Ghana health system

Structure

  • Public sector: run by Ghana Health Service and Teaching Hospitals (agencies of Ministry of Health (MOH)) 
  • Private sector: faith-based and private-for-profit health institutions
  • Ghana Health Service (GHS): responsible for service delivery
    • management of human resources, infrastructure, systems and supplies

Three-tier delivery system:

  • Primary (health centre)
  • Secondary (district hospital)
    • Districts divided into sub-districts which are further divided into Community Health Planning & Services (CHPS) zones
    • Integrated decentralized health service run from the district level
  • Tertiary levels (specialist and teaching hospitals).
  • A district with a population of 100,000 typically has one hospital, five health centres and 10-15 CHPS zones 

Training

Through clinical and laboratory Outreach Training and Supportive Supervision (OTSS) since 2012:

  • All prescribers at referral facilities trained under the revised case management protocol were trained in the use of injectable artesunate
  • Prescribers at lower level facilities were trained in the use of rectal artesunate

Challenges

  • Health management information system
  • Inequitable distribution of human resources
    • Distribution of clinical staff is skewed towards urbanized areas
    • 50% of health workers are located in three of the 10 most urbanized regions (Greater Accra, Ashanti and Eastern) 

Supply and procurement challenges

  • Delays in procurement and stock-out of essential commodities
    • Improvements with introduction District Health Information Management System 2 (DHIMS2)
  • Delayed reporting
  • Data quality 

Lack of funding to implement new strategy

  • Building capacity in advocacy and Behavioural Change Communication (BCC)
  • Supporting national and regional Health Promotion advocacy champions.

Funding

Main cost for management of severe malaria is procurement of injectable artesunate

  • Total need for injection artesunate is $7,151,861 (2015 Global Fund Concept Note)

Additional costs:

  • Logistics (intravenous infusions, rectal artesunate and management of complications)
    • Mostly covered by GoG and other partners
Funding gap:
  • 2016: 293,898
  • 2017: 239,067

    National Health Insurance Scheme

    • Established in 2003
    • Implemented by the National Health Insurance Authority (NHIA)
    • Covers 60% of the total national health expenditure and 42% of the population
    • Provided through fee for services and capitation
      • Both offer services as a part of a pre-determined free comprehensive package of health services
    • Covers 95% of health conditions affecting the population, including curative services, inpatient services, and emergency care