In April 2018, Ghana, with Germany and Norway, was a leader in urging for development of the GAP and was among the first countries to engage with the signatory agencies for stronger collaboration to support and accelerate achievement of UHC. At a policy dialogue at the Ghanaian Annual Health Summit in April 2019, attended by nine of the twelve GAP signatories and other development partners, the country identified sustainable financing for health and PHC as key areas for enhanced collaboration.
Ghana Health Service. ©WHO/Nana Kofi Acquah
We have reflected carefully on the Sustainable Development Goals, the Global Action Plan for Healthy Lives and Well-being for All, Astana Declaration on Primary Health Care, UHC 2030 Compact, initiatives of UHC 2030 and the Political Declaration on UHC adopted at the United Nations High Level Meeting in September 2019. These provide us with a clear framework for action.
Ghana has made a strong political commitment to UHC and prepared a UHC Roadmap to guide national work towards this goal. The Roadmap includes extending the package of essential services currently available through PHC to include the preventive services that are most cost- effective for UHC, building on the country’s Community- based Health Planning and Services programme. More work is required to strengthen the National Health Insurance Authority, which has low enrolment and a benefits package that comprises mainly curative services. This will be supported through the use of an actuarial model with different scenarios for extending the package, to be developed with support from the Global Fund and the United States Agency for International Development.
Because of fiscal constraints, resource mobilization for health is a challenge in Ghana, and overall domestic spending for health is under- prioritized, at about 6% of the national budget in 2017. A key strategy for achieving UHC was earmarking the country’s value added tax and introducing other pro-health taxes to finance health service expansion, although the timeframe for implementation may be revaluated in the context of COVID-19.
Gavi, the Global Fund and the World Bank are key multilateral funding partners for Ghana’s health system, and the Department for International Development in the United Kingdom and the United States Agency for International Development are key bilateral donors. In the area of health financing, WHO provides technical support for national health financing strategy development, national health accounts, political economy assessment, cross- programmatic efficiency and budget planning. In May 2019, Ghana was one of nine new countries to join the GFF, providing an opportunity for the GAP agencies engaged in sustainable financing for health (Gavi, GFF, the Global Fund, WHO and the World Bank) and other partners to discuss with the Government opportunities to better align their financial and technical support for advancing UHC. As a result of feedback received at a GFF country workshop in September 2019, the Government, signatory agencies and other partners agreed that, to enable multiple partner buy-in and build on existing collaboration and alignment, the GFF investment case would be referred to as a “prioritized operational plan and costing (POP-C)” for Ghana’s UHC Roadmap and serve as a work-plan for aligned development assistance on UHC and PHC in the medium term.
In November 2019, a national health financing forum was organized, led by the Government and supported by development partners, including GAP agencies, under the theme “Sustainable health financing for universal health coverage”. The Government identified four priority areas where GAP agencies and other partners could offer joint support to strengthen Ghana’s health financing strategy: resource mobilization and donor transition planning; public financial management reforms, including Ghana’s Integrated Financial Management Information System for more efficient use of resources; sustainable financing for PHC; and reform of the national health insurance scheme to support UHC. As a follow-up to the forum, the Chief Director of the Ministry of Health convened a task force to continue work on the prioritized operational plan and costing with national stakeholders, GAP signatories, other development partners, civil society and the private sector. The task force reports to the Health Sector Working Group, the country’s main health coordination platform, through the Minister of Health. This arrangement strengthens overall coordination and alignment of health partners in Ghana, including GAP agencies, the Department for International Development in the United Kingdom and the United States Agency for International Development, exemplifying how action prompted by the GAP can be extended flexibly to support country-level partnerships.
The GAP accelerator working group on sustainable financing for health has prepared a work-plan to guide further joint work by the GAP agencies. The plan includes support for Ghana’s next annual health summit; a coordinated plan for long- term technical assistance that could include additional support for implementation of the prioritized operational plan and costing, domestic resource mobilization, support for strategic purchasing reforms, public financial management, national health insurance and taxation, support for civil society engagement in budget discussions, joint missions and a longer-term joint development financing pipeline. Innovations such as use by GAP agencies of disbursement-linked indicators to support reforms are also being explored.
As Ghana tackles COVID-19, several GAP signatory agencies are seeking opportunities to redirect support to emergency preparedness and response to enable the continuity and longer-term strengthening of PHC service delivery.