Achieving a Shared Goal

The current health system in Ghana is unfair and inefficient. It doesn’t have to be. The government can and should move fast to implement free health care for all citizens. The findings in this report include:

• Coverage of the National Health Insurance Scheme (NHIS) has been hugely exaggerated, and could be as low as 18%.
• Every Ghanaian citizen pays for the NHIS through VAT, but as many as 82% remain excluded.
• Twice as many rich people are signed up to the NHIS as poor people. 64% of the rich are registered compared with just 29% of the poorest.
• Those excluded from the NHIS still pay user fees in the Cash and Carry’ system. Twenty five years after fees for health were introduced by the World Bank, they are still excluding millions of citizens from the health care they need.
• An estimated 36% of health spending is wasted due to inefficiencies and poor investment. Moving away from a health insurance administration alone could save US$83 million each year. Enough to pay for 23,000 more nurses.
• Through savings, good quality aid but primarily improved progressive taxation of Ghana’s own resources, especially oil, the government could afford to increase spending on health by 200%, to US$54 per capita, by 2015.

This would mean the government could deliver its own promise to make health care free for all - not just the lucky few at the expense of the many.

Key recommendations

For the Ghanaian Government:

• Commit to a clear plan to remove the requirement of regular premium payments, abolish fees in the parallel ‘cash and carry’ system and make health care free at the point of delivery for all by 2015
• Within the next six months implement the overdue commitment to make health care free for all people under 18 years old
• Commit to rapidly expanding and monitoring the health system so that all citizens have access to decent quality health care within 8km of their home
• Increase and sustain government spending to health to a minimum of 15% of total revenues. Aim to spend at least US$54 per capita by 2015 using progressive taxation, efficiency savings and good quality aid.

For donors:

• Stop using inaccurate accounts of Ghana’s progress to promote the introduction of health insurance in other low-income countries
• Support and do not block government and civil society efforts to transform Ghana’s health financing to a universal system free at the point of delivery and financed from general revenues and international aid.

This report was written and produced in partnership with national Ghanaian NGOs and contributes to Oxfam’s global campaign on health care for all.

Authors: Patrick Apoya (Consultant) and Anna Marriott (Health Policy Advisor, Oxfam GB)