In 2020, the government through the former Finance Minister, Ken Ofori-Atta announced a couple of health initiatives to improve healthcare service delivery during the presentation of the Budget Statement and Economic Policy in November the previous year.
The 287-paged policy statement was themed “Consolidating the Gains for Growth, Jobs and Prosperity for all”.
It, however, spoke very little about plans for the health sector.
A sectoral analysis of the budget showed healthcare not accounting for more than a substantial portion of the total presentation.
The New Patriotic Party (NPP) at the time promised to increase access to health care through the construction of new health facilities nationwide and the intended roll-out of drone technology for delivering essential medical products to hard-to-reach areas.
“Ghana has joined Rwanda in using drones to deliver critical medical products, blood products, medical cargo, emergency vaccines, life-saving and essential medicines on demand to every part of the country, regardless of road infrastructure. No hospital or clinic is too remote in the delivery of health services. In 2020, the Drone project will be rolled out nationwide to ensure that essential services such as blood and medical products’ delivery are extended to deprived areas of the country”, portions of the budget read.
On health infrastructure, the Regional Hospital in Kumasi, Bekwai District Hospital, Upper East (Bolgatanga) Regional Hospital, Greater Accra Regional Hospital, Ridge (Phase II) and four district Hospitals with Staff Housing at Twifo-Praso, Konongo-Odumasi, Tepa and Nsawkaw were said to be completed in 2020.
Several others were said to have their construction continued with the construction of University of Ghana Teaching Hospital (Phase II), Maternity Block at Korle-Bu Teaching Hospital, Reconstruction of Tema Regional Hospital and the Central Medical Store among others all said to commence in the same year.
The budget for the Health Ministry increased by 12% from GHS 6,038 million in 2019 to GHS 6,749 million in 2020.
Development Partners’ (“DPs”) budgetary support to the Ministry was however expected to decrease significantly from GHS796 million in 2019 to a projected GHS413 million in 2020, representing a decrease of 48%.
“Supplementary Budget”
In July 2020, Ken Ofori-Atta was in Parliament once again to present the 2020 mid-year budget review to the House.
This time around, the health sector featured strongly obviously because it had been some months following the outbreak of the Coronavirus and its attendant huge expenditure.
Government data suggested that, with the onset of the pandemic, it has recorded a revenue shortfall of GHS 13.4 billion (3.5% of GDP).
Expenditure on the other hand had seen an increase of GHS11.8 billion (3.1% of GDP) translating into a deficit increase of GHS 25.3 billion (6.6% of GDP).
The resultant fiscal deficit for 2020 was, thus, revised from 4.7% of GDP to 11.4% of GDP to reflect the impact of the pandemic.
Despite these, the government said it was committed to the expansion and construction of health facilities to enhance access to healthcare with emergency preparedness and Response Plan II to improve the testing and three case management capacity of the health system.
“Agenda 111”
It, therefore, outdoored “Agenda 111” with the aim to design, build, equip and staff new hospitals in every district without one, and a new regional hospital in every region with none.
The project which is yet to see some groundwork was to see to the construction of a 100-bed hospital in 88 districts that currently lack such facilities as well as regional hospitals in each of the six new regions.
Moreso, the Effia-Nkwanta Regional Hospital in the Western Region was to be rehabilitated, plus two new psychiatric hospitals as well as infectious disease centres for each of the three ecological zones.
Health Minister, Kwaku Agyeman-Manu disclosed during his vetting that about 13 districts are yet to offer government lands for the construction of district hospitals across the country.
This, he said had largely contributed to delays in the construction of these hospitals.
In his recent State of the Nation Address, President Nana Addo Dankwa Akufo-Addo reiterated his resolve to see to the realization of these projects almost a year after the announcement.
“As announced last year, Agenda 111, which will see to the construction of 100-bed District Hospitals in 101 districts with no hospitals, seven Regional Hospitals for the new Regions, including one for the Western Region, the construction of two new psychiatric hospitals for the Middle Belt and Northern Belt, respectively, and the rehabilitation of Effia-Nkwanta Hospital in the Western Region, is on course. Construction of some of these hospitals has commenced, and will continue without interruption,” he assured.
President Akufo-Addo continued saying: “Agenda 111, the largest ever investment in healthcare infrastructure in our history, is part of a massive vision for Ghana’s healthcare sector, the realization of which will lead to Ghana becoming a Centre of Medical Excellence and a destination for medical tourism”.
“More health interventions”
- National Emergency Preparedness and Response Plan (EPRP): A Ghana Health Service GHS 560 million plan put together to manage and control the spread of the virus and strengthen the national capacity for surveillance, diagnosis, and case management.
- Enhancement of Testing Facilities: The capacity of scientific research and testing teams at the three main national testing facilities were expanded to 10 sites, towards the decentralization of testing arrangements in the country
- Boosting Human Resource Capacity: Financial clearance granted for the employment of 24,285 additional health professional between March and June 2020 to increase staff strength in the health sector. 400 case management teams also trained to collect samples across the country.
- Infrastructure improvements: The government said it refurbished 10 treatment centres in districts close to formal entry points.
