THE GHANA 
HEALTH SECTOR 
 
 
 2008 PROGRAMME OF 
WORK 
 
 
 
MINISTRY OF HEALTH 
NOVEMBER 2007 

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ACRONYMS

AFP Acute Flaccid Paralysis

ART Anti-Retroviral Therapy
ARV Anti-Retroviral
ARI Acute Respiratory Infections
ASRH Adolescent Sexual and Reproductive Health
ATF Accounting, Treasury & Financial
BCC Behaviour Change Communication
BMC Budget Management Centres
BPEMS Budget, Public Expenditure Management Systems
CAM Complementary Alternative Medicine
CAN African Cup of Nations
CEO Chief Executive Officer
CHAG Christian Health Association of Ghana
CHPS Community Health based Planning & Services
CMS Central Medical Stores
CMR Child Mortality Rate
CPR Cardio Pulmonary Resuscitation
C/S Caesarean section
CSRPM Centre for Scientific Research into Plant Medicine
DHMT s District Health Management Teams
DP Development Partners
DEENT Department of Ear, Eye, Nose & Throat
ENT Ear, Nose & Throat
EPI Expanded Programme on Immunisation
FDB Food & Drugs Board
5yPOW Five-year Programme of Work
GCPS Ghana College of Physicians & Surgeons
GHS Ghana Health Service
GOG Government of Ghana
GPRS Growth and Poverty Reduction Strategy
HIRD High Impact Rapid Delivery

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HIV/AIDS Human Immunodeficiency Virus/Acquired Immune
Deficiency Syndrome
HMIS Health Management Information System
HR Human Resource
ICC Interagency Coordinating Committee
ICT Information Communication Technology
IGF Internally Generated Fund
IMCI Integrated Management of Childhood Illnesses
IPT Intermittent Preventive Treatment
ITNs Insecticide Treated Nets
KATH Komfo Anokye Teaching Hospital
KBTH Korle Bu Teaching Hospital
MDAs Ministries, Departments and Agencies
MDGs Millennium Development Goals
MOESS Ministry of Education, Science & Sport
MOH Ministry of Health
MRI Magnetic Resonance Imaging
MTEF Medium Term Expenditure Framework
NCD Non-Communicable Diseases
NDPC National Development Planning Commission
NGOs Non-Governmental Organisations
NHIC National Health Insurance Council
NHIF National Health Insurance Fund
NHIS National Health Insurance Scheme
OPD Out-patient Department
POW Programme of Work
PPM Planned Preventive Maintenance
RBM Roll-Back Malaria
RHMT Regional Health Management Teams
RHN Regenerative Health & Nutrition
RTA Road Traffic Accident
SARS Severe Acute Respiratory Syndrome
STD Sexually Transmitted Diseases
STG Standard Treatment Guidelines

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TB Tuberculosis
TRIPS Trade Related Intellectual Property Rights
TTH Tamale Teaching Hospital
WHO World Health Organisation

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 TABLE OF CONTENTS

ACRONYMS ............................................................................................................................ 3
TABLE OF CONTENTS .......................................................................................................... 6
MESSAGE FROM THE HON. MINISTER OF HEALTH...................................................... 8
1. INTRODUCTION............................................................................................................ 10
2. POLICY FRAMEWORK ................................................................................................ 12
2.1. VISION ..................................................................................................................... 12
2.2. MISSION .................................................................................................................. 12
2.3. POLICY OBJECTIVES ........................................................................................... 12
2.3.1. SECTOR GOAL................................................................................................ 12
2.3.2. STRATEGIC OBJECTIVES............................................................................. 12
2.3.3. GUIDING PRINCIPLES................................................................................... 13
3. KEY LESSONS AND CHALLENGES .......................................................................... 14
4. 2008 PRIORITIES ........................................................................................................... 16
4.1. PROGRAMME PRIORITIES .................................................................................. 16
4.2. EXPENDITURE PRIORITIES ................................................................................ 16
5. HUMAN RESOURCES FOR HEALTH......................................................................... 18
6. AGENCY SPECIFIC PROGRAMMES OF WORK....................................................... 19
6.1. GOVERNANCE AND FINANCING ...................................................................... 19
6.1.1. MINISTRY OF HEALTH HEADQUARTERS ............................................... 19
6.1.2. NATIONAL HEALTH INSURANCE.............................................................. 20
6.2. SERVICE DELIVERY............................................................................................. 21
6.2.1. GHANA HEALTH SERVICE .......................................................................... 21
6.2.2. CHRISTIAN HEALTH ASSOCIATION OF GHANA.................................... 23
6.2.3. TEACHING HOSPITALS ................................................................................ 24
6.2.4. PSYCHIATRIC HOSPITALS .......................................................................... 27
6.3. NATIONAL AMBULANCE SERVICE.................................................................. 28
6.4. REGULATION......................................................................................................... 29
6.4.1. FOOD AND DRUGS BOARD ......................................................................... 29
6.4.2. NURSES AND MIDWIVES COUNCIL .......................................................... 30
6.4.3. MEDICAL AND DENTAL COUNCIL ........................................................... 30
6.4.4. PHARMACY COUNCIL.................................................................................. 31
6.4.5. TRADITIONAL MEDICINE PRACTICE COUNCIL .................................... 32
6.4.6. PRIVATE HOSPITALS AND MATERNITY HOMES BOARD ................... 33
6.5. RESEARCH AND TRAINING................................................................................ 34
6.5.1. CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE ......... 34
6.5.2. TRAINING INSTITUTIONS............................................................................ 34
6.5.3. GHANA COLLEGE OF PHYSICIANS AND SURGEONS ........................... 35
7. CAPITAL INVESTMENT .............................................................................................. 37
8. 2008 HEALTH SECTOR BUDGET ............................................................................... 40

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9. PERFORMANCE ASSESSMENT FRAMEWORK....................................................... 50
9.1. MILESTONES.......................................................................................................... 50
9.2. INDICATORS AND TARGETS.............................................................................. 50
9.3. MONITORING AND REPORTING ON PERFORMANCEError! Bookmark not defined.
9.4. RISKS AND ASSUMPTIONS................................................................................. 55
10. ANNEXES ................................................................................................................... 57
Annex 1: CAPITAL INVESTMENT PLAN....................................................................... 58
Annex 2: FELLOWSHIP PLAN ......................................................................................... 70
Annex 3: PROCUREMENT PLAN .................................................................................... 72
Annex 4: NATIONAL HEALTH INSURANCE ALLOCATION FORMULA ................ 73

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 MESSAGE FROM THE HON. MINISTER OF HEALTH

The past year saw the introduction and implementation of a new health policy that defines
a new paradigm for health delivery. It also aims at placing health
within the overall framework of socioeconomic development and
thus contributing to the national agenda of transforming this country
into middle income status. An imperative of the new policy is the
acceleration of improvements in health status through drastic
reduction of the disease burden in the shortest possible time.

As some of you are aware, I have been a leading advocate for

behaviour and lifestyle changes based on my conviction that the disease burden we carry is
the result of choices we made and continue to make in our everyday lives. Most of these
diseases are preventable and avoidable and could be dramatically reduced by simple
changes in nutrition, physical activity and hygiene. It is for this reason that we have
introduced the Regenerative Health and Nutrition Programme.

The 2008 POW is one step in the build up toward the attainment of our set objectives of
fast tracking health delivery in a holistic, sustainable and equitable manner. The focus is,
therefore, to consolidate the unfinished agenda of high impact and rapid service delivery
by expanding to all regions, strengthening the weak and fragmented health system, scaling
up the programme of regenerative health & nutrition and expanding the coverage of the
National Health Insurance Scheme; while bringing unto the centre stage issues of equity,
efficiency and financial sustainability.

In 2008 the sector will address health risk factors through the promotion of healthy
lifestyles and behaviours. We will also focus on strengthening the health systems and
training of middle level health professionals. We will accelerate the implementation of the
high impact health, reproduction and nutrition interventions and services targeting the poor
and vulnerable groups and emphasize the improvement of quality and coverage of clinical
care focusing on the provision of emergency and essential obstetric care. Efforts will also
go into promoting good governance, partnerships and sustainable financing.

Additionally, the sector will introduce a number of new strategic initiatives. These include:

• The Productivity Improvement Initiative following the improvement in salaries of

health workers
• New approaches to identifying the poor under the National Health Insurance
Scheme as a way of reaching the poor not covered under the narrow definition of
indigents under the current provisions in the National Health Insurance Law.
• A general screening programme for the population including screening for breast
and prostate cancer in order to facilitate early detection and prompt treatment of
diseases

This programme of work will be funded by multiple sources including the consolidated
fund, donor funds, NHI and Internally generated funds. Though these are traditional
sources of funding, in 2008 the sector will experience a major shift from donor funding
through the health fund to budget support through Ministry of Finance and Economic
Planning. In addition there will be a substantial reduction in out of pocket payment for
health services and an increase in funding under the NHIS. These shifts will require that

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we ensure effective coordination and complementarity between the different sources of
funding, put in place mechanisms to engage MOFEP in enhancing public financial
management and ensuring predictability in government funding and improving timeliness
and systems for claims management under the NHIS. In addition the sector will ensure
effective budget execution including strengthening systems for internal controls and
external audit functions.

Obviously the implementation of the POW will call for greater collaboration,
harmonisation and alignment of efforts of all stakeholders in the health sector. This is the
only way we can ensure synergy in our actions and rapidly accelerate the reduction of the
overwhelming disease burden of communicable and pregnancy related diseases as well as
the rising non communicable diseases including trauma.

I wish on behalf of the government of Ghana to invite all stakeholders to appraise

themselves of the content of this document and join the Ministry of Health and its
Agencies in its execution. In particular I request your support to implement the innovations
and address the challenges to scaling up priority health interventions.

Major Courage E. K. Quashigah (Rtd)

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1. INTRODUCTION

The health sector in 2007 began implementing a new health policy and five year
programme of work (2007-2011) with a focus on achieving three inter-related and
mutually reinforcing objectives namely:

(a) ensuring that children survive and grow to become healthy and productive adults
that reproduce without risk of injuries or death;
(b) reducing the risk and burden of morbidity, disability, and mortality especially
amongst the poor and marginalized groups
(c) reducing inequalities in access to health, reproduction and nutrition services, and
health outcomes.

The five year Programme of Work (POW) was woven around the under-listed four
objectives that have guided annual programmes of work.

(a) promotion of healthy lifestyles and environment to reduce risk factors that emanate
from environmental, economic, social and behavioural causes
(b) improvement of access to quality health, reproduction and nutrition services
(c) strengthening capacity of the health system in the regulation, management and
provision of health services
(d) fostering good governance, partnerships and sustainable financing.

The 2008 POW presents a portfolio of policies, broad programmes, outputs and actions
that are required to be implemented by the health sector in the second year of
implementation of the third Five-Year Programme of Work. It derives from the five year
POW and its strength lies in the fact that it has been developed through collective work,
continuous dialogue and consultation with key partners, agencies and stakeholders in the
health sector.

The 2008 POW builds on achievements of the 2007 POW. In that regard it continues and
consolidates the priorities identified in 2007. These are scaling up the High Impact and
Rapid Delivery (HIRD) and Regenerative Health and Nutrition (RHN) programmes,
continuously refining the health worker incentive package and consolidating the NHI
programme. Like the 2007 POW, the 2008 POW is focus on a limited set of priorities.
These are

• Food safety
• Quality of clinical care
• Expansion of middle level training and enhancing productivity
• Intersectoral collaboration

Additionally, the sector will introduce a number of new strategic initiatives. These include:

• The Productivity Improvement Initiative following the improvement in salaries of

health workers

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 • New approaches to identifying the poor under the National Health Insurance
Scheme as a way of reaching the poor not covered under the narrow definition of
indigents under the current provisions in the National Health Insurance Law.
• A general screening programme for the population including screening for breast
and prostate cancer in order to facilitate early detection and prompt treatment of
diseases

The 2008 POW however makes a point of departure from previous POWs in its design and
orientation. It is operational in its orientation and may be described as an Agency-based
Programme of Work since it has been developed and authored largely by the implementing
agencies in response to the Sector’s Health Policy Framework, GPRS II, Millennium
Development Goals (MDGs) and third 5-yr POW (2007-2011). In this context it creates a
better alignment between the POW and budget structure thus laying the basis for
accountability within the health sector.

In a nut shell the 2008 POW maintains the central theme of creating wealth through health
with a significant focus on the promotion of individual lifestyle and behavioural change,
scaling up of high impact health, reproduction and nutrition interventions, continuing
investments in health systems development with emphasis on strengthening district health
systems and the promotion of good governance including sustainable financing and
partnerships. The document recognises the important role of other stakeholders and
consequently emphasises the promotion of intersectoral action to improve health
outcomes. Indeed all sectors that contribute to health development will therefore be
brought on board in efforts to accelerate progress towards the achievement of the MDGs
and GPRS II objectives.

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2. POLICY FRAMEWORK

The sector’s policies and priorities are located within the context of Government’s overall
development agenda as spelt out in the GPRS II, the National Health Policy and the five
year POW. It aims at contributing to national efforts of transforming Ghana into a Middle
Income Country by 2015.

2.1. VISION

The vision of the health sector is to create wealth through health and in so doing contribute
to the national vision of attaining middle income status by 2015.

2.2. MISSION

Our mission is to contribute to national socio-economic development and wealth creation

through (i) the promotion of health and vitality; (ii) ensuring access to quality health and
nutrition services for all people living in Ghana; and (iii) facilitating the development of a
local health industry.

2.3. POLICY OBJECTIVES

2.3.1. SECTOR GOAL

The ultimate goal of the health sector is to ensure a healthy and productive population that
reproduces itself safely.

2.3.2. STRATEGIC OBJECTIVES

The goal is to be achieved through four strategic objectives that provide a more balanced
approach to the known challenges of the health system in terms of the changing
determinants of health, the unfinished agenda of service delivery, the weak and
fragemented health system and the greater need for governance and sustainable fnancing.
These strategic objectives are to:

(a) address risk factors to health by promoting an individual lifestyle and behavioural
model for improving health and vitality, and strengthening inter-sector advocacy
and actions;

(b) rapidly scale up high impact health, reproduction and nutrition interventions and
services targeting the poor, disadvantaged and vulnerable groups and bridge the
gap between interventions that are known to be effective and the current relatively
low level of effective population coverage;

(c) strengthen the health system’s capacity to expand access, manage and sustain high
coverage of health services through investment; and

(d) promote good governance, partnerships and sustainable financing.

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 2.3.3. GUIDING PRINCIPLES

The objectives of the 2008 POW will be achieved through a combination of programmes
and investments underpinned by the following guiding principles:

Health is multi-dimensional in nature and requires partnerships.

Programmes design and development will:

• Be people centered focusing on individuals, families and communities in the life

settings,
• Recognise the inter-generational benefits of health
• Reinforce the continuum of care approach to health development
• Be prioritized to ensure maximum health gains for limited resources

It is expected that the community will be encouraged and expected to be part of the
planning implementation and evaluation of activities aimed at ensuring a healthy and
productive population. This is with a view to ensuring effective community ownership and
involvement – a key element towards sustainability.

Planning, resource allocation and implementation will be results-oriented paying attention

to equity, efficiency and sustainability

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3. KEY LESSONS AND CHALLENGES

The main challenges of the health sector in 2008 will revolve around financing the
programme of work within a budget constraint whilst managing the expectation of rapidly
scaling up the delivery of health interventions to meet the MDGs. In particular the sector
will need to address the relatively high wage bill without concurrent increases in resources
from the consolidated fund for services and investments. At the same time financing
through the NHI system is going up. Given that NHIF disbursements are governed by law
there is a limit to what NHIF can be used to fund within the sector. This not withstanding
the health sector has to depend increasingly on the NHIF to finance its service and
investment budgets. However this has to be done in a manner that does not undermine the
sustainability of the fund.

The NHI programme remains an important pro-poor strategy for the sector. Currently
exemptions constitute about 57% of total projected expenditures under this programme.
The benefit package under the NHIS includes children under 5, the elderly, pregnant
women and indigents. The opportunities under the NHIS and the known difficulties in
financing the exemptions under user fee system makes it imperative to transfer all
exemptions to the NHI system. On account of the narrow definition of indigents it is
expected that some poor people who can not afford the NHI premium may be deprived of
services. Approaches for identifying and recruiting the poor under the NHIS need to be
tested.

The NHIS continues to be confronted by a number of challenges. The desire to scale up

registration including possibility of decoupling children from their parents and the
persistent demands to expand the benefit package need to be reconciled with the threat of
sustainability of the fund. Secondly there is an emerging threat to sustainability of health
services from delays in reimbursement of claims. Thirdly, the management of reserves
need to be strengthened to ensure the overall sustainability. In the long term the issue of
provider and consumer moral hazards will need to be addressed to sustain the scheme.

The burden of diseases in the country has not changed significantly since independence
and this would undermine the NHIF unless concurrent action is taken in the areas of health
promotion and disease prevention. The pattern of diseases continues to be dominated by
communicable diseases, persistent under-nutrition and poor reproductive health. The
burden of non-communicable diseases such as cardiovascular disorders, diabetes and
cancers has emerged as a major challenge to service delivery and a threat to health and
national productivity. Similarly, mental health and neurological disorders are also on the
increase whilst trauma and other injuries contribute significantly to the most commonly
seen outpatient conditions. The two programmes introduced in 2007, the RHN and HIRD
programmes present opportunities to reverse this trend and therefore need to be sustained
and scaled up. It is however clear that extra effort and investments beyond what the budget
can support will be required to scale up programmes for achieving MDG5.

