ECON 215 Introduction to Economy of Ghana Session 13 – Health Sector Lecturer: Dr. Michael Danquah Contact Information: mdanquah.ug@gmail.com

Session Overview Session Overview: A healthy people makes a wealthy nation. This session considers the role of health in development, delves into the health sector of Ghana and discusses the policy interventions in Ghana’s health sector.  Goals/ Objectives: At the end of the session, the student will Be able to appreciate the benefits of health Be able to analyse the trends in Ghana’s health sector Be able to examine the policy intervention with Ghana’s health sector.

Session Outline The key topics to be covered in the session are as follows: Topic One: Health and Economic Development Topic Two: Ghana’s Health Sector Topic Three: Policy Interventions

Reading List Refer students to relevant text/chapter or reading materials you will make available on Sakai

Health and economic development Topic One Health and economic development

Benefits of Health Improved productivity: Better health can make workers more productive, either through fewer days off or through increased output while working. Improved health of family members will have a similar impact through reducing time lost to caring for dependants. Improved learning: Improved nutrition and reduced disease, particularly in early childhood, leads to improved cognitive development, enhancing the ability to learn. Healthy children will also gain more from school, having fewer days absent due to ill health. Enhanced learning through either of these mechanisms will add to human capital – an important determinant of economic growth. Reduced Family Size: Investments in sexual and reproductive health can lead to reduced poverty by reducing the size of families. At a societal level, similar investments may lead to demographic changes conducive to economic development. In particular, they may lead to a period in which countries have a high ratio of workers to dependents leading to increased national savings. Economic theory suggests that increased savings ought to enhance growth by providing funding for investment. On the other hand, in the medium term, population growth due to reduced infant mortality could reduce GDP per capita if population growth outpaces growth of available resources and capital.

Benefits of Health Cont’d Health and Investment: Healthier individuals will often have the ability and incentive to save more, and, this accumulation of capital may help fuel growth through investment. Similarly, companies may be more likely to invest when workforces are healthier or better educated. Improved disease environments may also support the development of sectors such as tourism. Increased availability of land for productive use: Eliminating particular illnesses may allow cultivation or other use to be made of previously unused land. Reduced Treatment Burden: Initiatives that prevent certain illnesses or provide for their early treatment can help avoid the major downstream costs associated with illness and subsequent complications. Because of this, such initiatives can reduce health care burdens on families and governments, freeing capital for investment in productive activities (freeing funding for governments to invest in infrastructure, for example, or for families to invest in education).

Some Characteristics of the Health System of Developing Countries Most developing countries have fewer health facilities compared to the developed countries and these facilities are often in very poor state. There are high patient-doctor and high patient-nurse ratios in developing countries compared to developed countries as a result of inadequacy of health personnel. Per capita public expenditures on health care are much small in developing than in developed countries Life expectancy is lower in developing countries relative to developed ones.

Some Characteristics of the Health System of Developing Countries Cont’d Private health facilities are few and mainly located in urban areas and are generally afforded by the wealthy There are also a number of indigenous (traditional) medical practitioners (particularly, herbalists) of various kinds in developing countries. Usually, a lot of people avail themselves to both modern and indigenous services. Health services are unevenly distributed among the population in developing countries resulting in the problem of unequal access to health facilities. There is often a lot of congestion at health facilities especially the public ones.

Topic Two Ghana’s health sector

Ghana’s Doctor Density Ghana’s doctor density ( the number of doctors per population of 1,000 people) is far from ideal, and worse than even the SSA average density- the doctor density of developing SSA is approximately 0.203, higher than Ghana’s by a factor of 2.1g based on comparable data from the world Bank (World Bank, 2014). The gap is even wider (by a factor of 7.9 and 18.8 respectively) when comparing Ghana’s situation with the average lower middle income country counterpart or the average upper middle income country model. In 2014, the doctor density situation worsened when compared with the 2013 density of 0.090 in 2014 compared with 0.103 in 2013. This is worrying and requires more aggressive policies. In doing so, widespread spatial doctor density inequalities ( table 7.5) must not be overlooked. For example, in 2014, doctor density in the upper west region was approximately eighteen-fold worse than that in the greater Accra region. Such disparities must be addressed at even more disaggregated levels, say at the district level.

