Health News of Thursday, 1 May 2014


Ghana must honor Abuja Declaration obligations – SEND Ghana

SEND-GHANA, a Non Governmental Organization (NGO) and a subsidiary of SEND Foundation of West Africa, has called on government to comply fully with the Abuja Declaration, which commits African governments to increase funding for the Health sector in their respective countries by at least 15 per cent.

Signed in Nigeria’s capital, Abuja, in April 2001, the Declaration also urges donor countries to scale up support for the health sector on the continent to help improve systems.

According to the World Health Organization (WHO), only one African country, Tanzania, has so far reached that target of increasing funding for health by at least 15 percent.

A 2011 report on the WHO’s website reads, “Overall, 26 [countries] have increased the proportion of government expenditures allocated to health and 11 have reduced it since 2001.

In the other 9, there is no obvious trend up or down. “Current donor spending varies dramatically, from US$ 115 per person in one country, to less than US$ 5 per person in 12 others.”

On Wednesday, SEND Ghana released a new report after a research that found that although Ghana’s yearly budgetary support for the health sector is still below the 15 per cent target set by the Abuja Declaration.

“Annual budget allocations to the health sector in nominal terms has seen increases over the years, however, it still falls short of 15% of the national budget in compliance with the Abuja Declaration,” said Dr. Ernest Tei Maya, who reviewed the findings of SEND Ghana’s research.

Speaking at a ceremony to launch the report, Dr. Maya – lecturer at the Public Health College of Health Sciences – said, “Till date, government allocation has been fluctuating between 10.5% and 12.5%.

In 2011 and 2012, there was significant improvement in internally generated funds with higher contribution to the health sector’s budget than any single source; be it Government of Ghana (GOG) or development partners.”

STAR Ghana, a donor agency, funded the SEND Ghana research. The document is titled: “Halting needless death of women: The need for priority investment in maternal healthcare delivery in Ghana”.

Dr. Maya said, “the study was conducted to identify the source of funding for six district health facilities for provision of maternal health services”.

According to him, some of the areas examined include “public financial management mechanism as pertained to budget transparency and credibility.”

Ghana is perceived as a nation that is on its way to attaining many of the Millennium Development Goals (MDGs) having succeeded in achieving MDG 1 in 2006.

The country has also made significant progress towards achieving MDGs 2, 3, 6 and 8.

As a signatory to the MDGs and the Abuja Declaration, which enjoins nations to, among other things, reduce maternal mortality, Ghana has over the last decade implemented a number of policy interventions, including the free maternal health care policy, national health insurance scheme, safe motherhood initiatives, and roll back malaria to address maternal healthcare challenges.

In spite of all these, however, experts say the pace of progress suggests that Ghana is unlikely to attain the goal of halving maternal mortality.

Key findings according to Dr. Maya, SEND Ghana’s research finding “show that the health sector draws its funds from three main sources (Government of Ghana, Internally Generated Funds and donor funds) and enjoys significant support from over 30 donors.

However, yearly donor disbursement is not always intended for family planning and maternal healthcare interventions.”

He said Ghana’s heavy dependence on donor support and internally generated funds to implement health sector activities was because “over 90% of government’s contribution to the health sector overall budget is used to settle emoluments of health staff, leaving less than 10% for investments.”

The funding challenges, he said, are compounded by the fact that “the sector does not receive its entire share of budget allocations.”

But, Dr. Maya said the situation is better at the district health directorates and facilities levels “where over 80% of their budgets request is honored from varied sources.”

However, according to Dr. Maya, the Ghana Health Service discriminates against some districts. “Between 2009 and 2012, only Agona East consistently received funds from Ghana Health Service.

Suhum received funds in 2012 whiles Ejura, Kpandai and East Mamprusi did not receive funds.”

He said such financial constraints hinder efforts to provide adequate health facilities, including well-equipped Community Health Posts (CHP) compounds and skilled personnel to man the facilities.

The report also bemoaned the lack citizen participation in putting together the health budget. “Citizens are not also involved in health budget planning. This state of affairs does not promote transparency in the allocation and utilization of funds earmarked for the implementation of maternal healthcare programmes,” Dr. Maya said.

Recommendations Dr. Maya reiterated that “Government should increase its financial commitments for investments and goods and services which support maternal healthcare and family planning services instead of depending on donor assistance by broadening its revenue base in order to have dedicated source to finance maternal healthcare.”

He added, “The Ghana Health Service should make it mandatory for the District Health Directorates and facilities to consistently use defined percentage of their Internal Generated Funds to support maternal healthcare”.

“There is the need for Ghana Health Service and its development partners to dialogue and devise means of merging fragmented maternal health programmes or interventions and funds for proper coordination, harmonization and alignment. In so doing utilization can be streamlined and properly accounted for on mutual grounds,” he added.

Given the importance of the general healthcare provision and in particular maternal healthcare in the communities, Dr. Maya said “the District Assemblies ought to incorporate maternal healthcare into their medium term development plans and adequately budget for it, and in so doing guarantee yearly funding to promote maternal health in the districts.”

“To contribute to strengthening public financial management systems for funding maternal health at the district level, it is essential for District Health Directorates and Facilities to make health budget and programme information accessible to increase citizens’ awareness in the districts and to seek their support for resource mobilization and successful implementation of programme,” he told guests at the ceremony.

Speaking at the same ceremony, the Chairman of the Parliamentary Select Committee on Health, Joseph Yieleh Chireh said, “there is the need for citizen awareness and people demanding what ought to be done, so that we improve the situation.”

He bemoaned the lack of personnel and resources in the health sector, saying, “Many of the health personnel are not prepared to go into the rural areas to provide services; we have a double agony of lack of personnel and lack or resources”.

Parliament, he said, “will work collaboratively with SEND Ghana and indeed all other stakeholders and ensure that Ghanaians have good health [systems]…and I urge all the stakeholders to do what they have to do including government.”