An emerging threat in 2008 is a meningitis epidemic likely to coincide with the period of
CAN 2008 and in the regions whose health infrastructure has been devastated by recent
floods. Indeed the floods have eroded the health gains so far made in these areas in terms
of the destruction of health infrastructure, disruption of health services and reversal of
progress in the control of diseases such guinea worm, malnutrition and malaria all of
which could undermine the achievement of the MDGs. These make re-establishing

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services and surveillance systems in these regions a priority. It also calls for strengthening
mechanisms for epidemic preparedness and response in the country.

The changes in Ghana’s demographic profile have major implications for the health sector.
Specifically the health sector needs to be positioned to respond to rapid urbanisation,
ageing, changes in lifestyle and disruption of the family and traditional structures and
support systems. In addition there is the need to integrate gender issues into the sector’s
programmes and priorities. This is primarily because men and women differ in terms of
their healthcare needs and have different roles to play in their responses to health
promotion and the reduction of barriers to accessing health services.

Today, the health sector is faced with an increasing demand for health services and rapidly
expanding urban and peri-urban areas as well as deprived rural areas. At the same time
existing health infrastructure are deteriorating and equipment are fast becoming obsolete
thus undermining quality of care. In addition the sector is faced with numerous
uncompleted projects with significant sunk costs. These issues will need to be addressed
within the medium to long term within the frame work of the Capital Investment Plan III
(CIPIII).

In 2007 the health sector abolished the additional duty hours allowance and introduced a
new salary structure. This is already slowing down the brain drain. The expansion of
training institutions with the initial assumption of a high brain drain already suggests that
the health sector will have more nurses than required and the wage bill will continue to
rise. Medium term programme for rationalising the human resource production needs to
be instituted as part of the current HR strategy. At the same time efforts need to go into
improving the productivity of health workers. These call for a reappraisal of the role of the
public sector in health delivery and the introduction of fundamental changes in the way
health workers are managed and motivated.

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4. 2008 PRIORITIES

4.1. PROGRAMME PRIORITIES

The priorities for 2008 are based on the need to consolidate the gains made in 2007.
Specifically the programme aims at scaling up the High Impact and Rapid Delivery
(HIRD) and Regenerative Health and Nutrition (RHN) programmes. Efforts at refining the
health worker incentive package and consolidating gains made in the implementation of
the NHI programme will continue to receive significant attention. The following priorities
will also be in focus:
• Promote the enforcement of regulations on food safety in collaboration with the
MLGRD
• Improve quality of clinical care with a focus on essential obstetric care
• Expansion of middle level training and enhancing productivity
• Intensify intersectoral collaboration in he implementation of the RNH programme

Some new strategic initiatives will also be pursued. These include a Productivity
Improvement programme to ensure that health worker performance is improved in
response to the improvement in salaries. This will involve the definition of job descriptions
and performance standards for different categories of health workers, the development of
guidelines for roistering and scheduling of work in hospitals, linking job descriptions to
performance appraisals and promotions.

The sector will seek new approaches to identifying the indigents under the National Health
Insurance Scheme as a way of reaching the poor not covered under the narrow definition
of indigents under the current provisions in the National Health Insurance Law.

A general screening programme will be introduced for the population. This will include
screening for breast and prostate cancer in order to facilitate early detection and prompt
treatment of diseases.

As in all other years, the poor will be exempted as much as possible from payment of user
fees through NHIF either by subsidizing or payment of premium. The capital investment
budget, on the other hand, will prioritize training institutions as well as provision of
infrastructure and equipment that contribute to quality improvements and enhance revenue
generation potential of health institutions such as laboratories, pharmacies, theatres and
mortuaries. It is hoped such interventions will expand access of health services to the
deprived as well as assist institutions to respond adequately to increased service load and
challenges of urbanization.

4.2. EXPENDITURE PRIORITIES

Though the sector’s resource envelope has increased in absolute terms from GH¢ 439.23
million in 2007 to GH¢763.02 million in 2008, the dwindling size of relative resources
allocated to the sector from the government budget, in real terms, and the shift by donors
to sector budget support have put resource allocation within the sector under severe
pressure. Consequently, all Agencies and Budget Management Centres (BMCs) are to
keep the nominal rolls updated throughout the fiscal year and ensure that the payroll is

16
reconciled with staff at post throughout the year. Additionally, all new recruitments are to
be approved by the Ministry prior to engagement.

As part of the sector’s expenditure programming policies to rein in the wage bill, trainee
allowances will be phased out in the short to the medium term. Consequently, a
programme is currently underway to phase out these allowances beginning with new
intakes into our training institutions in September 2007. The deprived area incentive
allowance will also not be implemented.

In line with our priority of reversing deteriorating health infrastructure and equipment, the
policy of Planned Preventive Maintenance (PPM) will be implemented. In view of this,
BMCs are required to prepare PPM plans and dedicate at least 10% of their internally
generated funds to the implementation of these plans. In addition, it is envisaged Agencies
and BMCs will implement efficiency savings programs targeted at minimising travels and
running costs of offices (fuel, utilities, stationery, etc).

To take advantage of economies of scale, the budgeting and procurement of public health
commodities such as vaccines, contraceptives and Insecticide Treated Nets (ITNs) will
continue to be carried out centrally to achieve optimal efficiency in the use of scarce
resources. All Agencies and BMCs have also been directed to budget for existing
commitments; particularly, maintenance contracts and to operate within the budget as the
Ministry will not pay off debts accumulated outside the budget

Finally, the item 4 budget will be centrally managed in consultation with heads of
Agencies. The budget will give priority to the following capital investment programmes:

• Counterpart funded projects

• Expansion of training institutions
• Construction of CHPS compounds
• Provision of basic equipment for Reproductive and Child health services and
management of pro-poor diseases such as Buruli Ulcer.
• Support to hospitals to expand portfolios that enhance quality and generate IGF
e.g. Laboratories, dispensaries, mortuaries, theatres

All hospitals are to earmark at least 10% of internally generated funds for the replacement
of equipment and machines and minor rehabilitation of infrastructure (minor civil works).

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5. HUMAN RESOURCES FOR HEALTH

The Ministry’s objective for Human Resources for Health is to ensure adequate numbers
and mix of well motivated health professionals distributed equitably across the country to
manage and provide health services to the population. A strategic plan which seeks to
improve and sustain the health of the population by supporting appropriate human resource
planning, management and training has been developed. This strategic plan will seek
among others to address the imbalance of health workers in favour of highly trained
professionals through scaling up the training of middle level health cadres, as well as
address the mal-distribution of health professionals.

The productivity of the health work force varies considerably across the country and is
generally perceived to be low. In 2007 the ADHA was replaced by the new Health Salary
Scheme aimed at improving performance and arresting the brain drain. This new salary
structure has had a considerable impact on the wage bill however this is not translating into
increased productivity of the health workforce. There is therefore the need to evaluate
these motivational packages to ascertain the impact on staff retention and performance. In
addition there is the need to determine other factors which may influence health workforce
productivity so as to find appropriate interventions to the issue.

The policy thrust for 2008 is to ensure an equitable distribution of the right numbers
and mix of health staff and introduce staff productivity improvement programmes.

KEY ACTIVITIES

• Implement the planned Human Resource strategic plan

• Conduct impact assessment to ascertain the impact of the new salary scheme and
other incentives introduced on staff productivity
• Review the expansion of the middle level training programme
• Deploy resources to the recently established Human Resource Observatory to
ensure the HR governance issues are complied with.
• Collaborate with MLGRD, MOESS and GCPS to effectively train and distribute
health personnel.

EXPECTED RESULTS

• Implementation of HR strategic plan

• Adequacy of staff mix
• Functional HR observatory

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6. AGENCY SPECIFIC PROGRAMMES OF WORK

6.1. GOVERNANCE AND FINANCING

6.1.1. MINISTRY OF HEALTH HEADQUARTERS

The Ministry of Health is responsible for stewardship of the entire health sector and
ensuring equity and efficiency in the sector activities. It exercises this function by
providing overall policy directions, institutional development, coordinating the activities
of agencies, partners and stakeholders involved in health and ensuring performance and
accountability within the sector. In addition, MOH coordinates planning, resource
mobilisation, budget execution, human resource development and the over all monitoring
and evaluation of the health sector performance.

In the last few years the health sector has been going through a period of organisational
reforms that has made coordination very challenging. In addition the financing
environment has changed following the introduction of NHIS and movement of partners to
budget support. Slow progress in improving outcomes requires stronger focus on
performance monitoring, organisational incentives and accountability as well as greater
harmonisation and alignment of activities of stakeholders.

The Thrust of the Ministry of Health in 2008 is to promote achievement of results

through good governance] the efficient, equitable and transparent mobilisation,
allocation and utilisation of resources and better harmonisation and alignment of
activities and investments by key stakeholders in health.

Priority Activities
• Oversee the execution of the 2008 POW and Budget and develop the 2009 POW
and Budget.
• Coordinate the activities of agencies and donors, and promote partnerships with
other MDAs, Private sector and NGOs/Civil society including the media.
• Define priorities and develop incentives and sanctions for aligning agency and
partner activities to priorities.
• Mobilise, allocate, monitor and account for the use of resources within the sector.
• Develop, implement and undertake quarterly monitoring of annual Procurement
Plans including the Capital Investment plan
• Explore options for aligning the procurement cycle to the budget and harmonise the
systems for budget, procurement, financial, stores and asset management.
• Oversee the development of innovations within the sector including scaling up
RHN, testing systems for identifying the poor under health insurance, introduction
of screening programmes,
• Integrate traditional medicine into general health system and support the
commercialisation of herbal medicines
• Strengthen internal audit systems, facilitate external financial and procurement
audit and ensure timely responses and follow-on actions to the audits.
• Develop and execute an agenda for policy research and implement a participatory
policy dialogue involving Agencies, Development Partners, NGOs Civil Society,
the Private Sector, Media and other MDAs, through monthly partners meetings,

19
 quarterly business meetings, biannual summits and relevant interagency/inter
stakeholder meetings.
• Review and reform existing systems for reducing wastage, enhancing quality and
ensuring standard pricing for medicines and promote local production to ensure
continued availability and affordability of essential medicines and logistics.
• Coordinate and harmonize data collection systems in the health sector and build
central data repository to support assessment of performance based on the sector
wide indicators.
• Continue efforts at rationalising the health sector wage bill and workforce numbers,
mix and distribution in line with staffing norms and implement initiatives to
improve workforce productivity within the health sector.
• Conduct annual sector-wide reviews and continuously monitor and report on
performance of Agencies, policies and commitments of the sector. Work towards
aligning the sector reviews to government wide reviews such as the MDBS and the
APR.

Expected Results
• Approved 2009 POW and Budget
• Improved compliance to financial regulation (Reduction in audit queries)
• Effective execution of budget (Predictability and Variance)
• Reduced lead time in procurement
• Broad and inclusive policy dialogue (Representation at partners meetings)
• Stronger evidence for policy and accountability (Timeliness of reporting)
• Medicines and Logistics supply security

Collaborators
Agencies of the Ministry of Health, MDAs, Development Partners, Private Sector,
NGOs/Civil society, Media, Public, Ghana AIDS Commission, Population Council, Ghana
Statistical Services, National Development Planning Commission, NHIC

6.1.2. NATIONAL HEALTH INSURANCE

The National Health Insurance Council (NHIC) was established by the National Health
Insurance Act, 2003 (Act 650) to ensure universal access to basic healthcare services to all
residents of Ghana. The Council’s mandate includes among others the regulation of
practice of DMHIS, accreditation of health care providers and the management of the
NHIF including providing subsidies for the healthcare of indigents and other exempt
groups.

As at September 2007 the Council had met the target of 55% coverage set for the year
2007 and one hundred, forty-three (143) schemes were fully operational and provisional
accreditation granted to all government facilities. An amount of ¢120,000 (GH¢12.00) was
paid as subsidy per head to the exempt group members and SSNIT contributors in the year
2007. However, given the rising cost of medical bills evident from bills submitted by
service providers and the Review of the Medicines List and Tariff Structure, it has been
proposed to increase the subsidy from GH¢12.00 to GH¢14.00 per person for 2008.

20
The delays in reimbursement of claims could potentially undermine service delivery. The
scheme also faced double counting of indigents because some population groups are
already covered under DHMIS. Chronic patients also do not adhere to referral
requirements of the scheme. These challenges have been compounded by delays setting up
zonal offices of the council and inadequacy of staff.

The thrust for the year is to consolidate gains made in the registration of clients,
strengthen the accreditation of providers and streamline claims management.

Priority Activities
• Renew the provisional accreditation granted government facilities and mount a
programme for accrediting all health facilities
• Extend coverage to cover five (5) more schemes whose establishment began in
2007.
• Assist schemes to build their administrative and logistical capacity
• Streamline the process for the identification of indigents to minimize double
counting
• Continue the subsidization of schemes to cover exempt groups
• Provide technical and financial support to distressed schemes
• Install Integrated MIS and ICT infrastructure to aid communication and data
analysis
• Recruit personnel for key positions and supporting roles
• Support the Ministry of Health to expand health services in the country in the
training of Health Assistants and KATH’s rehabilitation

Expected Results
• One hundred and forty-six (148) operational schemes
• Increased coverage of population
• Increased coverage of indigents, aged and under 18s
• % reduction in fraudulent registration
• % reduction in distress schemes
• Increased compliance with conditions for referrals

Collaborators
Ministry of Health, Ghana Health Service, Ministry of Finance and Economic Planning,
Private Hospitals and Maternity Homes Board, Ghana Registered Midwives Association,
Teaching Hospitals, Society of Private Medical and Dental Practitioners,

6.2. SERVICE DELIVERY

6.2.1. GHANA HEALTH SERVICE

The Ghana Health Service (GHS) has been established under Act 525 to ensure access to
health services at the community, sub-district, district and regional levels. Indicators on
specific programmes, such as EPI, TB control, malaria, HIV/AIDS and nutrition, showed
positive trends. However the burden of other communicable diseases including ‘neglected’
diseases and non-communicable diseases such as hypertension and diabetes continue to
increase due to unhealthy lifestyle choices. High maternal mortality, still birth rates and

21
infant mortality rates continue to persist due to the fact that uptake of health interventions
are not at their optimal levels. The rollout of CHPS as a strategy to extend health
interventions to the doorstep of the community has been extremely slow. In addition, the
quality of clinical care services especially for maternal and neonantal health is below
approved standards in most facilities.

Other more systems challenges facing the GHS include inadequate coverage of some
priority interventions; inadequate financing and delays in the disbursement of funds, poor
staff attitude and low productivity due to insufficient monitoring and supervision across all
levels of the GHS. There is also general lack of commitment and little accountability for
performance. NHI claims as a major source of funds remain poorly managed resulting in
delays in payment claims

The GHS will continue to use the HIRD strategy as basis for scaling up interventions
whilst systematically rolling up the CHPS strategy as well as ‘modernize’ clinical care
services with special emphasis on maternal and child health outcomes.

Priority Activities
• GHS will continuously mount surveillance and timely report on epidemic prone
diseases with a view to ensuring rapid response to and effectively manage and
control epidemics
• GHS will continue to scale up the implementation of interventions based on the
HIRD strategy.
• All GHS health facilities will be prepared to meet accreditation standards as
defined by NHI law including strengthening referral systems, instituting quality
assurance programmes and providing 24 hour essential services.
• Training in financial management including auditing will be done at all levels and
monitoring and supervision will be improved to ensure compliance to available
financial rules and regulations.
• The peer review mechanism and district league performance table will be extended
as mechanism to motivate lower level managers to perform.
• Introduce systems to improve management and access to health information at the
district level.
• Ensure compliance to planned preventive maintenance plans at all levels
• Refine and clarify strategies and programmes for promoting gender equity
• As part of the modernization agenda the GHS will introduce ICT extensively into
clinical care and as basis for improving claims management.
• Quality of midwifery care will receive greater attention and negative staff attitude
will be addressed.

Expected Results
• Coverage of key health interventions
• Proportion of health institutions meeting accreditation criteria
• Timeliness and completeness of surveillance reports
• Quality of midwifery care

Collaborators
Ministry of Health, Ghana Statistical Service, Ministry of Education Science and Sports
(MESS), Ministry of Local Government, Rural Development and Environment

22
(MLGRDE), Christian Health Association of Ghana (CHAG), Quasi-government
institutions, Teaching hospitals, Private Sector including NGOs, Research Institutions,
Professional and Civil Society Organisations, Regulatory Bodies, St John Ambulance,
Ghana Red Cross, Centre for Scientific Research into Plant Medicine (CSRPM), Ministry
of Private Sector Development, Ministry of Water Resources, Works and Housing,
Development Partners, National Health Insurance Council, Media and Public, Ghana
AIDS Commission

6.2.2. CHRISTIAN HEALTH ASSOCIATION OF GHANA

Institutions under CHAG exist to contribute to the efforts of the health sector to improve
the Health status of the people living in Ghana. CHAG member Institutions are
predominantly located in the hard to reach areas with a few in urban slums and are
therefore positioned to provide services to the poor and marginalized in fulfilment of
Christ’s Healing Ministry. In this context CHAG institutions see the regenerative health
programme as a central strategy to the overall efforts to improve the health of people living
in these catchment areas.

