2013 HEALTH SUMMIT PRESENTATION AT BUSINESS MEETING BY KOBINA ATTA - PowerPoint PPT Presentation

2013 HEALTH SUMMIT PRESENTATION AT BUSINESS MEETING BY KOBINA ATTA BAINSON (LEAD FACILITATOR) 2 MAY, 2012

OUTLINE  Holistic assessment of sector  Costing of health services  National Health Accounts  Evaluation of Free Maternal Care  Review of Capitation in Ashanti Region  Review of CHPS policy  Highlights of Speeches  Conclusion 2

HOLISTIC ASSESSMENT SECTOR SCORE • Outcome is POSITI TIVE with a Sector Score of +3 • Interpreted as a highly performing sector He alth Obje c tive Sc or e 2011 Sc or e 2012 HO 1 +1 0 HO 2 +1 0 HO 3 0 +1 HO 4 +1 +1 HO 5 -1 +1 Se c tor Sc or e +2 +3

PROGRESS AND CHALLENGES 1.OPD/capita: 1.17 (double 2006 figure) 2.Supervised delivery:  national coverage was 58.2%:  low coverage in Northern and Volta regions 3.EPI coverage: since 2007 coverage has steadily been close to 90% 4

HEALTH INSURANCE  Slight increase in active members to 34% 60.0% -2% 50.0% -26% 40.0% 2010 30.0% 2011 2012 20.0% 10.0% 0.0% AR WR NR BAR CR VR UE R UWR E R GAR T o ta l

g g g HE HEAL ALTH O TH OBJECTIVE 1 1 CONT NT. eve ment ement ment % non-wage GOG recurrent budget allocated to district level and 46.8 below 50% % 50.0% 55.3% 50.0% 38.5% Per capita expenditure on 50.7US health 26 US$ 28.6 28.0 35.0 30.0 D % population living within 8 km of health infrastructure N/A - N/A - N/A N/A

HEAL HE ALTH O TH OBJECTIVES Indicator 2010 2010 2011 2011 2012 2012 Target Achiev Target Achie Target Achie ement vemen vemen t t % of hospitals assessed for quality assurance and control - 80.0% N/A 90.0% - 70%

COST OF HEALTH SERVICES  Used existing data, when possible  Supplemented with facility-level survey  Compiled detailed information about each facility 8

AVAILABILITY OF ANTI-MALARIAL DRUGS RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy 9

CAPACITY TO TEST AND TREAT RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy 10

STORING VACCINES RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy 11

NATIONAL HEALTH ACCOUNT  National Health Accounts (NHA) is an internationally recognized framework that mea easu sures es and and trac tracks ks total tal he heal alth c care are exp xpend ndit iture ures in a country, thereby providing a systematic and comprehensive method for monit monitoring re oring resour urce fl flows ws in a country’s health system.  Current study compared expenditures in 2005 and 2010, 12

TOTAL HEALTH EXPENDITURE BREAKDOWN BY FINANCING SOURCE, 2005 AND 2010

Allocation of Health Funds from Financing Sources to Functions, 2010 120 100 5.47% 11.85% 21.23% 80 Percentage of THE 56.31% 32.73% 76.61% 60 80.61% 72.22% 85.28% 100% 88.15% 0.84% 40 15.20% 36.03% 20 5.16% 0.18% 30.83% 13.55% 3.92% 22.31% 16.96% 10.80% 3.71% 6.78% 2.13% 1.08% 0 0.04% Ancilliary services Health Health and Health- Health-related Medical goods Prevention and Services of Services of to medical care administration related functions dispensed to public health curative care rehabilitative care and health Expenditure outpatients services insurance Function International Funds Private Funds-Employer Private Funds- HH Public Funds- GoG Public Funds- NHIF

RECOMMENDATIONS  Institutionalize the NHA  Build technical capacity locally for resource tracking  Need for data disaggregation in the public sector to inform NHA and provide better analysis of the result 15

EVALUATION OF FREE MATERNAL CARE  Increase in number of facility-based deliveries by two thirds between 2007 (300,000) and 2011 (500,000); removed financial barrier  Decreasing trend in the institutional maternal mortality ratio (GHS data/100,000 live births (230 in 2007 to 170 in 2011)  Quality of care issues; inadequate human resources, equipment and infrastructure 16

2009 2009 2010 2011 2012 20 12 40% 40% 30% 30% AR AR WR 20% 20% NR NR BAR BAR CR CR 10% 10 VR VR UER 0% 0% UWR ER ER -10 10% GAR AR -20% 20% -30% 30% Percentage c chang anges in in mid midwife po popul pulat ation sinc since 2 2009

EVALUATION OF FREE MATERNAL SERVICES  Sustainability: linked to NHIS  Availability of blood products and ambulance 18

REVIEW OF CAPITATION PROJECT IN ASHANTI REGION – ANNUAL MEMBERSHIP 2 2 Ashant anti in ers in Eastern rn 1.8 1.8 e member 1.6 1.6 1.4 1.4 ive m 1.2 1.2 lions 1.19 1 1 activ 0.83 milli 0.65 0.98 of ac 0.8 0.8 0.79 0.6 0.6 0.58 er o 0.50 number 0.4 0.4 0.33 0.56 0.50 0.49 num 0.2 0.36 0.2 0.31 0.29 0.23 0.20 0 0 2009 2010 2011 2012 2009 2010 2011 2012 REGISTRED RENEWAL REGISTRED RENEWAL • In 2012, both renewal and registration as shrunk in Ashanti region

EFFECT AND RECOMMENDATIONS  Effect: Reduction of outpatient attendance in health centres and CHPS zones in districts with hospital.  Recomm mmend ndati tions ons: 1.Take gradual approach: enroll clients into preferred primary provider (PPP) first  2.Maintain focused and persistent communication  3. Build goodwill across political divide, media and identifiable interest groups 20

REVIEW OF CHPS POLICY • CHPS zones have increased but less functional. The national context has changed. • What are the implications of the NHIS on CHPS? • What are implications of decentralization on CHPS? • How do we retain CHOs and volunteers? • How do we improve managerial accountability? 21

RECOMMENDATIONS  Reorient managers and providers on the concept  Strengthen supervision  Improve community participation and ownership  Have a broader dialogue to discuss the future of CHPS in the light of the changing context 22

HIGHLIGHTS OF SPEECHES  To optimize the use of IT we need to identify strategic use of IT e.g. for health alerts  To achieve health objectives the Ministry ought to work with other ministries to establish an inter-ministerial committee  To reduce incidence of fake medicines we need to strengthen local manufacture  Need to consider intangible elements of health care e.g. customer care and staff attitudes 23

INDEPENDENT REVIEW TEAM 31/03/2011 HIGHLIGHTS OF SPEECHES  Need to address the urban menace by supporting the implementation of the recently developed urban policy  Explore new financing opportunities in health through public-private partnerships 24

CONCLUSION  According to holistic assessment sector has performed better but significant inequities remain  As Ghana transitions from low to high middle- income status external inflows will reduce  Ballooning wage bill threatens investments in services, infrastructure and equipment  Need to develop innovative ways to raise additional revenue e.g. Private sector  Greater efforts to reduce inequalities and improve efficiency. 25