

A4 Paper 5 boxes 125.00

Giant Stapler 1pc 35.00

17/06/08 Hp 1320 Tonner 4pcs 540.00

Pen Drive 2pcs 80.00

A4 Paper 4 boxes 100.00

11,935.10

Grand Total 41,343.95


49

Appendix 7(a)

Central Regional Hospital

Drug items not routed through stores

Pharmacy / Drugs

Date Item Quantity SRV L/F

Amount

(GH¢)

17/10/06 Caps Domadol (50mg) 10,000 162/06

27/10/06 Supp. Paracetamol (125mg) 500 167/06

" Flucloxacillin (250mg) 5000 167/06

" Supp.Diclofenac (100mg) 500 "

" Metronidazole Syrup 240 "

31/08/06 Pethidine 50mg 1000 142/06

22/09/06 Lipitor (10mg) 1500 157/06

15/08/06 Quinine Injection 700 134/06

24/08/06 Susp. Amoksiklav (45mg)

200

bottles 140/06

13/04/06 Ibuprofen 200mg Tab 30,000 20/CB/06

" Methytolpa 9000 "

" Pethidine Injection 2000 "

2/8/2006 Xone 250mg 300 124/06

13/02/07 Cipro 500

60

27/07/07 Ketamine 200

300

30/07/07 Pherobard 100

_


50

30/7/07 Largoctu 100

_

23/08/07 Inj. ATS 560

425.6

28/08/07 Inj. Metronidazole 2,500

2,375

11/10/07 Inj. Dalaciric 40

_

2/11/07 Inj. Ceftrizone 750

340

13/02/07 Triple Action Cream 50

76


51

Appendix 7(b)

Ridge Hospital

Pharmacy (drugs)

Date Items Quantity SRA

Ledger/

Folio

6/6/2008 Humulin 70/30 Insulin 100iv 100 pcs

L3/327

14/8/2008 Cefotaxine 2000 pcs 463088 L3/148

2/4/2008 Hydrallazine Injection 20g 200 pcs 184768

2/4/2008 No - Spa 40mg/20ml Injection 500 pcs 184773 L3/405

2/4/2008 Dextrose 10% Ino.18 Saline 1000 pcs 184764 L3/235

2/4/2008 Quinine 300mg Injection 2000 pcs 184756 L3/467

2/4/2008 Thiopentone 1gm 300 pcs 184756

2/4/2008 Dalacin C Injection 20 pcs 184759

2/4/2008 Ceftriaxone 1gm 3000 pcs 184757 L3/87

2/4/2008 Insulin Mixtard 30Hm 100 vls 184769 L3/330

2/4/2008 Actrapid Insulin Hm 100iu 50 vls 184769 L3/320

2/4/2008 Clexane Injection 4000iu 20 pcs 184769 L3/157

2/4/2008 Dextrose Saline 500iu 1500 pcs 184765 L3/201

2/4/2008 Ranitidine Injection 200 pcs 184756 L3/489

2/4/2008 Naloxone 0.4mg Injection 20 pcs 184756 L3/413

13/9/2008 Domadol/Tramadol 50mg 1800 pcs

L3/257

14/8/2008 Ferrons Sulphate Iron 200mg 50,000 pcs 463082 L1/350

14/8/2008 Spironolactone 50mg 980 pcs 463091 L2/270

19/6/2008 Gyno-Daktarin Ovule 10 pcs 463054 L5/259

14/8/2008 Quinine 300mg Tabs 2800 pcs 463091 L2/243

14/8/2008 Tamoxifen 10mg 300 pcs 463092 L2/73

14/8/2008 Tegretol 200mg 200 pcs 463091 L2/312

14/8/2008 Aspirin Soluble 75mg 24,000 pcs 463091 L1/95

16/9/2008 Ringers Lactate 500ml 2000 pcs


52

Abbreviations

IGF – Internal Generated Fund

GOG – Government of Ghana budgetary support

DPF – Donor Pool Fund

FAR – Financial Administrative Regulation

NHIS – National Health Insurance Scheme

NHIA – National Health Insurance Authority

L. I. – Legislative Instrument

GHS – Ghana Health Service

MOH – Ministry of Health

NICU – Neo Intensive Care Unit

NHIL – National Health Insurance Law

NGO – Non Governmental Organisation

LPO – Local Purchase Order

OPD – Out Patients Department