In fulfilling this mandate, CHAG member institutions are faced with the problem of
inadequate human resource and weak management capacities and systems. In particular
the health information systems at both the secretariat and institutions are not properly
developed and this affects their ability to manage and provide services effectively. Finally,
CHAG secretariat does not have the requisite personnel, skills and experience to
effectively manage and report on its financial activities.

The Thrust of the Christian Health Association of Ghana is to draw on its comparative
advantage to innovate, fill service gaps and improve quality of health services.

Priority Activities
• Set up a Health Management Information system at the secretariat and institutions
for data capture and reporting including financial reporting.
• Re-orient and train health workers in the regenerative health and nutrition and other
HIRD programmes including a healthy schools programme with emphasis on
hygiene, physical exercise and school feeding.
• Collaborate with District Assemblies and other stakeholders to support the scaling
up of Community based Planning and Services (CHPS) especially in deprived
districts and communities, with focus on increasing package of public health
services delivered
• Establish screening and management programmes for diabetes, hypertension,
cancers, sickle cell, and asthma in all designated CHAG district hospitals
• Initiate a programme to engage the services of specialised health care providers
through a volunteer/part time/exchange schemes.

Expected Results
• Professional staff recruited.
• An operational HMIS
• Timely and accurate monthly, quarterly and yearly financial reports.

23
Collaborators
Ministry of Health (MoH), Ghana Health Service (GHS), Development Partners, District
Assemblies, Communities

6.2.3. TEACHING HOSPITALS

6.2.3.1. KORLE BU TEACHING HOSPITAL

Korle Bu Teaching Hospital (KBTH) was established to provide tertiary health care for all
Ghanaians. It is also to provide facilities to educate and train health professionals, conduct
research and provide specialist outreach services to all Ghanaians. Currently KBTH has 17
clinical and diagnostic departments and units and has an average daily out-patients
attendance of 1,200 with an admission rate of about 150 patients per day.

The hospital faces on daily basis, challenges such as overcrowding and congestion of
departments and wards by patients. In addition to this there are obsolete medical
equipment and deteriorating physical structures. These challenges pose a threat to effective
and efficient health care delivery at the hospital.

The thrust for 2008 is to ensure that resources are directed towards improving the
provision of quality tertiary health care through the upgrading of the
infrastructure and review of standards of operation at all clinical and
management levels.

Priorities Activities
• Reorganise services to focus on referral and tertiary services and improve the
quality of patient care
• Introduce programmes to promote regenerative health and behaviour change
among client.
• Put in place programmes aimed at attracting and retaining the required number of
staff to ensure quality of care.
• Expand, modernise and rehabilitate physical structures and facilities, equipment
and tools;
• Review financial management systems and improve on internal controls as part of
the revenue mobilization efforts.
• Upgrade connectivity and ICT infrastructure to improve information management
• Develop operational research capacity at all levels

Expected Results
• Increase in number of referred cases as against OPD cases
• Physical structures modernized and rehabilitated
• Financial management practices and internal controls improved
• Staffing levels improved
• New equipment provided to replace obsolete ones

24
Collaborators
Ministry of Health, GHS, KATH, Tamale Teaching Hospital, Medical & Dental Council,
Nurses and midwives Council, University of Ghana Medical School, School of Public
Health, Pharmacy Council, CHAG, Mutual Health Insurance Organization and National
Health Insurance Council,.

6.2.3.2. KOMFO ANOKYE TEACHING HOSPITAL

Komfo Anokye Teaching Hospital is mandated to provide specialist clinical care services,
train under graduate and post graduate medical students and undertake research into
emerging health issues in Ghana. However due to funding difficulties the hospital has not
been able to fulfil this mandate as expected.

Emergency cases recorded over the past 3 years have increased and it is expected that this
will increase further in 2008 due to hosting of CAN 2008 in Ghana. Maternal and child
deaths are still unacceptably high. The situation is compounded by the congestions at both
the Paediatric and Obstetrics and Gynaecology wards. Management systems are also weak
resulting in inadequate number of human resources, especially specialized nursing cadres,
inadequate equipment and inadequate physical infrastructure.

The thrust for 2008 is to improve quality of services for better care outcomes by
improving the human resource base and health infrastructure of the hospital.

Priority Activities
• Scale up specific specialised services such as Urology, Neurology, Dialysis and
Accident and Emergency.
• Introduce the provision of Paediatric Cardio thoracic, Orthodontic and Advanced
Restorative and MRI services
• Reconstitute and strengthen mortality audit committees
• Expand library facilities for students and Practitioners
• Set up faculty for the training of critical care Physicians and Nurses
• Conduct operational research, including patient satisfaction surveys
• Conduct research into emerging diseases like HIV/AIDS, Diabetes and
Hypertension
• Intensify performance monitoring, quality assurance and promote financial
accountability and controls.

Expected Results
• Improved care outcomes (reduced institutional deaths)
• Increased efficiency in use of resources (optimal use of hospital beds and other
resources)
• Improved critical care services (human resource for critical care developed)
• Operational research activities increased

Collaborators
Ministry of Health, Korle Bu Teaching Hospital, Tamale Teaching Hospital, Ghana Health
Service, Medical and Dental Council, Nurses and Midwives Council, Pharmacy Council
and Kwame Nkrumah University of Science and Technology.

25
 6.2.3.3. TAMALE TEACHING HOSPITAL

The Tamale Teaching hospital is currently in the process of being upgraded into a teaching
facility for the University of Development Studies. Consequently the focus of its activities
is related to building the requisite capacity for tertiary and teaching services. In addition
the hospital aims at improving quality and affordable referral services by well-trained,
highly motivated and customer-friendly professional health staff.

The major challenges facing the hospital are the weaknesses in management and support
systems particularly with respect to information and records management, equipment
management and the inadequate human resource base. In addition to these challenges there
are general weaknesses in financial management leading to poor revenue mobilization.
There are also significant weaknesses in procurement practices and planned preventive
maintenance.

To address these challenges, the 2008 programme will focus on building overall
management capacity, initiate moves to improve the human resource base and putting in
place mechanisms to improve revenue generation.

The thrust for 2008 will be on building strong, effective and efficient management and
support systems and structures to enhance service delivery and to build capacity towards
effective tertiary Health Care and Medical Education

Priority Activities
• Decentralise management structures through the creation of sub-BMCs
• Develop strategic plan to attract and retain the requisite staff numbers and staff mix
• Set up a functional emergency service including emergency preparedness plan.
• Initiate activities to improve internal revenue generation and to control expenditure
and minimise waste
• Implement a planned preventive maintenance programme for buildings, equipment
and transport
• Review and improve records and information management in all departments
• Reorganise the procurement and stores management system in accordance with the
procurement law and manual
• Reconstitute and strengthen mortality audit committees

Expected Results
• Management practices improved (New management structure with designated sub-
BMCs created)
• Staff numbers increased
• Revenue generation improved
• Emergency services functional

Collaborators
Ministry of Health, Korle Bu Teaching Hospital, Tamale Teaching Hospital, Ghana Health
Service, Medical and Dental Council, Nurses and Midwives Council, Pharmacy Council,
DMHIS

26
 6.2.4. PSYCHIATRIC HOSPITALS

The Mental Health Unit seeks to promote mental health, prevent mental illness, provide
quality mental health care to persons with mental illness and ensure a sustainable,
equitably distributed quality and efficient client-centered community based mental health
service to all people in Ghana. The Mental Health Unit has two components: the
institutional component comprising the three psychiatric hospitals at Accra, Pantang and
Ankaful, and the community component comprising the psychiatric wings of some
regional and district hospitals, and community psychiatric nursing.

Stigma at all strata of the society remains the core and bane of mental health care. Stigma
prevents patients from seeking early treatment and leads to relatives abandoning their
wards at the hospitals and in the communities. Through stigma, mental health is often
considered as an afterthought in decision making. Human resource remains a major
problem in mental health care. There is general shortage of health workers but this is even
much more acute in mental health sector. Currently there are about 500 psychiatric nurses
for 22 million people in Ghana, giving a ratio of 1 nurse to 44,000 people. The ratio for
consultant psychiatrists is 1:2 million people. This poses a great challenge to accessibility
and quality of care. Mental health services are skewed to the southern sector as there is no
psychiatric hospital north of Accra.

Non-availability of psychotropic drugs is another major issue. The old generation drugs are
still being prescribed and these are often in short supply. Even though these drugs are
purchased at a heavy cost, the current procurement system sometimes leads to expiry of
the drugs bought. In addition inadequate financing is an obstacle to mental health care. By
policy, mental health care is free and the government is the sole financier yet the release of
funds has been inadequate and irregular. This leads to a handicap in our ability to deliver
quality care. The National Health Insurance Scheme also does not adequately address
mental health. The 2008 POW of mental health combines the three psychiatric hospitals
and the activities of the national coordinator of community psychiatric nursing.

The thrust for 2008 is to improve the human resource capacity for Mental Health and
ensure that all individuals especially the poor and the vulnerable groups have access to
quality mental health care.

Priority Activities
• Implement programmes to train and recruit additional psychiatric nurses and
psychiatrists
• Conduct Research into mental health issues
• Re-equip laboratories for the 3 facilities
• Ankaful
a. Increase revenue generation by expansion and improvement of mortuary
services
b. Re-equip the operating theatre and rehabilitation centre
• Accra
a. Provide 24-hour service for dispensary
b. Decongest the wards,
• Pantang
a. Establish infirmary wing for physically ill patients
b. Establish detoxification unit for alcohol and substance abuse

27
 c. Establish VCT and prevention of mother to child transmission services for
HIV prevention
d. intensify outreach services and mental health education
e. Institute private partnership programmes to improve mental health services
in the communities.

Expected Results
• Coverage of outreach services
• Number of psychiatric nurses and psychiatrists trained/recruited
• Functional Detoxification unit established for Pantang
• Functional laboratories for all facilities
• % increase in IGF

Collaborators
Ministry of Health, the 3 Teaching Hospitals, CHAG, Ghana Health Service, NGOs/CSOs

6.3. NATIONAL AMBULANCE SERVICE

The mandate of NAS is to provide pre hospital care to the sick and the injured and
transport them to health facilities. It aims to improve the outcome of accidents and
emergencies through efficient and timely pre hospital care. However, the coverage of
ambulance services is limited to regional capitals and a few districts. NAS also lacks the
right calibre of personnel and services are limited to provision of only basic care. Again,
health institutions also have inadequate infrastructure to respond appropriately to accidents
and emergencies.

The thrust for 2008 is to increase access to emergency care through the establishment
and operation of an efficient nationwide ambulance service.

Priority Activities
• Establish 6 additional ambulance stations
• Recruit and train 100 emergency medical technicians (EMT)- Basics and upgrade
the skills of 45 EMT- Basics to EMT- Advance.
• Introduce a program to ensure timely and efficient management of emergencies
• Screen and immunize at risk EMTs against hepatitis B
• Strengthen the functional and communication linkages between NAS, facility
based ambulance and health facilities
• Finalise the NAS bill for approval by cabinet and passage by parliament

Expected Results
• Six new ambulance stations established/number of districts with functional
ambulance services.
• One hundred EMT-Bs trained and 45 EMT- Bs upgraded
• Immunisation of 100% EMTs against hepatitis B

Collaborators
Ghana Health Service, Ghana national Fire Service, District Assemblies, NADMO, Quasi-
Government Hospitals, Teaching Hospitals, CHAG Facilities.

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 6.4. REGULATION

6.4.1. FOOD AND DRUGS BOARD

The Food and Drugs Board was set up by the PNDCL 305B (1992) to regulate the
manufacture, importation, exportation and distribution of food, drugs, cosmetics, medical
devices and household chemicals in the country. In Pursuance of Sections of this law, and
in order to ensure the safety and quality of regulated products, the Board prepares
guidelines to provide players and stakeholders in the food and drug industry with the
requirements of the Food and Drugs Board (FDB) and also provide a comprehensive
procedure for bringing their activities into compliance with the law. In line with these
provisions the Board has made a strong presence at the ports of entry to inspect, collect
data and store information for appropriate regulatory decision-making.

Despite these achievements, the capacity of the board to protect consumers from locally
manufactured goods is limited due to inadequate personnel. This calls for a concerted
effort to extend regulatory activities to the district through increased involvement of the
district assemblies.

The FDB Policy Thrust for 2008 is to improve surveillance on locally produced food and
medicinal products and to protect the consumer by ensuring the safety and efficacy of
food and drug products on the local market as well as food and drug products processed
for export.

Priority Activities
• Develop relevant regulations and guidelines to ensure food and drug safety
• Mount a comprehensive Public Awareness campaign on Food and Drug Safety
• Train identified food processors with special emphasis on schools feeding
programmes, major street-food joints and selected local restaurants.
• Plan and execute regulatory enforcement programmes in collaboration with the
Metropolitan, Municipal and District Assemblies.
• Review and improve systems for continuous monitoring and assurance of quality,
safety of food and medicines including traditional medicines
• Finalize the framework and manual for pharmaco-vigilance

Expected Results
• Guidelines on food and drug safety developed
• Improved knowledge in basic food safety among food processors and handlers
• Increased surveillance activities on safety of food and medicinal products

Collaborators
Ministry of Health, Ghana Health Service, The Ghana Standards Board (GSB),
Environmental Protection Agency (EPA), Ghana Tourist Board (GTB), Pharmacy Council,
Veterinary Council

29
 6.4.2. NURSES AND MIDWIVES COUNCIL

The Nurses and Midwives Council of Ghana is mandated to regulate nursing and
midwifery education and practice. With the current rise in the numbers of trainee nurses,
the responsibility of the Council has increased. This situation is compounded by the
dwindling staff numbers leading to increased workload and reduction in staff morale
within the council.

Due to ineffective collaboration between the Council and health care facilities in the
country, there are difficulties in regulating standards of nursing and midwifery practice.
The effect is that most cases of professional misconduct are not reported to the Council.

The thrust of the council for 2008 is to ensure increased adherence to standards of
nursing and midwifery practice within health facilities with emphasis on the public
sector.

Priority Activities
• Recruit more staff to augment the existing staff numbers in the Council.
• Update the knowledge of nursing and midwifery educators and practitioners on
current trends in the profession
• Conduct support supervisory visits with the view to enforcing standards of
professional practice at all health institutions and facilities throughout the country
• Prepare curricula for new post basic nursing programmes like paediatrics, accident
and emergency, community Psychiatry.
• Decentralize activities of the Council by establishing two more zonal offices in
Ashanti and western regions
• Conduct operational research on topical nursing issues e.g. Attitude of nurses

Expected Results
• Staff numbers of the Council is improved
• Supervision strengthened through increased visits to training schools and sites
• New curricula for post basic nursing programmes developed.
• Two zonal offices of council established.

Collaborators
Ghana Health Service(GHS), Teaching Hospitals, National Accreditation Board (NAB),
all nursing and midwifery training institutions , International Nursing and Midwifery
Regulatory Bodies and Associations, Health Partners (WHO, USAID, CHPS-TA, QHP,
DANIDA, GSCP), Christian Health Association of Ghana (CHAG), and the Universities.

6.4.3. MEDICAL AND DENTAL COUNCIL

The Medical and Dental Council is a statutory governmental agency that regulates the
standards of training and practice of medicine and dentistry in Ghana. It operates by
prescribing, developing and enforcing high standards of medical and dental practice that
will ensure the safety of the public. It also works through empowering the public to
become active participants in their medical and dental treatments.

30
The Council has inadequate requisite staff to manage the secretariat and this affects it
operations and the regular update of the register. The council is also faced with inadequate
numbers of accredited facilities for training housemen in specific disciplines leading to
congestion at the two teaching hospitals in the country. The existing standards and
guidelines also need to be reviewed in the context of new developments and policy shifts
in the health sector.

The thrust of the council for 2008 is to strengthen human resource capacity to improve
on regulatory activities of the council.

Priority Activities
• Recruit staff to augment the current workforce of the Council
• Develop A Comprehensive Registration Information Documentation System
• Accredit 2 regional hospitals and 10 district hospitals for housemanship training in
Internal Medicine, Obstetrics and Gynaecology, Paediatrics, and Surgery
• Develop policy and guidelines on Continuing Professional Development (CPD)
• Develop standards and guidelines for facilities and practitioners to ensure ‘fitness
to practice’ medicine and dentistry.
• Review curricula of training institutions to respond to current trends and
developments.

Expected Results
• The capacity of the council to pursue its mandate is improved (update of register to
reflect actual numbers of doctors and dentists practicing in the country)
• Training Institutions’ curricula reviewed
• 10 district and 2 regional hospitals accredited for housemanship training
• Standards and guidelines of professional practice updated.

Collaborators
Training Institutions (Kwame Nkrumah University of Science and Technology
School of Medical Sciences, University of Ghana Medical School), Teaching
Hospitals, Ghana Health Service, Private Hospitals and Maternity Homes Board,
Ghana Medical Association, Society of Private Medical and Dental Practitioners

6.4.4. PHARMACY COUNCIL

The Pharmacy council seeks to guarantee the highest level of pharmaceutical care to
Ghanaians. In addition, the Council collaborates with related local agencies and
international pharmaceutical organizations to enhance the effectiveness of pharmaceutical
services and rational medicines use in the country.

Though progress has been made to extend pharmaceutical services to all parts of the
country, problems with regard to equitable distribution of these services still remain. There
is also the need to protect the rights of the consumer by ensuring that medicines are used
rationally.

31
The thrust of the pharmacy council for 2008 will be to work towards improving access of
Pharmaceutical facilities to deprived areas and to empower consumers to use medicines
rationally.

