Communiqué of Ghana's healthcare financing

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Abuja Declaration: the Government’s pledge

In 2001, the Government of Ghana (Government) signed the Abuja Declaration, thereby committing itself to spending at least 15% of the total national budget on health (15% Benchmark). Recent data from the World Health Organisation (WHO) indicates that since 2001Ghana has hit 15% Benchmark of general expenditure on health twice (2005 and 2007). According to recent data, in 2012 the Government fell short of meeting this benchmark, spending only 12.5% of its total budget on health.

So, over a decade since signing the Abuja Declaration, the Government has still not honoured its pledge.

The WHO in 2010 recommended that, in order to achieve universal access to healthcare by 2015, Ghana’s total health spending – including both government and private spending – should amount to a minimum of US$54 per person. This target cannot be met if the Government does not meet the 15% Benchmark.

With this in mind, as well as the Government’s commitments to health development and financing embodied in the Abuja Declaration, twenty three (23) of Ghana’s Civil Society Organisations in Health (the CSOs) met in Accra on July 9, 2013. The product of that meeting is this Communiqué, which intends to:

Urge the Government to make specific commitments at the Abuja+ 12 Heads of State Special Health Summit so that Ghana can finally alleviate the gap on its spending on health and honour its Abuja Declaration pledge by achieving the 15% Benchmark; and
Reaffirm the position of the CSOs in relation to healthcare - in particular maternal and newborn healthcare - so that these issues may be at the forefront of the Government’s discussions at the Abuja+ 12 Heads of State Special Health Summit.

CSOs communique on achieving the 15% Benchmark

While Ghana’s domestic financing for health has improved since the Abuja Declaration, there is still an urgent need for actual public expenditure in healthcare and increased efficiency in the use of such resources. Greater and efficient healthcare financing is not only necessary for honouring the Government’s Abuja Declaration pledge, but also for achieving the MDG goals and universal access to basic healthcare. The 15% Benchmark can be achieved if the Government takes active steps to:

alleviate the gap on its spending on healthcare;
facilitate the actual release and disbursement of allocated funds; and
manage identified funding leakages.

If these steps are taken, the Government can increase spending in critical areas of health care, and at the same time achieve the 15% Benchmark and honour its Abuja Declaration pledge. We, the CSOs, therefore urge the Government to make the following commitments to fulfill the 15% Benchmark of the Abuja Declaration pledge:

Promptly disburse funds budgeted to institutions (not just their allocation) so that allocated funds are actually spent and those institutions may be empowered to perform their duties to the health sector;
Avoid increasing the NHIS premium as a “quick fix” to increasing financing, which will defeat its essence as a social protection programme targeted at the poor. The Government should instead focus on innovative ways to raise funds;
Ensure the NHIA strengthens the implementation of the capitation and improves the modalities to reduce over-spending and funding leakages;
Increase the Government’s role as the largest contributor to healthcare, rather than placing that responsibility on individuals. This will also alleviate the risk of the poor being denied access to healthcare and/or pushing others into poverty due to personal expenditure on health;
Segregate and clarify budget lines for various sub-sectors in health so that expenditure can be tracked for accountability and monitoring purposes;
Ensure healthcare is one of the key sectors in the four medium term sectors selected for funding from the Petroleum Fund;
Provide greater regulatory framework to ensure the efficient use of resources disbursed to various sectors so as to prevent leakage of revenue which would otherwise be channelled into the healthcare sector. This will also alleviate unwarranted burden on tax payers; and
Strengthen greater Government/donor and aid agency coordination, while harmonising the interests of all key stakeholders, in order to achieve greater alignment in the use of funds and, therefore, strengthen accountability.
Provide adequate resources to health and social-determinants of health and pool resources to protect people from the financial consequences of ill-health. The Government must take appropriate measures to implement universal health coverage in Ghana to prevent people from falling into financial catastrophe and ensure that all those who need healthcare get it.
Devote funds to ensuring the active and effective engagement of the community, civil society organisations and other non-state actors in all processes relating to healthcare, including policy, planning, financing, implementation and monitoring;
Depoliticise the NHIA to ensure its efficient operation as the manager of the insurance scheme;
Accelerate infrastructural development in the health sector. More investment is urgently needed to improve maternal and newborn survival, as well as the health of the population as a whole;
Devote funds to improving access to basic emergency obstetric care in rural communities and encourage greater collaborations with civil society organisations working within those communities;
Provide better funding for the training of Skilled Birth Attendants (SBAs)and make professional midwives, who are the most appropriate care givers, available at rural community levels;
Provide the legal framework and equipment needed for emergency sexual and reproductive healthcare needs. There is currently a need for comprehensive abortion care to provide young adults and adolescents greater information on reproductive health rights issues;
Reduce reliance on foreign donors and generate funds internally to tackle diseases, such as TB and malaria;
Deepen the Government’s partnership with CSOs working within the health sector by providing funding and capacity building opportunities;
Increase the availability of CHPS compounds and community case management systems. These have already proven to be successful, however, such facilities greatly depend on various and much needed human and medical resources and will only continue to be effective if the Government commits to making them fully functional;
Put considerable premium on preventative health care in Ghana. More funds must be allocated to this area - rather than to curative care - as a means of building a healthy population at a lesser cost; and
Provide a programme to facilitate local companies playing a more significant role in the provision of drugs not currently available in Ghana. To achieve this, appropriate measures must be put in place to upgrade local manufacturing companies so that they can provide the essential medicines needed.