Doctor Density (per 1,000 people), by Region 2010 2011 2012 2013 % change (2012-2013) 2014* % change (2013-2014 Western 0.032 0.038 0.036 -6.63 0.033 14.88 Central 0.055 0.049 0.04 0.046 -3.71 0.071 -53.85 Greater Accra 0.244 0.269 0.284 0.309 -8.83 0.294 4.65 Volta 0.031 0.042 0.040 0.048 -19.9 0.035 27.8 Eastern 0.063 0.062 0.501 0.057 -12.3 20.0 Ashanti 0.139 0.130 0.103 0.108 -4.69 0.072 33.33 Brong Ahafo 0.044 0.064 0.060 5.93 0.061 -2.13 Northern 0.052 7.36 0.029 40.00 Upper East 0.026 0.025 0.037 -44.9 11.1 Upper West o.o26 -4.68 0.016 36.36 National 0.096 0.100 -7.21 0.090 12.53

Maternal Mortality Rate At the institutional level the maternal mortality rate (MMR) decreased from 154 deaths per 100,000 live births in 2014 to 142 in 2014, a decline of approximately 8%. It must be noted , however, that institutional rates represent less than one half of the total. For example, according to WHO(2015), estimated MMR was 380 per 100,000 live births in 2013, but the Ghana Health Service reported institutional MMR of 1154, representing about 40% of the total. Although Ghana’s total MMR is much lower than the SSA average of 510 it lags behind the lower middle income Country (LMC) average of 240 and the UMC average of only 57, perhaps representing mainly an infrastructure (both hard and soft) deficiency not akin to LMC status.

Other Health Statistics Antenatal care coverage, supervised deliveries, and the proportion of pregnant women receiving at least two doses of tetanus-toxoid vaccine deteriorated in 2014 compared with 2013 by about 4,17 and 10 percentage points, respectively. All three indicators also missed their targets. Postnatal care coverage and the family planning acceptor rates, however, improved during the year under review

Status of Selected Health Indicators 2010 2011 2012 2013 2014 Target Institutional MMR (per 100,000 live Births) 166 195 152 154 142 100 ANC Coverage 93.30% 91.30% 93.80% 90.80% 86.70% 100% % Supervised Delivery (including Trained Traditional Birth Attendant-TBA 55.20% 58.60% 58.02% 83.40% 66.70% 90% PNC Coverage 59.60% 65.30% 85.00% 85.60% 100.3% 70% FP Acceptor Rate 34.70% 28.10% 25.20% 24.70% 29.10% 38% TT2+ vaccination coverage 77.50% 67.00% 76.90% 71.50% 61.40%

Topic Three Policy interventions

Ensure the reduction of new HIV and AIDS/STIs infections, especially among the vulnerable groups The strategies to be implemented over the medium-term to reduce new HIV/AIDS and STI infections, especially among the vulnerable groups include: expand and intensify HIV Counselling and Testing (HTC) programmes; intensify education to reduce stigmatisation; intensify behavioural change strategies especially for high risk groups for HIV & AIDS and TB; promote the adoption of safer sexual practices in the general population; and promote healthy behaviours and the adoption of safer sexual practices among PLHIV, MARPs and other vulnerable groups.

Ensure the reduction of new HIV and AIDS/STIs infections, especially among the vulnerable groups Cont’d Others are: develop and implement prevention programmes targeted at the high risk groups and communities; scale-up and improve the quality of elimination of mother-to child transmission (eMTCT) of HIV services; intensify advocacy with key stakeholders to reduce infection and impact of HIV/AIDS and STIs; and strengthen collaboration among HIV/AIDs and STIs, and sexual and reproductive health programmes.

Improve HIV and AIDS/STIs case management In order to improve HIV and AIDS/STIs case management the strategies to be implemented are: scale-up and sustain the quality of HIV/AIDS and STIs treatment, care and support activities, including increasing ART and PMTCT sites; support the local production of Antiretroviral Therapy (ART); strengthen logistics management and forecasting; and develop and implement a programme to deepen public awareness and management of HIV/AIDS and STIs.

Improve institutional and financial capacity, for efficient and effective delivery of HIV/AIDS & STIs services The key strategies to be implemented to achieve improved institutional and financial capacity are: strengthen the management capacity of Ghana Aids Commission (GAC) and NACP, and implement arrangements of HIV/AIDS services; establish sustainable financing arrangement for the delivery of HIV/AIDS and STIs services; ensure the implementation of the GAC resource mobilisation strategy; improve the quality assurance of HIV/AIDS commodities; ensure continuous quality improvement of PMTCT and ART sites; and promote the implementation of Private Public Partnerships (PPPs) arrangements for the delivery of HIV and AIDS/STIs services.

References