Priority Activities
• Develop and implement policies and programmes to enhance access to deprived
areas
• Institute public education activities on rational medicines use (RUM) and danger
of drug abuse
• Work with collaborators in the pharmaceutical industry to assure quality of
medicines available to the population.
• Expand pharmaceutical services to increasingly cover the deprived areas.

Expected Results
• Increase number of licenses issued to pharmacies and chemical sellers in deprived
areas.
• Percentage population knowledgeable in RUM increased

Collaborators
Pharmaceutical Society of Ghana, Food and Drugs Board, Ghana Standards Board, Ghana
Police Service, Media, NGOs, District Assemblies

6.4.5. TRADITIONAL MEDICINE PRACTICE COUNCIL

The Traditional Medicine Practice Council has the mandate to regulate the practice of
traditional medicine in Ghana. Presently the legal instruments to guide its functions and
operations exists however the Council is still not in place even though the secretariat has
been established.

Currently, the key challenges of the Secretariat of the Council include inadequate
resources to pursue its mandate effectively. There is inadequate staff capacity and efforts
at building these have progressed slowly. These have greatly affected the secretariat’s
ability to enforce regulatory provisions on Traditional Medicines Practitioners of which the
majority have not received formal education.

The thrust for 2008 is to continue to build structures to enable the secretariat enforce
the provisions of the law on Traditional Medicine Practice in Ghana

Priority Activities
• Advocate for the establishment of the Traditional Medicine Practice Board
• Recruit staff to augment the existing numbers in the secretariat
• Organise awareness creation/ public education activities and sensitization on the
registration and licensing of Traditional Medicine Practitioners.
• Certify Traditional Medicine Practitioners and licence Practice Premises.
• Develop standard Operating Procedures Manuals for quality assurance in
traditional medicines practice.

32
Expected Results
• Effective structures for the regulation and practice of Traditional Medicine in
Ghana
• At least 500TMPs registered and certified and 300 licensed practice premises.

Collaborators
Ministry of Health, College of Health Sciences- Kwame Nkrumah University of Science
and Technology, World Health Organization, Pharmacy Council, Food and Drugs Board
,Centre for Scientific Research into Plant Medicine, Ghana Federation of Traditional
Medicine Practitioners Association and Ghana Association of Medical Herbalists
(GAHM).

6.4.6. PRIVATE HOSPITALS AND MATERNITY HOMES BOARD

The Private Hospitals and Maternity Homes Board was established to assist in the
provision of appropriate regulations relating to private health care practice and the delivery
of appropriate services by approved private hospitals and maternity homes.

The laws and statutes governing health service provision and public health protection are
fragmented and inadequate in ensuring quality and efficiency in the private sector. There
are different standards for regulating private sector and public sector services. The
institutional framework for regulating the sector relies on sanctions for enforcement, with
very limited emphasis on providing incentive support and monitoring and evaluation. Non-
enforcement and malfunctioning of regulation has also led to the non-recognition of the
capabilities and contributions of the Board to the sector’s outcome. In addition the
activities of the board have been affected by inadequate management systems and resource
flow.

The thrust for 2008 is to reorganize and equip the board to improve on its regulatory
function.

Priority Activities
• Update database on private health care sector
• Review and amend existing legal instruments to ensure that same standards are
used in regulating both public and private health sectors.
• Advocate for the establishment of a council for the board.
• Assist in the identification of underserved areas for locating facilities to ensure
equitable distribution of private facilities across the country

Expected Results
• Private healthcare facilities database updated
• Revised and Amendment legal instruments
• Functional council established

Collaborators
Ministry of Health, Private Medical and Dental Practitioners association, Ghana registered
Midwives Association, Medical and Dental Council, Nurses and Midwives Council,
Pharmacy Council,

33
 6.5. RESEARCH AND TRAINING

6.5.1. CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE

The Centre for Scientific Research into Plant Medicine has the mandate to undertake
research and development of plant medicine and to liaise with Traditional Medicine
Practitioners in plant medicine development and dissemination of research findings.

The center currently works on developing herbal medicines from local herbs, some of
which are cultivated under programme of development of local medicinal plants. The
center also runs a clinical unit which treats patients with products developed at the center
and runs clinical trials on new products. Products developed by herbalists are also
sometimes brought for analysis.

The key challenge is inadequate budgetary allocation to expand services to meet the ever
growing demand for herbal products and information on herbal medicines in use in Ghana.
The other challenge is the retention of the core technical and research officers due to high
attrition as a result of poor remuneration.

The thrust for the centre in 2008 is to reposition the center to respond to the changing
needs for herbal medicines in health care delivery in Ghana.

Priority Activities
• Reprioritise research on herbal medicines to focus on priority diseases of public
health importance.
• Initiate a recruitment exercise to improve staffing situation at the centre.
• Streamline procedures for the provision of technical support services to Traditional
Health Practitioners.
• Undertake training of students/interns in herbal medicine development and provide
research information on traditional medicines.
• Research and develop Herbal Medicines into modern dosage forms.
• Establish 2 satellite centers for clinical services

Expected Results
• Increased use of herbal medicinal products developed at the center in health
facilities including public health institutions
• Internship programme for Medical Herbalist streamlined.
• Two satellite centers for clinical services established

Collaborators
CSIR (Health and Environment), Food and Drugs Board, Noguchi Memorial Institute for
Medical Research, University of Ghana, KNUST, Traditional Medicine Practice Council,
WHO, Other Development Partners, Health training Institutions, Aberdeen University,
Scotland, University of Michigan, USA.

6.5.2. TRAINING INSTITUTIONS

Training of Health Professionals in Ghana is a shared responsibility between Ministry of

Education, Ministry of Health, the private sector and quasi government organizations.

34
However, there has not been much collaboration and consultations between the
stakeholders in the production of health professionals. This has created a gap between
planning, production and placement of certain categories of health professionals like
herbal medicine practitioners and nurse practitioners. There is therefore the need to ensure
effective collaboration between the Training Institutions in the public sector and the other
sectors to create synergies and harmonization in training.

In the last five years, the Ministry has made significant gains in the production of Health
professionals following the establishment of new schools and restructuring of programmes
as well as expansion of existing schools. These measures have resulted in the
establishment of Ghana College of Physicians, Direct Midwifery Training, Direct Medical
Assistants Training, Diploma in Community Health and the Middle level cadre Training.

Production of certain categories of health professionals has been scaled up resulting in an

average of 20% increase in admission into the Health Training Institutions. However,
production of health professionals has seen implementation difficulties in the areas of
infrastructure, equipment and capacity of tutors. The need to strengthen capacities of
Training Institutions is therefore paramount.

The policy thrust of the Ministry is to provide adequate resources to support training of
appropriate cadres of the health workforce.

Priority Activities
• Scale up middle level cadre training with emphasis on midwifery and medical
assistants.
• Increase the number of trainees admitted into the training schools.
• Increase resource allocation to the training institutions
• Organise Continuing professional education for tutors
• Work with District Assemblies and other agencies to identify and sponsor students
within deprived areas for middle level training

Expected Results
• 20% increase in enrolment of midwives and medical assistants
• 35 existing libraries supplied with books
• 20 existing demonstration rooms equipped
• 10 additional practical sites accredited and 15 new preceptors identified and
trained.
• 120 tutors upgraded
• 20% of students admitted sponsored by District Assemblies and other agencies

6.5.3. GHANA COLLEGE OF PHYSICIANS AND SURGEONS

The Ghana College of Physicians and Surgeons was mandated to train specialists in
medicine, surgery and allied specialties to meet the needs of the country. The college has
made a lot of progress since its inception although problems such as inadequate physical
facilities, poor revenue mobilisation and poor financial management practices remain. The
managerial capacities of administrative staff also need upgrading to bring the performance
of the college to acceptable standards. Also, the college is finding it difficult to accredit

35
adequate health facilities to support the training of its students because most facilities are
less endowed with the requisite resources.

The thrust of the college’s policy is to expand the continuous professional development
programme, improve training outcomes and build general capacities to enable the
college operate more efficiently.

Priority Activities
• Formulate guidelines for the smooth running of the continuous professional
development programme
• Generate revenue by offering the college’s facilities to the general public for
seminars, workshops and conferences
• Arrange for short training courses, seminars and workshops for the accounting and
audit staff of the college to upgrade their knowledge and competencies.
• Provide specialist education in medicine, surgery and related disciplines,
• Conduct research in medicine, surgery and related disciplines.
• Collaborate with stakeholders to improve the facilities and human resource base of
accredited health facilities
• Prepare and publish journals

Expected Results
• Number of articles published
• Number of specialists produced
• Number of professionals benefitting from continuous professional development
• Formulation of guidelines for the professional development programme.
• Increased revenue generation to support the college’s activities

Collaborators
Ministry of Health, Medical and Dental Council, Medical schools, Teaching Hospitals,
Ghana Health Service, Ministry of Education, School of Public Health

36
7. CAPITAL INVESTMENT

This section of the POW addresses a combination of investments in infrastructure,

equipment, Information Communications Technology (ICT) and transport including
ambulance for sustaining and expanding the delivery of health services. In that regard this
section contributes to the targets set under Strategic Objective 3 of the POW by
strengthening health system capacity to expand, manage and sustain a high coverage of
high quality health interventions and services for promoting health, preventing diseases,
treating the sick and rehabilitating the disabled.
A review of the capital investment environment shows some key challenges that need to be
addressed in 2008. These include:
• The increasing demand for health services in response to the National Health
Insurance Scheme and the need to scale up achievement of health related
Millennium Development Goals. This includes the increasing demand to expand
the national Ambulance Service to all regions and districts
• Threats to quality of care arising out of deteriorating health infrastructure and
obsolete equipment
• Disruption of the health services from the devastating effects of the recent floods in
the affected regions of the country;
• Inadequate funds for the huge capital investment contributing to the several
uncompleted capital projects as well as outstanding payments owed to contractors,
suppliers and consultants for work done on various projects;
• Ageing of vehicles and relatively slow deployment of ICT affecting service
delivery and management.
• Understanding the health service capacity needs of the newly created districts
• Rapid urbanisation with its attendant pressures on limited health facilities.
• Inadequate emergency and epidemic preparedness of health facilities

The Thrust of the 2008 Investment POW is to complete ongoing projects with priority to
projects with significant contribution to enhancing quality and equitable access to
health care and scaling up achievement of health related MDGs.

Priority Activities
Criteria for 2008 Capital Expenditure Priorities
• Commitments such as Matching Funds required for projects funded under mixed
credits/grants and payment of accumulated debts from 2007;
• Projects with 100% secured/earmarked funding;
• Ongoing projects procured under international competitive tendering with legal
implications for GOG arising from delays in payments;
• Ongoing projects with high level of completion and substantial sunk cost that can
be completed in 2008;
• Investments that respond to priorities of the MOH POW III (2007 – 2011) and the
MOH Health Policy with emphasis on investments that could propel the
achievement of the MDGs by 2015;
• Basic emergency and essential obstetric care equipment, transport and ambulance
requirements;
• MIS/ICT requirements for full integration of the NHIS and its DMHIS

37
Infrastructure
• Finalize the 2007-2011 Capital Investment Plan
• Execute the 2008 Capital Investment plan with emphasis on projects that promote
equity and improve quality of care. These include Offices for regulatory bodies,
Facilities for training institutions, Staff accommodation, CHIPS and health centres,
District hospitals, DHMT & RHMT office facilities, Accident and emergency
preparedness facilities, Specific facilities in regional and tertiary hospitals,
Reconstruction/rehabilitation of health facilities destroyed by recent floods
• Deploy the Capital Investment Planning Model in the development of the 2009
Capital Investment Plan
• Appraising and mobilizing resources to finance priority projects including
renovation and planned preventive maintenance of existing health service facilities
• Design a framework for routine progress and expenditure tracking system for
capital investment in collaboration with Development Partners;
• Collaborate with the District Assemblies to construct and equip CHPS compounds
in the sub-districts.

Equipment
• Provide equipment for emergency and essential obstetric care in selected districts
• Develop sustainable strategies for financing planned preventive maintenance and
replacement of equipment
• Review, rationalize and manage equipment maintenance contracts such as contracts
with Taylor & Taylor, Philips, etc.
• Provide requisite equipment for CHPS facilities constructed by the District
Assemblies of the Ministry of Local government and Rural Development;
• Install and commission equipment procured under Spanish Protocol in selected
hospitals

Transport and Ambulance

• Implement the medium term vehicle replacement plan targeting over aged vehicles
particularly in the deprived districts;
• Monitor and enforce adherence to guidelines on transport use and management;
• Ensure financing and implementation of planned preventive maintenance to
increase vehicle availability;
• Procurement of ambulances to support expansion of National Ambulance Service
and upgrading existing ones to enhance quality of Ambulance Service.

Information Communication Technology (ICT)

• Implement a strategic plan to support the development of an integrated and
consolidated National Health Information System including a link between
financial management and service delivery information;
• Scale up the district wide system for information management in collaboration with
NHIS and the District Mutual Insurance Schemes to ensure the availability of
accurate and reliable routine service-based data;
• Deploy integrated MIS solution and ICT to health institutions and District Mutual
Health Insurance Scheme as part of the NHIS-World Bank funded ICT project
aimed at effective communication between the schemes, the secretariat and service
providers;

38
 • Maintain and continuously update the MOH website

The following major projects with secured funding and completed preparatory activities
including appraisals will be commenced:
• Major rehabilitation and upgrading of Tamale Teaching Hospital ORET funding
• Construction of Bekwai and Tarkwa District Hospitals under ADB III
• Construction District Hospital at Nkawie with ORET funding
• Sunyani Regional Hospital staff accommodation project

Expected Results
The following projects will be completed and commissioned:
• Ghana College of Physicians and Surgeons office complex at Ridge. Currently the
facility is only at the stage of practical completion.
• Offices and Laboratories for Food and Drugs Board
• Offices for the Nurses and Midwifes Council
• Office Complex and Training Centre for NAS/ST. John’s Ambulance, Accra
• KBTH Medical Block
• Doctors’ Flats at KBTH
• KATH Maternity and Children’s Hospital
• National Accident and Emergency Centre at KATH
• Doctors’ and Nurses’ Flats at KATH
• Office blocks for Ghana Health Service at LFC
• Gushegu District Hospital
• Dental facilities in 22 hospitals nationwide under ORET sponsorship. Final
completion envisaged in 2008
• 35 District hospital projects including 3 under OPEC sponsorship
• 43 Health Centres nationwide including 21 under OPEC sponsorship
• 2nd Phase of the Bolgatanga Regional Hospital project with BADEA funding
• 6 no. DHMT & RHMT office facilities
• 34 no. staff accommodation projects in selected districts
• 50 new CHPS Compounds
• Reconstruction/rehabilitation of about 50 district health facilities destroyed by
floods in the 3 northern regions comprising mainly CHPS, nutrition and health
centers
• Equipment procured under the Spanish Protocol installed and commissioned to
replacement obsolete equipment in selected hospitals and health centres.
• Procurement of basic essential obstetric and emergency equipment
• Procurement of transport for various levels of the sector with emphasis on the
districts
• Integrated MIS solution and ICT infrastructure for NHIS deployed nationwide.
• Classroom and/or hostel blocks in 10 selected nursing training institutions.

39
8. 2008 HEALTH SECTOR BUDGET

The year 2008 which marks the second year of the third Five Year Program of Work of the
sector is a year of uncertainty as far as funding of the sector is concerned. This suggests
that an end to the initial SWAp arrangement is in sight. The health sector 2008 budget
derives from the third health sector Medium Term Expenditure framework.

The sector is going through a budgetary transition. From the previous common fund
arrangements of having most of our donor funding passed through the Health Fund (or
pooled donor funds) most of the funding from our health partners will now be channelled
through the sector budget support (SBS) and the earmarked funds. On the other side, the
NHIS is beginning to play a major role in the funding of the sector.

It is not clear how the SBS will operate. It is also not certain how inflows from the NHIS
would be. The only traditional source which remains the same is the GOG source but even
there ,sharp variation in proportion of funding to the item levels do exist with the
implementation of the new salary regime which proves to leave little for the service
provision, support and investment services.

Macro level analysis of 2008 allocation to the MOH

Of total GOG vote of GH¢2.805 billion, the MOH has been allocated GH¢ 0.268 billion
constituting 9.6% compared with the 2007 provision of 13.8% of GOG to the ministry.
This is a 4 percentage fall from the 2007 provision. In nominal terms there is an increase.
The likelihood that this would be revised upwards exists because of the head count which
is still in progress. What ever the increase may be, the P.E. would take a near 80%age of
the total. As in previous years, not much would be available for service delivery and
service delivery will suffer if no buffers are found.
MOH’s share of the total of Donor, IGF and HIPC is 12.7%, 38.5%, and 2% respectively.
Overall, 12.1 % of MOFEP ceilings has been allocated to the MOH. This level is yet
below the 15% Abuja pledge. Table 1 presents these details.

Table1: Macro level analysis of 2008 allocation as presented by MOFEP1 (‘000)

GOG Donor User fee HIPC Total

MOH 268,509.10 126,731.00 115,071.00 2,500.00 512,811.10

Total country 2,805,928.00 1,000,166.00 299,184.00 127,550.00 4,232,828.00
MOH share of 9.6 12.7 38.5 2.0 12.1
total (%)

1
The expected NHIF inflows are not included.

40
Total 2008 resource envelope

A total resource envelope of GH¢ 722.573 million is expected to finance the health sector
in 2008. GoG provides the largest with 37.2%2 followed by NHIS, User fee, Budget
support, Earmarked Funds, and HIPC inflows with 32.6%, 15.6%, 7.3% , 7% and 0.3%
respectively –see Table 2 a

Against the GH¢ 921.1 million estimated as the need in 2008 (see Table 3) a funding gap
of GH¢198.5 million exists.