- The Church of Health Sector Related Measures: Pentecost, Catholic Church and the Ghana Football Association provided facilities with a combined bed capacity of 1950 to serve as isolation canters
- Provision of relevant logistics: The government provided 3,600,000 reusable face masks, 50,000 medical scrubs, 90,000 hospital gowns, and 90,000 headcovers to the health facilities between April and June 2020. Screening cubicles provided at formal entry points, including Kotoka International Airport. Vehicles have provided for monitoring and supervision.
- Incentives for Health Workers: The government spent GHS 320 million in providing income tax waiver for 137,000 health workers, allowance of 50% of basic salary to 10,000 frontline workers as well as free transportation during the lockdown.
The restoration of training allowances for student nurses was a major policy decision of the government.
From 2017 to the end-December 2019, a total amount of GHS 467,840,800 was paid to an average nursing student population of 50,825 per academic year.
As of end-June 2020, an amount of GHS 57,800,000 was released for payment to 48,200 nursing students.
What analysts make of efforts
Health Economist and Senior Lecturer at the University of Ghana Business School, Dr. Gordon Abeka Nkrumah is of the view that the government ought to be commended for the bold steps it took in managing the pandemic at the very early stages.
He was however concerned about the second wave of the pandemic which he attributed to the laxity in the build-up to the general elections.
“I think that when they read the mid-year budget, the context then and now are different. I will imagine that the government will be trying to bring the rise of the COVID-19 infections down for economic activities to pick up. So health workers were assured of their safety and welfare. The government did quite well by expanding our testing centres. We were doing well until we lost guard with political activities bringing about the second wave”, he said.
“Agenda 111” not a solution
For Dr. Nkrumah, the government’s Agenda 111 project appears to be a misplaced priority to the outbreak.
He wants resources earmarked for the move deployed in a rather much more efficient manner.
“Our biggest issue should be financing for service delivery. How we deploy resources to ensure that the NHIS works efficiently and how we bring preventive care into our standard system of care which has been curative in NCD prevention. Those are areas we need to begin focusing our attention but the biggest challenge to the NHIS is Sustainable Financing.”
“So if we have any money that is where we need to spend it. But if you say you want to build new hospitals, who are going to man it? Are they done with matching the new hospitals to the old ones? That is not what we need. We don’t need hospitals to deal with COVID-19 but if you have stronger primary healthcare and better communication, you would be able to change behaviour and reduce infections,” he added.
Nana Kofi Quakyi, Public Health Advocate and Research Fellow, Health Policy & Management at the New York University’s School of Public Health also shares a similar opinion.
“We have to look at pragmatic realities here. These projects are not going to come in the next year or two. If we say that is COVID-19 health care spending, then we are missing the point. We need to make sure we are spending the money on immediate priority. Ghana is operating with the reality of limited resources so allocating them must be made to where they are most beneficial especially in the short term to make sure we are maximizing the impact there. We have to be practical and prioritize,” he advised.
2021 expectation by health players
But ahead of the budget presentation today Friday, March 12, 2021, by the Parliamentary Affairs Minister, Osei Kyei-Mensah-Bonsu [Caretaker Finance Minister], players in the health sector are anticipating a few measures to be high on the agenda going forward.
Vaccination Programme
Dr. Nkrumah expects for instance that efforts must be made to reduce new infections and hospitalizations to ensure the speedy resumption of economic activities.
With an expectation of a return to normalcy by the first or second quarter of 2022 when about 70 percent of the population have received the COVID-19 jab, he is proposing huge government investment in the ongoing nationwide Coronavirus vaccination program.
“I am expecting that a lot more money is pumped into the vaccination program. We shouldn’t just be buying the vaccines, but we should also make sure that our deployment is good enough. Even as we invest in vaccines, we need to make sure that we develop smart methods to get the vaccines into people’s arms. If we are able to do this quickly, it will get businesses on full scale and employment will resume. Budget is not only an item indicator. An item indicated without money allocated is basically nothing. I expect enough money allocated in the budget for the vaccination programme.”
Sharing his thoughts on the same subject matter, Nana Kofi Quakyi intimated that, the government must come clear on the total amount of money being used for the vaccination exercise and its accompanying activities.
“We want to hear more of what the government is budgeting for this vaccination drive. We need to get the amount we are spending. Initially, they said GHS 58 million for vaccinating the 20 million target but that calculation was based on the average vaccination. But we need more communication, education and sensitization and public engagement. We need to spend more money on operational research, monitoring side effects. What are the allocations we are doing there?” he noted.
Health Research
The Public Health analyst believes the presentation will be incomplete if it does not hammer on the government’s plans to increase funding to Ghana’s research institutions as the pandemic rages on arguing that stifling such entities of money will be inimical to the country’s fight against the virus.
“There are obvious areas where we have to scale up our investments and focus. The lack of data and speed in response will be problematic. For example, we want to see a lot of investments in the work that WACCBIP is doing. So what are we doing in terms of budgeting in that public health research that informs our policies for the long term in other health conditions and expenditures?” Nana Kofi Quakyi advocated.
Frontline workers incentives
For him, he urged more budgetary allocation for the continuous tax reliefs and other allowances for frontline health workers.
“We want to hear more about the healthcare worker incentive. They have been on the frontline for more than a year now. Not all health workers have received tax incentives. What is being done to make sure that they receive the money? It is important that appropriate and timely incentives are given to them.”
The 2021 budget is expected to cover areas of national development including, security, economy, agriculture, environment, education and particularly health due to the COVID-19 pandemic and the roll-out of the country’s vaccination exercise.