Table 2a : Total 2008 resource envelope(‘000 GH cedi

Source GOG NHIS User Fee HIPC Budget Support Earmarked Total

level 268,509 235,430 112,630 2,500 52,866 50,638 722,573

% of
total 37.2 32.6 15.6 0.3 7.3 7.0 100.0

The trends of the health budget from 2005-2008 indicate nominal increases in successive
years. The budget increased by 33.34% in 2006 from 2005 and in 2007 increased by
18.68% over the 2006 level, whiles in 2008 (Indicative) the increase has been 33.87 over
the 2007 level. These do not include the NHIF. With the NHIF added the increase of 2006
over 2005 was 95% (The operation of the NHIF began in 2006 which accounts for the big
jump.) The increase in 2007 over 2006 was 22% whilst the increase in 2008 over 2007
with the NHIF inclusive is 28%. Considering the level of inflation, these can be said to be
increases in real terms. It should however be noted again that the PE component over
shadows most of these increments.

Table 2b: Trend of MOHbudget allocation (GH¢ ‘000) (Total Budget excluding NHIF)
ITEM/YEAR 2005 2006 2007 2008

1 132,896.00 172,938.00 221,437.00 254,767

2 20,283.00 24,350.00 25,101.00 42,966.00
3 32,136.00 79,804.00 96,754.00 120,788.00
4 59,961.00 49,962.00 44,845.00 101,081.64
Total 245,276.00 327,054.00 388,137.00 519,602.64
% Increase over previous year 33.34 18.68 33.87

National total Budget including NHIF 245,276.00 478,419.00 583,737.00 748,234.00

% Increase over previous year 95.00 22.00 28.00

2
A head count is underway of all health staff and the exact amount to be provided for personal emoluments
is yet to be determined. Meanwhile, a …estimate of GH¢298 million is projected.

41
 Item-wise distribution of 2008 budget

The share of resource by item indicates that item 1 constitutes 35.26%, Item two
constitutes 8.09% while items 3 and 4 constitute 42.83% and 13.82% respectively (see
table 2c). The table also indicates the source of funding the items. Item one is financed
basically by GOG although NHIS and user fees also provide for some item one. User fee
and the NHIS are the major source for item 2 with GOG providing about half the levels of
NHIS and user fees. The biggest source of funding for item three is the NHIS while item
four funding source is earmarked funds and the NHIS. Table 2c provides the details.

Table 2c : Total resource envelope by item and source in GH¢ ‘000

Budget Earmarked % of
Source GOG NHIS User fee. HIPC Support * Total total
Item 1 239,311.00 10,490.00 4,966.00 254,767.00 35.26
Item 2 10,904.10 21,820.00 24,736.00 500 500 58,460.10 8.09
Item 3 10,039.00 148,780.00 74,299.00 39,900.00 36,467.85 309,485.85 42.83
Item 4 8,263.10 54,330.00 8,629.00 2500 12,466.00 13,669.81 99,857.91 13.82
Total 268,517.20 235,420.00 112,630.00 2,500.00 52,866.00 50,637.67 722,570.87 100.00
% of
total 37.16 32.58 15.59 0.35 7.32 7.01 100.00
* level of Earmarked is still in compilation and not definite

Detailed analysis of 2008 by item

The 2008, health sector budget is guided by the principle of efficiency gains to ensure
prudent allocation of resources. The budget also tries to protect essential commodities, pro
poor activities and public health programmes through ring fencing. There is a gradual shift
of resources from IGF generating institutions to non IGF generating institutions as well as
support to pro poor and other public health programmes.

The table 3 below shows the total health budget by source and how this has been allocated
to the sub-items and to support 2008 health programmes.

Personnel Emoluments – Item 1

Personal emoluments are costs pertaining to manpower employed by the Ministry of
Health to carry out its functions. The item one budget prioritizes payment of salaries of staff at
post and other related expenditure as summarised in Table 3. The main source of Item 1
expenditure is GOG and it constitutes 86% of the total GoG vote and 29.46% of the national health
budget. The NHIF vote for Item 1 covers the emoluments of the Council and District Secretariats
of the District Mutual Health Insurance Secretariats. The IGF component of item one is used to pay
for the emoluments of contract workers in the IGF generating institutions. The total need is GH¢
298 million as against GH¢ 254.767 million indicative available

Administrative Services - Item two

These are the overhead costs and include items such as utilities, maintenance of vehicles &
equipment printing and publication, office consumables, allowances, etc.. The main

42
funding sources of Administrative cost of the Ministry of Health are GOG and user
fees/NHIF. It must be said that most of the NHIF funding goes to support the NHI council
and the DMHIS. Table 3 provides details on the share out to item two.

Service Vote - Item 3

Service vote covers the cost of service delivery incurred by BMCs in their operations and
covers a wide range of activities that underpin the core functions of the Ministry and its
agencies. These include essential commodities expenditure, public health goods, special
programmes, and pro poor activities. The table3 shows how the Service budget for 2008
has been allocated. Apart from the operational cost of agencies which are decentralised,
most of the Item 3 vote has been ring fenced to ensure that the essential inputs required for
service delivery are protected. Ring fenced items are centrally located at MOH
headquarters and this explains the relatively high percentage of the budget found in the
summary table.

Investment- Item 4

The aggregated budget available for the sector in 2008 by all sources of funding is
GH¢101.081 million compared with a total need of GH¢254.159 leaving a gap of
GH¢153.07 million

Allocation to Agencies
Tables 4a, b & c present allocations to the agency level of the 2008 budget. In table 4a,
some ring-fenced items have been lodged in Health Hq but to be benefited especially by
the district level. Sending the ring-fenced items to the beneficiary levels, as in tables 4b
and 4c, the allocations become clearer. The non-wage recurrent share indicates 59% to the
district level, 18% to the Teaching Hospitals, 9% to GHS Regional health services, 5% to
Health Hq and 1 percent each to GHS Hq and Psychiatry hospitals. The Health Hq
includes all the Medical Statutory bodies and other subvented organizations. This excludes
NHIS.

Table 4a: 2008 budget by item and sub-head (including undistributed NHIF) Ring
fenced lodged in Headquarterss*
INCL NHIS

level/item PE Admin Service Investment TOTAL %

Total Ministry of Health 254,767,000 41,966,617 266,283,063 101,081,644 654,807,649 100
Health Headquarters 26,322,950 1,934,297 4,061,294 78,065,887 110,384,428 17
Subvented Organizations 6,357,000 1,192,000 3,738,000 2,992,000 14,279,000 2
Teaching Hospitals (Tertiary Health
Services) 61,396,336 8,500,081 11,594,498 3,594,033 85,084,948 13
Ghana Health Service Headquarters 3,598,385 813,466 883,416 13,786,124 19,081,391 3
Psychiatry Hospitals (Tertiary Health
Services) 15,579,209 631,513 396,903 0 16,607,625 3
Regional Health Services 16,730,684 7,970,011 2,663,604 0 27,364,299 4
District Health Services 101,991,761 20,043,439 5,893,052 103,800 128,032,052 20
Training Institutions 13,500,000 881,810 1,632,296 2,539,800 18,553,906 3
National Health Insurance. 0 0 235,420,000 0 235,420,000 36
* The investment vote under Health Hqrs includes debt servicing to be administered by the MOFEP.

43
Table 4b: 2008 budget by item and sub-head)
excluding NHIS, and RINGFENCED SENT TO THE BENEFICIARY LEVELS
level/item PE Admin Service Investment TOTAL %
Total Ministry of Health 254,767,000 42,966,617 70,763,063 101,081,644 460,287,649 100
Health Headquarters 26,322,950 1,934,297 4,061,294 78,065,887 110,384,428 24
Subvented Organizations 6,357,000 1,192,000 3,738,000 2,992,000 14,279,000 3
Teaching Hospitals (Tertiary Health
Services) 61,396,336 8,500,081 11,594,498 3,594,033 85,084,948 18
Ghana Health Service hq 3,598,385 813,466 883,416 13,786,124 19,081,391 4
Psychiatry Hospitals (Tertiary Health
Services) 15,579,209 631,513 396,903 0 16,607,625 4
Regional Health Services 16,730,684 7,970,011 2,663,604 0 27,364,299 6
District Health Services 101,991,761 21,043,439 45,793,052 103,800 168,932,052 37
Training Institutions 13,500,000 881,810 1,632,296 2,539,800 18,553,906 4
National Health Insurance. 0 0 0 0 0 0

Table 4c: NON WAGE

RECURRENT (excluding NHIS)
level/item PE Admin Service Investment TOTAL %
Total Ministry of Health 42,966,617 70,763,063 113,729,680 100
Health Headquarters 1,934,297 4,061,294 5,995,591 5
Subvented Organizations 1,192,000 3,738,000 4,930,000 4
Teaching Hospitals (Tertiary Health
Services) 8,500,081 11,594,498 20,094,579 18
Ghana Health Service hq 813,466 883,416 1,696,882 1
Psychiatry Hospitals (Tertiary Health
Services) 631,513 396,903 1,028,416 1
Regional Health Services 7,970,011 2,663,604 10,633,615 9
District Health Services 21,043,439 45,793,052 66,836,491 59
Training Institutions 881,810 1,632,296 2,514,106 2
National Health Insurance. 0 0 0 0 0

44
 Table 3: Details at item and sub-item/programme level (‘000 GH¢)
Budget Total
Need GOG HIPC Support NHIS IGF Earmarked Available Gap
ITEM 1
Established post
241,670.00 225,318.00 10,490.00 235,808.00 5,862.00
Trainees on Payroll
6,007.00 6,007.00 6,007.00 0.00
Regulatory Bodies
1,151.00 1,151.00 1,151.00 0.00
Ambulance Services
1,080.00 1,080.00 1,080.00 0.00
Attrition
-8,140.00 -8,140.00 -8,140.00 0.00
Training Allowance
-160 -160 -160.00 0.00
Contract Appointments
9,897.00 4,966.00 4,966.00 4,931.00
Promotion
9,164.00 0.00 9,164.00
Waiting for financial clearance

10,284.00 10,284.00 10,284.00 0.00

Waiting for processing onto
pay roll
3,771.00 3,771.00 3,771.00 0.00
Recruitments
22,582.00 0.00 22,582.00
Consultancy
471 0.00 471.00
Intake into training institutions

360 0.00 360.00

Subtotal 298,137.00 239,311.00 0.00 0.00 10,490.00 4,966.00 0.00 254,767.00 43,370.00

0.00

ITEM 2 -
33,420.00

Operational costs for MOH &

agencies excl NHIS 8,684.00 24,736.00 33,420.00 0.00
Cuban Doctors 1,000.00 1,000.00
1,000.00 0.00
Procurement 3,000.00
0.00 3,000.00
Reviews, health summits and 2,000.00 500
Audits
500 1,000.00 1,000.00
Blood Transfusion 300 120
120.00 180.00
ICT Maintainance 100 100
100.00 0.00
Audit/ Financial Magt 1,000.00 500
Strengthen
500.00 500.00
NHIS Administration / 21,820.00
Logistics
21,820.00 21,820.00 0.00

Subtotal 62,640.00 10,904.00 0 500 21,820.00 24,736.00 0 57,960.00 4,680.00

ITEM 3 -

Operational costs for MOH &

agencies excl NHIS 42,827.00 7,128.00 34,699.00 41,827.00 1,000.00

Procurement 0.00 0.00

Pharmaceutical 36,660.00 36,660.00 36,660.00 0.00

Vaccines 7,133.00 1,900.00 2,000.00 3,233.00 7,133.00 0.00

Contraceptives 3,986.00 300 1,400.00 1,986.00 3,686.00 300.00

TB drugs 450 450 450.00 0.00

Procurement of psychiatric
drugs 450 450 450.00 0.00

45
Printing & Publication 940 500 440 940.00 0.00

HIV/AIDS 1,200.00 1,200.00 1,200.00 0.00

Malaria/ACT 8,402.00 500 7,902.00 8,402.00 0.00

ITNs 6,820.00 2,000.00 2,000.00 2,820.00 6,820.00 0.00

Basic health equip / Cold

Chain 1,146.00 500 500.00 646.00

Anti Snake & Rabies 2,538.00 1,500.00 1,500.00 1,038.00

Subtotal 112,552.00 7,428.00 - 10,400.00 4,000.00 71,799.00 15,941.00 109,568.00 2,984.00

Programme -

Nutrition and malaria project 6,650.00 100 6,550.00 6,650.00 0.00

Guinea worm eradication

activities 3,000.00 203 1,000.00 1,203.00 1,797.00

Cumunicable diseases (pro-

poor) 1,000.00 1,000.00 1,000.00 0.00

Screening Program ( general

prostate and breast
mammogram 1,000.00 1,000.00 1,000.00 0.00

Specialist outreach Services 1,500.00 500 500.00 1,000.00

Counterpart for WFP 500 200 200.00 300.00

MCH Campaigns 18,000.00 5,000.00 5,000.00 13,000.00

HIRD implementation 17,000.00 1,000.00 11,000.00 5,000.00 17,000.00 0.00

Regenerative Health &

Nutrition 3,000.00 2,000.00 2,000.00 1,000.00

Labiofarm 2,000.00 1,000.00 1,000.00 1,000.00

Equipment maintenance and

reagents 5,000.00 2,500.00 2,500.00 5,000.00 0.00

Productivity Improvement
Initiatives 200 200 200.00 0.00
Strategic Initiative Fund
1,000.00 0.00 1,000.00
Emergency preparedness 5,000.00 300
800 1,100.00 3,900.00

Sub total 64,750.00 1,803.00 - 26,000.00 - 2,500.00 11,550.00 41,853.00 22,897.00

Exemption -

Buruli Ulcer 500 500 500.00 0.00

Refund of Medical exemptions 3,560.00 500 3,060.00 3,560.00 0.00

Piloting NHIS subsidies 500 500 500.00 0.00

Support to Finacially
Distressed Schemes 5,000.00 5,000.00 5,000.00 0.00

Premium for poor people

under NHIS 134,730.00 134,730.00 134,730.00 0.00

Sub total 144,290.00 - - 1,500.00 142,790.00 - - 144,290.00 0.00

Overseas conferences
500 400 400.00 100.00

Fellowship 2,000.00 300 1,500.00 1,800.00 200.00

Budget and PoW 100 100 100.00 0.00

46
Health Research 500 500 500.00 0.00

Sub total 3,000.00 800 - 2,000.00 - - - 2,800.00 200.00

Grand Total Item 3 306,199.00 10,031.00 0 39,900.00 146,790.00 74,299.00 27,491.00 298,511.00 7,688.00

Investment 0.00

Emergency and Essential

Obstetric Care Equipment 18,493.00 4,000.00 2,000.00 2,000.00 6,629.00 3,864.00 18,493.00 0.00
Infrastructure
214,000.00 4,263.10 2,500.00 8,466.00 39,340.00 17,167.00 71,736.10 142,263.90
Transport and Ambulances
4,000.00 2,000.00 2,000.00 4,000.00 0.00
MIS & ICT
13,706.00 11,280.00 2,116.00 13,396.00 310.00
NHIS Reserve Fund
3,960.00 3,710.00 3,710.00 250.00

Total 254,159.00 8,263.10 2,500.00 12,466.00 56,330.00 8,629.00 23,147.00 111,335.10 142,823.90
Grand Total
921,135.00 268,509.10 2,500.00 52,866.00 235,430.00 112,630.00 50,638.00 722,573.10 198,561.90

47
 2008 Donor Inflows
Revenue Table 1
Donor Funds for 2008
In 000 GH¢
Earmarked
Donor Sector Support Health Fund Grant Loan Total Item 1 Item 2 Item 3 Item 4 Unallocated
DFID 25,944 0 0 0 25,944 0 0 0 0
DANIDA 4,508 0 0 0 4,508 0 0 0 0
DUTCH 22,880 0 0 0 22,880 0 0 0 0
KUWAIT(TA for MCH) 0 0 138 0 138 0 0 0 0
BMH (Gusheigu) 0 0 2,208 1,380 3,588 0 0 0 1,148
BMH (Dist. Dental Fac) 0 0 773 0 773 0 0 0 0
UNICEF 0 0 6,624 0 6,624 0 0 0 0 6,624
IDA(Regional HIV/AIDS) 0 0 3,680 0 3,680 0 0 0 0
AfDB((Trypon. Program) 0 0 1,380 0 1,380 0 0 0 0
AfDB(HSR III) 0 0 3,542 2,447 5,989 0 0 0 10,579
NDF (HSSP) 0 0 0 221 221 0 0 0 0
NDF(Health Serv. Rehab) 0 0 0 3,091 3,091 0 0 0 0
WFP 0 0 1,104 0 1,104 0 0 0 0 1,104
WHO 0 0 7,259 0 7,259 0 0 0 0 7,259
JICA 0 0 4,720 0 4,720 0 0 0 0 4,720
USAID 0 0 23,368 0 23,368 0 0 0 0 23,368
UNFPA(Reprodutive Hlth 0 0 2,208 0 2,208 0 0 0 0 2,208
GAVI 0 0 1,720 0 1,720 0 0 0 0 1,720
GLOBAL FUND 0 0 34,675 0 34,675 0 0 0 0 34,675
BADEA 0 0 0 258 258 0 0 0 1,285
BELG (Clinical Lab Proj) 0 0 0 3,864 3,864 0 0 0 0
WORLD BANK - Malaria and Nutrition 0 0 0 4,600 4,600 0 0 0 0
World BANK - Health Insurance 0 0 0 2,116 2,116 0 0 0 0
OPEC - 2nd RHSP 0 0 0 1,960 1,960 0 0 0 1,074

48
SARG - Health Cent. Pro 0 0 0 460 460 0 0 0 0 460
GRAND TOTAL 53,332 0 93,398 20,396 167,127 0 0 0 14,086 153,041
Pipeline Agreements
Tamale Teaching Hospital (ORET) 0 0 0 16,350 16,350 16,350 0

Other Sectors
Dfid Multi-sector HIV 0 0 3,220 0 3,220 0 0 0 0 3,220
Danida - HIV/AIDS NSF II Basket 0 0 184 0 184 0 0 0 0 184
Danida - AIDS SWAp 0 0 1,656 0 1,656 0 0 0 0 1,656
World Bank (Multi-Sector HIV/AIDS) 0 0 0 3,680 3,680 0 0 0 0 3,680
UNFPA(Pop. & Devt) 0 0 1,288 0 1,288 0 0 1,288 0 0

49
9. PERFORMANCE ASSESSMENT FRAMEWORK

9.1. MILESTONES

In 2008, the health sector will continue to consolidate its mutually reinforcing policies and
priorities initiated in 2007. It will also continue with the unfinished agenda of high impact
and rapid service delivery in addition to consolidating and strengthening the weak and
fragmented health system. It will further enhance governance through sustainable
financing. Specifically, these will be done through

(i) scaling up both programmes of regenerative health and nutrition and high
impact rapid delivery to all regions;
(ii) further rationalizing salaries of health workers particularly through the
implementation of initiatives that promote and augment workforce
productivity; and
(iii) expanding the coverage of the National Health Insurance Scheme while
being cognizant of issues of equity, efficiency and financial sustainability.

These will be complemented by additional initiatives to be vigorously pursued in the

following areas:

(a) promotion of safe food and access to water with the object of reducing food
and water borne diseases;
(b) enhancement of the quality and coverage of clinical care including
referrals, revamping of hospitals and mortuaries, development of clinical
protocols, provision of infrastructure and equipment to laboratories,
pharmacies and theatres;
(c) expansion of middle level training programmes targeted at the training of
medical assistants, midwives, and health assistants for the sub-districts
while enhancing workforce productivity with improved HMIS; and
(d) strengthening of inter-sector collaboration.

9.2. INDICATORS AND TARGETS

The table below shows the indicators and targets for measuring and assessing performance
of the health sector in 2008.

50
 9.3.

Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

GOAL ONE: Ensure that children survive and grow to become healthy and productive adults that reproduce without risk of injuries or death and age healthily

1 IMR 71 (2001) N/A 64 53

2 U5MR 111 (2001) N/A 105 90

3 MMR Survey to provide baseline N/A N/A3 To be determined

after the baseline
4 U5 prevalence of low weight for age 18% (MICS 2006) N/A 16% 12%

5 Total Fertility Rate 4.4 N/A 4.3 4.2

GOAL TWO: Reduce the excess risk and burden of morbidity, disability, and mortality especially in the poor and marginalized groups

6 HIV+ prevalence among pregnant women 15-24 years 3.2 <4.0 <4.0 <4.0

7 Incidence of Guinea worm 4,136 <3,500 <3,500 <1500

GOAL THREE: Reduce inequalities in access to health services and health outcomes

8 Equity Index: Poverty (U5 Mortality Rate) 1.18 (118:100) N/A 1.18 1.18

9 Equity Index: Geography (services) (Supervised deliveries) 1: 2.05 (WR 26.5: CR 54.3) N/A 1: 2.05 1:1.8

10 Equity Index: Geography (resources) (Nurses: Population) 1: 4.14 (Upper West: 1: 44,317 to Total N/A 1:3.5 1:2.5
population 1: 10,700)
11a Equity Index: NHIS Gender (Female/Male card holder Not currently measured but will be captured in N/A N/A To be set once
ratio) 2008. baseline is
developed.
11b Equity Index: NHIS poverty (Ratio lowest quintile to whole Baseline to be developed from District MICS N/A N/A To be set once
population who hold NHIS cards) 2007 baseline is
developed

3
The non-applicable status is due to the baseline currently being collected, therefore at this stage a target cannot be set.

51
 Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

Thematic Area 1: Healthy Lifestyle and Healthy Environment4

12 % of households with sanitary facilities 18%(MICS 2006) N/A 70 85%

13 % of households with access to improved source of 74% (DHS 2003) N/A 78 90%
drinking water

14 Obesity in adult population 25.3% (DHS 2003women age 15-49 with BMI N/A 25%5 20%
≥25.0)

Thematic Area 2: Provision of Health, Reproduction and Nutrition Services

15 % children 0-5 months exclusively breastfed 54% (MICS / DHS) N/A 60% 74.4%

16 % deliveries attended by a trained health worker 45% 59% 60% 70%

17 Contraceptive Prevalence Rate (CPR) (For modern 0.19 (DHS 2003) 0.27 0.28 0.35
methods)
18 Antenatal care coverage 69.4 (DHS 2003) 95% 95% 99%

19 % of U5s sleeping under ITN 35% 60% 60% 80%

4
The targets set in this thematic area are desired targets; they are not within the health sector’s remit and therefore the sector cannot be held accountable
5
The target is not ambitious due to the RHNP is not expected to have an impact for a few years

52
 Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

20 % of children fully immunised by age one 84% (This is for Penta3) 90% 92% 94%

21 HIV+ clients receiving ARV therapy 7,388 25,000 38,000 71,000

22 Outpatients attendance per capita (OPD) 0.53 (OPD) 0.60 0.60 1.2

23 Institutional maternal mortality rate 2.19/1000 1.80/1000 1.75/1000 1.5/1,000

24 TB treatment success rate 72.30% 85% 80% 85%

25 % population live within 8km of health infrastructure Baseline not set N/A To be set To be set once
once baseline baseline is
is determined. determined.
26a Doctor: population ratio 1:10, 641
26b Nurse: population ratio 1: 1,587

27 % total MTEF expenditure on health 15% 15.5% 15.5% 16%

28 % non-wage GOG recurrent budget allocated to district 48% >40% >40% >40%
level and below

29 Per capita expenditure on health 21.45 24.64 39.11 67.32

30 Budget execution rate (by source, by line item and by level) For GOG: (Item 1 – 100%, Item 2 – 100%, Item
3 – 74%, Item 4 – 109%)
HIPC – 94%
Donor – 71.9%

31 % of annual budget allocations to items 2 and 3 (GOG and For Item 2 – 50% of budget released by end
HF) disbursed to BMCs by the end of June June.
32 % of population with valid NHIS membership card 25% 55% 65% 80%

53
 Indicator 2006 Baseline 2007 Target 2008 Target 2011 Target

33 Proportion of claims settled within 4 weeks Not currently measured, will develop baseline N/A To be To be developed
once ICT is in place developed once baseline is
once baseline set.
is set.
34 % of IGF from NHIS 45% N/A 55% 70%

54
Monitoring and reporting on the performance of the health sector in 2008 will be
approached from three main angles. Firstly, a year on year tracking of progress based on
the sector-wide indicators will be undertaken. In 2008 steps will be taken to continue to
refine some of the indicators which are being introduced for the first time in the Five Year
POW. Tracking these indicators will require significant agreement on the definitions and
criteria for data collection and efforts will be made to work on these during the year.
District coverage surveys will be undertaken to validate data from the routine data
collection system.

The second approach will be through the Intra and inter agency performance hearing
system. Guidelines will be provided to all agencies on the mechanism for the performance
hearings and efforts will be made to improve the structured participation of all
stakeholders. The third approach will be the Annual Review activities which will include
in-depth reviews and the independent review exercise.

9.4. RISKS AND ASSUMPTIONS

The major risks to the successful implementation of the POW are outlined as follows:

• Budget execution (predictability, timeliness and adherence)

o Approved budget is not fully released. The sector would continue to
dialogue and review plans and programmes
o Funds for the implementation of programmes and activities are released
late. Reprioritisation of plans and programmes
• The continuing unresolved HR management challenges which can lead to
industrial unrests. Continue to dialogue with the stakeholders and ensure industrial
harmony exists at all levels
• Unusually large disasters that will require mass shifts of resources. In 2008 this is
very real as a result of the following:
o Hosting of Ghana 2008. Work with Local organising Committee to put in
place emergency measures to prevent any disaster before, during and after
the Ghana 2008 football tournament Possibilities of Epidemic outbreaks.
Ensure there is a National Epidemic Response Plan
o Impending elections during 2008. Work with various stakeholders to
minimise violence during and after elections
• Performance of the economy
o Inflation. Keep reviewing plans and programmes to keep expenditure
within budget limits
o Energy and utilities. Efficient utilisation of resources and reprioritise plans
and programmes

The successful implementation of the programme of work is based on the assumption that
all the programmes and activities outlined will translate into verifiable outcomes that will
lead to the attainment of the set objectives. It also assumes the following:

• The health problems and challenges defined and for which programmes have been
designed are valid.
• The estimated budget is approved for disbursement

55
• The budget estimated is adequate for all financial requirements for the
implementation of the POW
• The approved budget is disbursed in a timely manner and rationally utilised
• The budget earmarked for the POW is executed to the level where programmes and
activities are not adversely affected.
• All BMCs have the minimum required capacities including requisite staff in the
utilisation of resources for the activities outlined
• All collaborators play their expected roles in the implementation process
• Procurement plan is adhered to
• There is no force majeure

56
10. ANNEXES

57
Annex 1: CAPITAL INVESTMENT PLAN

58
 Table 1: Agency/BMC Allocations

2008 BUDGET % OF 2008

ITEM AGENCY/TITLE OF PROJECT PROVISION TOTAL
GH(¢) BUDGET
A GHANA HEALTH SERVICE
Selected CHPS, HC, DH, DHNT, RHMT & staff accommodation projects with high level of
1 9,193,614.98
completion and sunk cost that can be completed in 2008
2 Sunyani Regional Hospital staff accommodation project 5,500,500.00
3 Reconstruction/rehabilitation of sub-district facilities destroyed by floods in 3 northern regions 1,200,000.00
4 Matching Fund for BADEA Projects - Rehabilitation of Bolgatanga Regional Hospital 2,371,440.00
5 Matching Fund for ADB III/NDF Projects 12,590,746.16
6 Matching Fund for OPEC II Projects (21 No. Health Centres) 370,812.52
7 Matching Fund for OPEC II Projects (3 No. District Hospitals) 985,003.48
8 Procurement of Equipment & Transport 12,855,543.00
9 Sub-Total 45,067,660.14 42.32

B TRAINING SCHOOLS
Allocation for selected projects in CHNTS, SOH, HATS, Nursing & Midwifery training institutions
1 2,189,800.00
with high sunk cost that can be completed in 2008
Construction of Offices & Lecture Halls for the Ghana College of Physicians and Surgeons at Ridge,
2 350,000.00
Accra
3 Sub-Total 2,539,800.00 2.38

C TEACHING HOSPITALS
1 KORLE BU TEACHING HOSPITAL
i Refurbishment of the Medical Block 2,000,000.00
ii Refurbishment of the Maternity Block 700,000.00
iii Preparatory works for Urology Department 500,000.00
iv Surgical Medical Emergency 80,000.00
v Drug Addiction Rehab. Centre 270,000.00
vi Plastic Surgery 354,457.00
vii Sub-Total 3,904,457.00 3.67

2 KOMFO ANOKYE TEACHING HOSPITAL

i Completion of Maternity and Children’s' Block 2,000,000.00
ii Completion of Doctors' Flats 318,000.00
iii Purchase of ICT/Computers 232,701.00
iv Refurbishment of Wards 78,375.00
v Completion of Office Complex/Resource Dev. Centre 285,000.00

59
vi National Accident & Emergency Centre 8,689,620.60
vii Sub-Total 11,603,696.60 10.90

3 TAMALE TEACHING HSPITAL

i Major Rehabilitation and Upgrading of Tamale Teaching Hospital 17,125,500.00
ii Sub-Total 17,325,500.00 16.08

D STATUTORY BODIES/SUBVENTED ORG.

1 Construction of Offices and Laboratories for Food and Drugs Board 1,750,000.00
2 Office Complex and Training Centre for National Ambulance Service in Accra 401,896.00
3 Construction of Offices for the Nurses and Midwives Council 605,599.22
4 Investment Requirement for CSRIPM & TAMD 737,005.00
5 Investment Requirement for Pharmacy Council 32,000.00
Completion of office accommodation and construction of staff accommodation for Medical and dental
6 120,000.00
Council
National Health Insurance Council/Infrastructure, ICT & Reserve Fund (Excluding KATH A+E &
7 18,605,189.70
others)
8 Sub-Total 22,251,689.92 20.90

E MOH HEADQUARTERS/NATIONAL
1 Transport and Ambulances 4,000,000.00
3 Sub-Total 4,000,000.00 3.76

F GRAND TOTAL 106,492,803.65

60
 Table 2: Allocations per Expenditure Priorities

2008 BUDGET % OF 2008

ITEM PRIORITY LEVEL/TITLE OF PROJECT PROVISION TOTAL
GH(¢) BUDGET

A. MATCHING FUNDS & OTHER COMMITMENTS

1 Matching Fund for BADEA Projects - Rehabilitation of Bolgatanga Regional Hospital

2,371,440.00
2 Matching Fund for ADB III/NDF Projects 12,590,746.16
3 Matching Fund for OPEC II Projects (21 No. Health Centres) 370,812.52
4 Matching Fund for OPEC II Projects (3 No. District Hospitals) 985,003.48
5 Major Rehabilitation and Upgrading of Tamale Teaching Hospital 17,125,500.00
6 2007 Outstanding Bills 1,693,200.00
7 Sub-Total 33,443,502.16 31.40

PROJECTS PROCURED UNDER ICB WITH LEGAL CONSEQUENCES

B.
FOR DELAYED PAYMENTS
1 National Accident & Emergency Centre at KATH 8,689,620.60
2 Construction of Offices and Laboratories for Food and Drugs Board 1,750,000.00
3 Construction of Offices for the Nurses and Midwives Council 605,599.22
4 Sunyani Regional Hospital staff accommodation project 5,500,500.00
Construction of Offices & Lecture Halls for the Ghana College of Physicians and
5
Surgeons at Ridge, Accra 350,000.00
6 Sub-Total 16,895,719.82 15.87

ONGOING PROJECS WITH HIGH LEVEL OF COMPLETION &

C.
COLOSSAL SUNK COSTS
1 Refurbishment of the KBTH Medical Block 2,000,000.00
2 Refurbishment of the KBTH Maternity Block 700,000.00
3 Preparatory works for KBTH Urology Department 500,000.00

61
4 KBTH Surgical Medical Emergency 80,000.00
5 KBTH Drug Addiction Rehab. Centre 270,000.00
6 KBTH Plastic Surgery 354,457.00
7 Completion of KATH Maternity and Children’s Block 2,000,000.00
8 Completion of Doctors' Flats at KATH 318,000.00
9 Refurbishment of Wards at KATH 78,375.00
10 Completion of KATH Office Complex/Resource Dev. Centre
285,000.00
11 Office Complex and Training Centre for National Ambulance Service in Accra
401,896.00
12 Investment Requirement for CSRIPM & TAMD 737,005.00
13 Investment Requirement for Pharmacy Council 32,000.00
Completion of office accommodation and construction of staff accommodation for
14
Medical and dental Council 120,000.00
15 Sub-Total 7,876,733.00 7.40

ONGOING INVESTMENTS THAT RESPOND TO POW PRIORITIES &

D.
MDG'S

Selected CHPS, HC, DH, DHNT, RHMT & staff accommodation projects with high
1
level of completion and sunk cost that can be completed in 2008
9,193,614.98
Reconstruction/rehabilitation of sub-district facilities destroyed by floods in 3 northern regions
2 1,200,000.00

National Health Insurance Infrastructure & Reserve Fund (Excluding NHIC ICT &
3
KATH A+E) 7,325,,189.70
4 Sub-Total 17,718,804.68 16.64

E NURSING TRAINING INSTITUTIONS PROJECTS

62
 Allocation for selected projects in CHNTS, SOH, HATS, Nursing & Midwifery
1
training institutions with high sunk cost that can be completed in 2008
2,189,800.00
2 Sub-Total 2,189,800.00 2.06

F EQUIPMENT, TRANSPORT & ICT

1 Purchase of ICT/Computers for KATH 232,701.00
2 ICT requirements for NHIC 11,280,000.00
3 GHS Procurement of Equipment & Transport for Districts
12,855,543.00
4 National Transport and Ambulances 4,000,000.00
5 Sub-Total 28,368,244.00 26.64

G GRAND TOTAL 106,492,803.65

63
 2008 CAPITAL INVESTMENT BUDGET

2008 SOURCE OF FUNDING (GH¢)

COST TO
BUDGET
TITLE OF PROJECT COMPLETION
PROVISION
GH(¢)
GH(¢) GOG DONOR EARMARKED HHIS HIPC I
CY/BMC ALLOCATIONS

HEALTH SERVICE
CHPS, HC, DH, DHNT, RHMT
commodation projects with high
13,458,530.98 9,193,614.98 0.00 1,926,200.00 1,147,539.98 4,840,000.00 1,27
ompletion and sunk cost that can
eted in 2008
Regional Hospital staff
9,000,000.00 5,500,500.00 2,000,000.00 3,500,500.00
dation project
ction/rehabilitation of sub-
cilities destroyed by floods in 3 2,000,000.00 1,200,000.00 1,200,000.00 0.00 0.00 0.00 0.00
gions
Fund for BADEA Projects -
ation of Bolgatanga Regional 2,404,450.00 2,371,440.00 1,086,640.00 0.00 1,284,800.00 0.00 0.00

Fund for ADB III/NDF Projects 25,156,117.00 12,590,746.16 2,011,772.78 0.00 10,578,973.38 0.00 0.00
Fund for OPEC II Projects (21
1,824,664.16 370,812.52 89,992.52 0.00 280,820.00 0.00 0.00
h Centres)
Fund for OPEC II Projects (3
3,106,860.59 985,003.48 191,643.48 0.00 793,360.00 0.00 0.00
ct Hospitals)
nt (Emergency & Essential
25,000,000.00 12,855,543.00 0.00 4,000,000.00 3,864,000.00 2,000,000.00 0.00 2,99
Care)
l 81,950,622.73 45,067,660.14 6,580,048.78 5,926,200.00 21,449,993.36 6,840,000.00 0.00 4,27
% of 2008 Investment Budget 42.32 79.63 47.54 52.32 20.86 0.00 4

NG SCHOOLS
n for selected projects in
SOH, HATS, Nursing &
training institutions with high
that can be completed in 2008 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00
ion of Offices & Lecture Halls
hana College of Physicians and
at Ridge, Accra 350,000.00 350,000.00 0.00 350,000.00 0.00 0.00 0.00
l 8,982,189.50 2,539,800.00 0.00 2,539,800.00 0.00 0.00 0.00
% of 2008 Investment Budget 2.38 0.00 20.37 0.00 0.00 0.00 0

NG HOSPITALS
BU TEACHING HOSPITAL
ment of the Medical Block 2,000,000.00 2,000,000.00 0.00 0.00 2,000,000.00 0.00 0.00
ment of the Maternity Block 700,000.00 700,000.00 0.00 0.00 0.00 0.00 0.00 70
ry works for Urology
nt 500,000.00 500,000.00 0.00 0.00 0.00 0.00 0.00 50
Medical Emergency 80,000.00 80,000.00 0.00 0.00 0.00 0.00 0.00 8
iction Rehab. Centre 270,000.00 270,000.00 0.00 0.00 0.00 0.00 0.00 27
rgery 354,457.00 354,457.00 0.00 0.00 0.00 0.00 0.00 35
l 3,904,457.00 3,904,457.00 0.00 0.00 2,000,000.00 0.00 0.00 1,90
% of 2008 Investment Budget 3.67 0.00 0.00 4.88 0.00 0.00 2

ANOKYE TEACHING
AL
on of Maternity and Childrens'
2,000,000.00 2,000,000.00 0.00 0.00 0.00 2,000,000.00 0.00
on of Doctors' Flats 318,000.00 318,000.00 0.00 0.00 0.00 0.00 0.00 31
of ICT/Computers 232,701.00 232,701.00 0.00 0.00 0.00 0.00 0.00 23
ment of Wards 250,000.00 78,375.00 0.00 0.00 0.00 0.00 0.00 7
on of Office Complex/Resource
re 4,000,000.00 285,000.00 0.00 0.00 0.00 0.00 0.00 28
Accident & Emergency Centre 8,689,620.60 8,689,620.60 0.00 0.00 0.00 5,344,810.30 3,344,810.30
l 15,490,321.60 11,603,696.60 0.00 0.00 0.00 7,344,810.30 3,344,810.30 91
% of 2008 Investment Budget 10.90 0.00 0.00 0.00 22.40 100.00 1
E TEACHING HSPITAL
habilitation and Upgrading of
eaching Hospital 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00
l 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00
% of 2008 Investment Budget 16.08 9.39 0.00 39.88 0.00 0.00 0

ORY BODIES/SUBVENTED

ion of Offices and Laboratories

and Drugs Board 1,750,000.00 1,750,000.00 0.00 0.00 1,200,000.00 0.00 0.00 55
mplex and Training Centre for
Ambulance Service in Accra
521,896.00 401,896.00 401,896.00 0.00 0.00 0.00 0.00
ion of Offices for the Nurses
wives Council 757,600.00 605,599.22 505,555.22 0.00 0.00 0.00 0.00 10
nt Requirement for CSRIPM &
737,005.00 737,005.00 0.00 0.00 0.00 0.00 0.00 73
nt Requirement for Pharmacy
32,000.00 32,000.00 0.00 0.00 0.00 0.00 0.00 3
on of office accommodation and
on of staff accommodation for
nd dental Council 250,000.00 120,000.00 0.00 0.00 0.00 0.00 0.00 12
Health Insurance
nfrastructure, ICT & Reserve
cluding KATH A+E & others) 29,445,189.70 18,605,189.70 0.00 0.00 0.00 18,605,189.70 0.00
l 33,493,690.70 22,251,689.92 907,451.22 0.00 1,200,000.00 18,605,189.70 0.00 1,53
% of 2008 Investment Budget 20.90 10.98 0.00 2.93 56.74 0.00 1

EADQUARTERS/NATIONAL
, Motor Bikes and Ambulances 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00
l 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00
% of 2008 Investment Budget 3.76 0.00 32.09 0.00 0.00 0.00 0

TOTAL 233,096,781.52 106,492,803.65 8,263,000.00 12,466,000.00 40,999,993.36 32,790,000.00 3,344,810.30 8,62

ATIONS BY EXPENDITURE
PRIORITIES

ING FUNDS & OTHER

TMENTS
Fund for BADEA Projects -
ation of Bolgatanga Regional
2,404,450.00 2,371,440.00 1,086,640.00 0.00 1,284,800.00 0.00 0.00
Fund for ADB III/NDF Projects 25,156,117.00 12,590,746.16 2,011,772.78 0.00 10,578,973.38 0.00 0.00
Fund for OPEC II Projects (21
h Centres) 1,824,664.16 370,812.52 89,992.52 0.00 280,820.00 0.00 0.00
Fund for OPEC II Projects (3
ct Hospitals) 3,106,860.59 985,003.48 191,643.48 0.00 793,360.00 0.00 0.00
habilitation and Upgrading of
eaching Hospital 58,775,500.00 17,125,500.00 775,500.00 0.00 16,350,000.00 0.00 0.00
l 91,267,591.75 33,443,502.16 4,155,548.78 0.00 29,287,953.38 0.00 0.00
% of 2008 Investment Budget 31.40 50.29 0.00 71.43 0.00 0.00 0

TS PROCURED UNDER
H LEGAL
QUENCES FOR DELAYED
NTS
Accident & Emergency Centre
8,689,620.60 8,689,620.60 0.00 0.00 0.00 5,344,810.30 3,344,810.30
ion of Offices and Laboratories
and Drugs Board 1,750,000.00 1,750,000.00 0.00 0.00 1,200,000.00 0.00 0.00 55
ion of Offices for the Nurses
wives Council 757,600.00 605,599.22 505,555.22 0.00 0.00 0.00 0.00 10
Regional Hospital staff
dation project 9,000,000.00 5,500,500.00 2,000,000.00 0.00 3,500,500.00 0.00 0.00
ion of Offices & Lecture Halls
hana College of Physicians and
at Ridge, Accra 350,000.00 350,000.00 0.00 350,000.00 0.00 0.00 0.00
l 20,547,220.60 16,895,719.82 2,505,555.22 350,000.00 4,700,500.00 5,344,810.30 3,344,810.30 65
% of 2008 Investment Budget 15.87 30.32 2.81 11.46 16.30 100.00 7
NG PROJECS WITH HIGH
OF COMPLETION & HUGE
OSTS
ment of the KBTH Medical
2,000,000.00 2,000,000.00 0.00 2,000,000.00 0.00 0.00
ment of the KBTH Maternity
700,000.00 700,000.00 0.00 0.00 0.00 0.00 0.00 70
ry works for KBTH Urology
nt 500,000.00 500,000.00 0.00 0.00 0.00 0.00 0.00 50
rgical Medical Emergency 80,000.00 80,000.00 0.00 0.00 0.00 0.00 0.00 8
ug Addiction Rehab. Centre 270,000.00 270,000.00 0.00 0.00 0.00 0.00 0.00 27
astic Surgery 354,457.00 354,457.00 0.00 0.00 0.00 0.00 0.00 35
on of KATH Maternity and
Block 2,000,000.00 2,000,000.00 0.00 0.00 2,000,000.00 0.00
on of Doctors' Flats at KATH 318,000.00 318,000.00 0.00 0.00 0.00 0.00 0.00 31
ment of Wards at KATH 250,000.00 78,375.00 0.00 0.00 0.00 0.00 0.00 7
on of KATH Office
Resource Dev. Centre 4,000,000.00 285,000.00 0.00 0.00 0.00 0.00 0.00 28
mplex and Training Centre for
Ambulance Service in Accra
521,896.00 401,896.00 401,896.00 0.00 0.00 0.00 0.00
nt Requirement for CSRIPM &
737,005.00 737,005.00 0.00 0.00 0.00 0.00 0.00 73
nt Requirement for Pharmacy
32,000.00 32,000.00 0.00 0.00 0.00 0.00 0.00 3
on of office accommodation and
on of staff accommodation for
nd dental Council 250,000.00 120,000.00 0.00 0.00 0.00 0.00 0.00 12
l 12,013,358.00 7,876,733.00 401,896.00 0.00 2,000,000.00 2,000,000.00 0.00 3,47
% of 2008 Investment Budget 7.40 4.86 0.00 4.88 6.10 0.00 4

NG INVESTMENTS THAT
D TO POW PRIORITIES &

CHPS, HC, DH, DHNT, RHMT

commodation projects with high
ompletion and sunk cost that can
eted in 2008 13,458,530.98 9,193,614.98 0.00 1,926,200.00 1,147,539.98 4,840,000.00 0.00 1,27
 ction/rehabilitation of sub-
cilities destroyed by floods in 3
gions 2,000,000.00 1,200,000.00 1,200,000.00 0.00 0.00 0.00 0.00
Health Insurance Infrastructure
e Fund (Excluding NHIC ICT &
+E) 17,855,189.70 7,325,189.70 7,325,189.70
l 33,313,720.68 17,718,804.68 1,200,000.00 1,926,200.00 1,147,539.98 12,165,189.70 0.00 1,27
% of 2008 Investment Budget 16.64 14.52 15.45 2.80 37.10 0.00 1

G TRAINING
UTIONS PROJECTS
n for selected projects in
SOH, HATS, Nursing &
training institutions with high
that can be completed in 2008 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00
l 8,632,189.50 2,189,800.00 0.00 2,189,800.00 0.00 0.00 0.00
% of 2008 Investment Budget 2.06 0.00 17.57 0.00 0.00 0.00 0

MENT, TRANSPORT & ICT

of ICT/Computers for KATH 232,701.00 232,701.00 0.00 0.00 0.00 0.00 0.00 23
rements for NHIC 11,590,000.00 11,280,000.00 11,280,000.00
ent of Equipment 25,000,000.00 12,855,543.00 0.00 4,000,000.00 3,864,000.00 2,000,000.00 0.00 2,99
, Motor Bikes and Ambulances 30,500,000.00 4,000,000.00 0.00 4,000,000.00 0.00 0.00 0.00
l 67,322,701.00 28,368,244.00 0.00 8,000,000.00 3,864,000.00 13,280,000.00 0.00 3,22
% of 2008 Investment Budget 26.64 0.00 64.17 9.42 40.50 0.00 3

TOTAL 233,096,781.52 106,492,803.65 8,263,000.00 12,466,000.00 40,999,993.36 32,790,000.00 3,344,810.30 8,62

 Annex 2: FELLOWSHIP PLAN

Ministry of Health
2008 Fellowship Year
FOREIGN
Unit Total
Course/Programme Country Long Short Cost (£) Number Cost
1 Cert.Accident & Emerg.ency UK √ 8,000 1 8,000
2 Cert.Intensive Care UK √ 8,000 1 8,000
3 Msc Emergency Medicine UK √ 20,000 1 20,000
4 MSc Advance Trauma UK √ 20,000 1 20,000
5 MSc Control of Infectious UK √ 20,000 1 20,000
Diseases/Epidemiology
6 Msc Nutrition & Dietetics UK √ 20,000 1 20,000
7 Msc Health Financing UK √ 20,000 1 20,000
Economics & Insurance
8 MSc Health Mgt Infor.Sys. UK √ 20,000 1 20,000
9 MSc Opthalmic Nursing UK √ 20,000 1 20,000
10 MSc Com'ty Pschiatry UK √ 20,000 1 20,000
ToTal 10 176,000
REMARKS
Total cost for 2007 foreign programmes
=£176,000
Cedi equivalent =¢2,816,000,000
Local Programmes
1 MSc Clinical Pharmacy Ghana √ 1,500 3 4,500
2 MPH Health Promotion Ghana √ 1,500 6 9,000
and Education
3 MPH Reproductive Health Ghana √ 1,500 6 9,000
4 MSc Environmental Sci. Ghana √ 1,500 1 1,500

70
 5 MPH Ghana √ 4,000 10 40,000
6 MA HRM Ghana √ 2,000 2 4,000
7 MSc Health Planning and Ghana √ 1,500 4 6,000
Management
8 MBA HRM Ghana √ 4,500 3 13,500
9 EX.MA. GOV.&LEAD. Ghana √ 2,000 2 4,000
10 EX.MA.PUB.ADM.. Ghana √ 2,000 1 2,000
11 PG DIP.EDU Ghana √ 500 30 15,000
12 B.ED HLTH SCI.EDU. Ghana √ 1,000 40 40,000
13 BSc Infor.Com. Ghana √ 1,500 1 1,500
Sci.& Tech.
14 Msc Nursing Ghana √ 3,000 5 15,000
15 Mphil Nursing Ghana √ 3,000 4 12,000
16 Mphil Clinical Psychology Ghana √ 3,000 2 6,000
17 Allied Health Ghana √ 500 30 15,000
Total 150 198,000
REMARKS
Total cost for 2007 Local programmes
=£198,000
Cedi equivalent =¢3,168,,000,000
Total cost for 2007programmes for continuing students =£568,500
Cedi equivalent =¢9,016,000,000

Grand Total= ¢9,016,000,000 +¢3,168,000,000+¢2,816,000,000=(¢15,000,000,000)

71
 Annex 3: PROCUREMENT PLAN
VALUE
PROCUREMENT Gh¢ START COMPLETI PROCUREMEN
CATEGORIES (000) % FREQ. FUNDING SOURCE DATE ON DATE T METHOD
HF Gh¢ IGF GOG Budgetary Total Available Gap Gh¢
PHARMACEUTICALS (000) Gh¢(000) Gh¢(000) Support Gh¢ 000) Gh¢ (000) (000)
Drugs & Nondrug
Consumables 36,660 10.61 1 36,660.00 36,660.00 0.00 NOV. 2007 MAY,2008 ICB

EPI Vaccines 20,607 5.96 1 15,598.75 1500.00 1,900.00 18,998.75 1,608.72 NOV,2007 SEPT, 2008 UN AGENCY
EPI STATIONERY 13,149 13,149.00 NOV,2007 SEPT, 2008 SHOPPING/NCB

Contraceptives 3,986 1.15 2 500.00 1,400.00 1,900.00 2,086.00 NOV,2007 SEPT, 2008 UN AGENCY

TB drugs 450 0.13 2 450 450.00 0.00 FEB. 2008 AUG. 2008 UN AGENCY
Procurement of
Psychotropic drugs 450 0.13 2 450 450.00 0.00 NOV. 2007 MAY,2008 UN AGENCY

Printing & Publication 940 0.27 1 440.00 500 940.00 0.00 JAN. 2008 JUNE ,2008 SHOPPING/NCB

HIV/AIDS 14,838 4.29 2 10,967.74 1,200 12,167.74 2,670.26 JAN. 2008 SEPT, 2008 ICB

Malaria/ACT 8,402 2.43 1 500 500.00 7,902.00 MAR. 2008 SEPT, 2008 ICB

ITNs 5,820 1.68 3,000 3,001.68 2,818.32 JAN. 2008 SEPT, 2008 ICB
Basic health equip / Cold
Chain 1,146 0.33 1 500 500.00 646.00 NOV. 2007 AUG, 2008 UN AGENCY

Anti Snake & Rabies 2,538 0.73 1 1,500 1,500.00 1,038.00 FEB. 2008 AUG. 2008 ICB
INVESTMENT
Emergency Obstetric
Equipment 16,340 4.73 1 3,864.00 9,340.00 4,000.00 2,000 19,204.00 -2,864.00 JAN. 2008 AUG. 2008 ICB
Equipment Maintenance & CONTRACT
Reagents 5,000 1.45 1 2,500.00 2,500 5,000.00 0.00 JUNE. 2006 SEPT, 2008 SECURED

Capital projects 214,000 61.93 1 17,240.00 12,200.00 8,466 37,906.00 176,094.00 FEB. 2008 SEPT, 2008 ICB
SERVICES

Procurement Audit 60 0.02 1 - 60.00 NOV. 2007 MAY,2008 ICB

Financial Audit 150 0.04 1 - 150.00 NOV. 2007 MAY,2008 ICB

Nutrition and Malaria
Project 1,022 0.30 1 1,022.00 1,022.00 -0.50 JAN. 2008 AUG. 2008 ICB

345,557.
TOTAL 97 100.00 31,452.49 66,181.68 18,200.00 24,366.00 140,200.17 205,357.80

72
Annex 4: NATIONAL HEALTH INSURANCE ALLOCATION FORMULA

GENERAL ASSUMPTIONS FOR THE 2008 ALLOCATION

Budgetary Allocation
On the basis of MOFEP projections for 2008, the National Health Insurance Fund is
expected to realize an amount of GH¢235.42 million in the year 2008. This amount
represents an increase of 33.83% over last year’s budgetary allocation of GH¢175.91
million. The projected budgetary receipt of GH¢235.42 million is expected from the
two main sources; namely the NHIL and SSNIT contributions.

Registration Coverage
Council set a target of 55% coverage for 2007. Current (September 2007) registration
figures indicate that 55% of the population had been registered. Based on available
statistics, a registration target of 65% has been set for 2008. The allocation of the
Fund is therefore based on the assumption that 65% of the population of Ghana will
access benefits under the scheme in 2008.

Number Of Schemes
As at the end of October 2007, one hundred and forty-three (143) schemes were fully
operational. Provision has been made to cover five (5) more schemes whose
establishment began in 2007 and are expected to be operational in 2008. The
allocation of the Fund is therefore based on the assumption that one hundred and
forty-six (148) schemes will be operating in 2008.

Per Head Subsidy

An amount of ¢120,000 (GH¢12.00) was paid as subsidy per head to the exempt
group members and SSNIT contributors in the year 2007. However, given the rising
cost of medical bills which is evident from the bills submitted by service providers
and the Review of the Medicines List and Tariff Structure, it has been proposed to
increase the subsidy from GH¢12.00 to GH¢14.00 per person for 2008.

This figure looks even lower given the fact that figures received from the various
schemes as at the end of October 2007 indicate an average national per capital cost of
an encounter with a health service provider to be ¢93,000.00 (GH¢9.30GP),. It is
assumed that on average a person makes two encounters with health service providers
in a year. These two encounters per a person per year give a resulting average national
per capital cost of ¢186,000 (GH¢18.60GP)

Investment Income For 2007

It is expected that an amount of One hundred and Forty-One million, Eight hundred
and Nine Thousand, Six hundred and Twenty-Four Ghana Cedis, Fifty-Four Ghana
Pesewas (GH¢141,809,624.54) will remain in investment at the end of 2007.

The expected investment income from the above investment is estimated at

GH¢21.22 million. This will not be available for allocation as it will be retained in
the investment account to grow the Fund. As a result, the total inflow to the NHIF in
2008, is estimated to be GH¢256.64 million.

73
 DETERMINATION OF ALLOCATION OF FUNDS

Based on the above stated main objectives of the fund, the following criteria as
described by Act 650 shall be applied;

• SUBSIDIES FOR THE EXEMPT GROUPS AND SSNIT

CONTRIBUTORS

The law (Act 650) proposes subsidies to DMHIS to cover the health care cost of those
exempted by law. The exempt groups are;

a) Indigents
b) Under 18 years of age with both parents or guardians as contributors
c) Under 18 years with community approved single parents
d) Pensioners under the SSNIT Scheme
e) Aged (70 years of age and above).

Premiums of contributors to the SSNIT Pension Scheme are to be paid from the NHIF
by virtue of the payment of 2.5% of their SSNIT contribution to the NHIF.

The calculation of the subsidy below for each category of the exempt is based on
certain assumptions indicated in the explanatory notes under 7.0

SUBSIDY DISTRIBUTION TABLE FOR 2008

*Ghana’s Population as at 2000 was about 20m

Category Estimated % of Estimated Amount Total Remarks
Total Population Registered per Amount
Number Number for Person GH¢
2008 GH ¢
Indigent 940,000 4.70 799,000 14.00 11.19m 10% on 20m population less the Aged and
children population {i.e. 10% of 20m-(0.6m-
10m) =0.94m. An amount of GH¢11.19m has
been allocated to meet the premium of 85%
of the aged estimated to be registered for
2008
Under 18 10,000,000 50.00 7,500,000 14.00 105.00m Children Under 18 years of age are estimated
years to constitute about 50% of the country’s
population. 75% of this population is
estimated to be registered for 2008. An
amount of GH¢105.00m is allocated to meet
their contributions to HISs.
SSNIT 70,000 0.35 63,000 14.00 0.88m 90% of the 70,000 estimated SSNIT
Pensioners Pensioners are estimated to be registered for
2008. A total amount of GH¢0.88m has been
allocated for their premium.
Aged (70 600,000 3.00 510,000 14.00 7.14m Based on the estimated 3% of the aged
years & population, a total amount of GH¢7.14 has
above) been allocated to meet the premium of 85%
of the aged estimated to be registered for
2008
SSNIT 800,000 4.00 680,000 14.00 9.52m. An amount of GH¢9.5.2m has been allocated
Contributors to meet the premium of 85% of SSNIT
contributors expected to be registered.
Total 12,410,000 9,552,000 GH¢14 133.73m

74
 OTHER MANDATORY AND ADMINISTRATIVE COMMITMENTS OF THE
NATIONAL HEALTH INSURANCE COUNCIL

Disbursement will be made in 2008 for the following other mandatory and
administrative expenditures;
a) Council Secretariat Operations
b) Support to Service Providers
c) Health Service Investment
d) Support to Financially Distressed Schemes (Reinsurance)
e) Administrative and Logistical Support to the Schemes
f) Headquarters Building
g) MIS & ICT Solution
h) Investment

OTHER MANDATORY AND ADMINISTRATIVE COMMITMENTS OF 2008

ALLOCATION TABLE

ITEM AMOUNT % 0F REMARKS

FUND
Council Secretariat 10.49 million 4.46 2008 Budget
Operations
Support to Service 10.05 million 4.27 i. To enable Service Providers respond to health insurance
Providers and MOH requirements, a provision is made as seed loan of GH¢30,000
Programs for drug stock for each district hospital payable in 6 months.
GH¢4.05
ii. Support for M O H health preventive programs GH¢6.00m
Health Service 36.32 million 15.43 Investment to be made in:
Investment
i. Training of Health Assistants GH¢23.50m
ii. KATH’s rehabilitation GH¢12.84m

Support to Financially 5.00 million 2.12 Average support of GH¢100,000 each for estimated 50
Distressed Schemes Schemes.
(Reinsurance)
Administrative and 21.81 million 9.26 i. To provide for Motor bikes, bicycles and
Logistical Support to Outboard motors. GH¢310,000
the Schemes ii. To provide Administrative Support of an average
of GH¢70,348.80 to each scheme. (GH¢10.42m)
iii. To settle outstanding bills-Stationery and software cost
(Contingent Liability) GH¢3.00m
iv. Provision to cover allowance/cost for 700 service
personnel for the schemes: GH¢432,000
v. Pre-Financing of New I D cards GH¢5.00m
vi. To undertake capacity building of the schemes.
(GH¢1m)
Vii. To undertake adverts/publicity of schemes(GH¢1.66m)
Headquarters Building 3 million 1.27 For the construction of Headquarters building
MIS & ICT Solution 11.28 million 4.79 An amount of $24m (GH¢22.56m) is needed for the
installation of Integrated MIS Solution, IT Infrastructure,
PABX etc. (these are all nationwide in character) The amount
of GH¢11.28m provided represents the other 50% of the
installation cost which is expected to be paid in 2008.
Investment 3.73 million Investments for 2008

Total 101.68 million

75
 SUMMARY OF PROPOSED ALLOCATION OF FUNDS FOR 2008

Proposed Allocation of Funds To Various Activities

ACTIVITY ALLOCATION
GH ¢ (%)
Subsidy for Exempt Groups
133.73 million 56.80
Council’s Operations
10.49 million 4.46

Service Providers Support 10.05 million 4.27

Health Service Investment 36.34 million 15.44

Support to Financially Distressed Schemes
(Reinsurance) 5.00 million 2.12
Administration/Logistics
21.82 million 9.27

Headquarters Building 3.00 million 1.27

MIS & ICT Solution 11.28 million 4.79

Investment 3.71 million 1.57

Total 235.43 million 100

COMPARATIVE YEARS FUNDS ALLOCATION ANALYSIS

2008 2007
ACTIVITY ALLOCATION ALLOCATION VARIANCE
GH ¢ (%) 2007 GH¢ (%) GH¢
Subsidy for Exempt Groups
133.73 million 56.80 90.02 million 51.27 43.71m
Council’s Operations
10.49 million 4.46 7.90 million 2.59m

Service Providers Support 10.05 million 4.27 10.05 million 0

Health Service Investment 36.34 million 15.44 29.33 million 7.01m

Support to Financially Distressed
Schemes (Reinsurance) 5.00 million 2.12 5.00 million 0
Administration/Logistics
21.81 million 9.26 17.67 million 4.14m

Headquarters Building 3.00 million 1.27 2.00 million 1.00m

MIS & ICT Solution 11.28 million 4.79 11.28 million 0

Investment 3.71 million 1.57 2.65 million 1.06m

100
Total 235.43 million 175.91 million 59.51m

76
 Subsidy’s variables:

a) Indigent
b) Under 18 years
c) SSNIT Pensioners
d) Aged
e) SSNIT Contributors

Allocation Formula

Allocation = (a + b + c + d + e) x GH¢14+Admin Cost

PROPOSED ALLOCATION OF FUNDS TO VARIOUS EXPENDITURE ITEMS

Expenditure Council Reserve Secretariat DMHIS Service Total

Item Secretariat & Fund Building Providers
Zonal Offices GH¢ GH¢ GH¢ GH¢ GH¢
Personal 2.17m - - 5.41m - 7.54m
Emolument
Administration 4.09m - - 8.83m - 12.92m
Exp.
Service 1.68m - - 120.48m 23.55m 145.71m
Capital Expenditure 2.29m - 3.00m 11.59m 12.84m 29.72m
Total 10.19m - 3.00m 146.31m 36.39m 195.89m
% of Total 4.60% - 1.53% 73.27% 18.58% 100%
Budgetary
Amount

EXPLANATORY NOTES

SUBSIDY

• Indigents
Indigents as described by law are people who are very poor. The Ghana Living
Standard Survey puts the poverty rate in Ghana at 40%. It must be stated that most of
those considered very poor can not afford the annual highly subsidized premium of
¢72,000.00. Without relevant statistical data certain assumptions were made in
arriving at a proportion of the population who would be considered indigents. Ghana’s
population as at 2000 was about 20 million. To estimate the indigent population, there
is the need to avoid double counting, considering the fact that certain population
groups are already covered under the DMHISs. Consequently, 600,000 people
constituting the aged population (i.e. 3% of 20 million) and another 10,000,000
representing the population of those less than 18 years (i.e. 50% of 20 million) are
subtracted from the total population. The remaining population will be 9.4 million
(viz 20 million less 10.6 million).

It is assumed that 10% of the net population of 9.4 million would constitute the
indigent population and hence the indigent population estimated to be 940,000. 85%
of indigents (i.e.799,000 indigents) are estimated to be covered under the scheme in
2008. An amount of GH¢12.00 is allocated as premium for each indigent and hence, a

77
total amount of GH¢11.19 million (i.e. GH¢14.00 x 799,000) will be required as
subsidy to DMHISs for the indigents in 2008.

• Children under 18 years

The law prescribes that those under 18 years be catered for by government. The 2000
population Census estimated the population strength of this category to be 10 million.
It is estimated that 60% of this number will be covered under the scheme in 2008. A
provision of GH¢101.69 million (i.e. ¢14.00 x 7,500,000) has been made to cover
the premium of the 7,500,000 under 18 years estimated to be covered under the
scheme in 2008.

• SSNIT Pensioners
From data available at SSNIT the number of SSNIT pensioners is estimated to be
70,000. It is estimated that 90% of this number (i.e.63, 000) will be covered under the
scheme in 2008. An amount of GH¢0.88 million (i.e. GH¢14.00 x 63,000) is allocated
to cover the premium of the 63,000 SSNIT pensioners expected to be covered under
the scheme in 2008.

• The Aged
Those considered to be the aged population are those of 70 years and above. The 2000
population Census estimated that the aged population is 3% of the total population of
the country (i.e. 600,000). Considering the fact that the aged suffer a number of
chronic diseases such as hypertension, diabetes, cancers, heart diseases etc, and the
fact that they are economically vulnerable makes them a very important population
group to be considered in the development of the health insurance formula. It is
expected that 85% of the aged (i.e. 510,000) will be covered under the scheme in
2008. An estimated amount of GH¢7.14 million (i.e. GH¢14.00 x 510,000) is
allocated for the premium of the 510,000 aged expected to be covered under the
scheme in 2008.

• SSNIT Contributors
From data available at SSNIT, the total number of SSNIT contributors is estimated at
800,000 for 2008. SSNIT contributors are automatically covered under the law
because of their 2.5% monthly contribution to the NHIF. It is estimated that 680,000
SSNIT contributors representing 85% of the total number of SSNIT contributors will
be covered under the scheme in 2008. An amount of GH¢9.52 million (i.e. 680,000 x
GH¢14.00) is therefore allocated to cover their premium to the DMHIS in 2008.

COUNCIL HEADQUARTERS & REGIONAL/ ZONAL OFFICES OPERATIONS

The Council has directed that expenditure on its Secretariat should not exceed 5% (in
line with international best practices) of total revenue to the Council. A total of
GH¢10.49 million has been earmarked for the activities of the Secretariat of the
NHIC (Including the 10 number Regional/Zonal Offices. Expenditure on the
Council’s operations covers both recurrent and capital cost. The Council’s budget
represents about 4.49% of total expected receipts for the year 2008.

SUPPORT TO SERVICE PROVIDERS

The Act enjoins Council to facilitate access of the population to basic health services.
To enable health care providers deliver quality care and to improve access to health

78
services, GH¢10.05 million has been allocated for this purpose. The amount is
expected to be given as seed loan to district hospitals for drug stock and will be
payable over a 6 month period.

i. Each hospital will be granted a loan of GH¢30,000.00

ii. Support for Preventive Programs GH¢6.00m

HEALTH SERVICE INVESTMENT

As support to the Ministry of Health to expand health services in the country an
amount of GH¢36.34 million is provided for health service investment. The
investment to be made in:

i. Training of Health Assistants GH¢23.50m.

ii. KATH’s rehabilitation GH¢12.84m.

REINSURANCE ALLOCATION
For DMHIS that are financially distressed Act 650 mandates the Council to provide
them with the necessary assistance to enable them adjust their economic position to
make them viable and sustainable provided they operate under sound management
and financial practices. It is estimated that 50 Schemes will be financially distressed
in 2008. It is estimated that schemes that will be distressed will need an average
amount of ¢1 billion each to enable them adjust their financial situation. A total
amount of GH¢5.00 million (50 x GH¢100,000.00) has therefore been set aside to
enable the Council fulfill this mandate. It is recognized that all 148 DMHIS have a
possibility of being financially distress; however, a worse case scenario of 50
distressed cases in the year is used.

ADMINISTRATIVE AND LOGISTICS SUPPORT FOR SCHEMES

To ensure an effective administration of the schemes, the schemes need to be assisted
to build their administrative and logistical capacity on continuous basis to meet
expanding responsibilities.
A total amount of GH¢21.81 million will be required by Council to provide
administrative and logistical support to the Schemes. The following are expected to be
covered under this budget:

i. Provision of motor bikes, bicycles and Outboard motors: GH¢0.310m.

ii. Provision of an average administrative support of GH¢70,348.80 to each scheme:
GH¢10.41m (GH¢70,348.80 x 148)
The GH¢70,348.80 per scheme is expected to cover the following:

• salaries of staff - GH¢40,348.80 ; and

• general administrative expenses - GH¢30,000.00
iii. Provision to cover allowance/cost for 700 service personnel for the schemes:
GH¢0.432m.
vi. To settle outstanding bills-Stationery and software cost (Contingent Liability)
GH¢3.00m
v. Pre-Financing of New I D cards GH¢5.00m
vi. Capacity building of the schemes through training: GH¢1m.
vii. Adverts/publicity of schemes: GH¢1.66m

79
HEADQUARTERS BUILDING
The National Health Insurance Council Secretariat which is housed in a refurbished
bungalow is not large enough to accommodate further staff and thus putting
constraints on the employment staff. Most of the key positions as well as other
supporting staff positions at the Secretariat are yet to be filled and therefore the need
for adequate office space.

There is space for the expansion of the Headquarters building. A budget of GH¢3.00
million is allocated for the project in 2008.

Council wishes to undertake the expansion with dispatch; however some

administrative procedures must be followed, especially to comply with the provisions
of the Public Procurement Act, 2003. The project is expected to start at the beginning
of 2008.

MIS & ICT SOLUTION

ICT solutions are required to facilitate the day to day operations of the Headquarters
and the Schemes. The business activities will be performed to ensure that:

ƒ There is effective communication between the Schemes, the Headquarters

and Service Providers for data collection and analysis, which is critical for
meeting the objectives of the Council;
ƒ Managing risk, controlling fraud and ensuring financial sustainability; and
ƒ Addressing the portability requirement.

A total amount of $24m (GH¢22.56 million) is needed for the installation of

Integrated MIS Solution, IT Infrastructure, PABX (VOIP Solution) etc. (these are all
nationwide in character). An amount of GH¢11.28 million represents the other 50%
of the total installation cost is expected to be paid in 2008 and has therefore been
provided for this year.

80