Dear P4H members. Lots of things are happening in Ghana in the field of Health Financing. So much that it is challenging to understand how the different initiatives combine and all together fit in a clear direction and plan. Well.... here is a pleasant summary from Mr Kingsley ADDAI FRIMPONG, Technical Officer in Health Financing in the Ghana WHO country office. Hope it helps!
Health expenditure & COVID-19
The WHO country office in Ghana is discussing a partnership analytical work with the University of Ghana/School of public health on -Sustaining public health emergency (PHE) financing strategy for Ghana (possible Co-financing from Gates Foundation). The proposed work will combine research and advocacy to push the agenda for a high level strategy for financing public health emergencies in Ghana. The work will be around the following packages:
- Budget analysis: This package will undertake historical analysis of annual national and health sector budget and spending over the past decade, with a view to analyzing budgeted amounts and ad-hoc spending on PHEs to identify opportunities for creating space for future PHE financing. This will include desk review of relevant documents from Ministries of Health Finance, together with other grey literature on pandemic financing.
- Strategy for PHE financing: This package will review grey literature relating to best practices in PHE financing and, based on outputs from (1) above and literature, identify and propose a range of context-specific options for financing future PHE.
- Intensive stakeholder engagement: Based on the outputs of (1) and (2) above, we will engage key stakeholder groups, including the Parliamentary Select-Committee on Health and Finance, development partners, civil society organizations, key members of Ghana’s Covid-19 Response Team for inputs but also to court their support in elevating the need to revise/develop a national strategy for PHE where necessary – or even ensure operationalization of existing document.
The School has an ongoing work with Duke Global Health Institute, being funded by the Gates Foundation and they are thinking of extending the scope to work with WHO on this. This could be a medium-long term project where results will be available for publication in December 2020. At the country level, WHO is planning to start data collection for 2018 and 2019 NHA, which will be outside COVID-19 spending. Unless, we want to update the questionnaires to include COVID-19.
COVID-19 Resource Mapping and Expenditure Tracking:
Following the outbreak, the Health Sector DP Group developed a COVID-19 Resource Mapping Tool to identify available resources within the ecosystem to support COVID-19 response, and within the context of the National COVID-19 Preparedness and Response Plan. Even though, the budget for the plan was not available, it was decided to move ahead with the mapping and commitment process. Aside the DP’s effort or resource envelope, the president of the Republic also established a COVID-19 Trust Fund focusing on the private sector, among others. So technically, the total resource envelope for the COVID-19 response will be made up of the Health Sector DPs contribution, Trust Fund and re-programming of national budgets to the health sector. Any exercise on expenditure tracking will have to gather data from all the above sources.
As part of the GFF investment case process, the idea is to have on RMET for the country along the identified priorities in the UHC Roadmap. In this case, COVID-19 RMET will come as a sub-set of the national clinical and public health emergency pillar. A consultant has been recruited to work with the TWG and the UHC Roadmap Taskforce – work-in-progress. The timeline for this exercise could be July 2020.
National Strategic Plan & GFF model
Ghana launched the UHC Roadmap (2020 – 2030) in December 2019. According to the MoH, the UHC roadmap is the commitment of the government and people of Ghana to shape the future of health care in Ghana. it takes inspiration from the National Health Policy and sets the strategic direction for the health sector in the next 10 years. It has reflected carefully on the Sustainable Development Goals, Global Action Plan for Healthy Lives and Well Being, Declaration on Primary Health Care in Astana (2018), UHC 2030 Compact, initiatives of UHC 2030 and the Political Declaration of UHC adopted at the UN High Level Meeting in September 2019.
The UHC Roadmap document has the following priority areas:
- Essential services for the population
- Management of clinical and public health emergencies
- Improve quality of care and information management
- Enhanced efficiency in HR performance
- Institutional reforms for sector effectiveness
- Health policy, financing and systems strengthening
In the same year, Ghana joined the GFF and we are currently in a process of developing the investment case. To operationalize the aspirations of the UHC Roadmap, the Minister of Health formed the UHC Prioritized Operational Plan -Costing (POP-C) Taskforce with the mandate to sequenced interventions/reforms/strategies/strategic shifts out of the identified priorities in the UHC roadmap. This is the same as the GFF’s investment case. I am learning that the output of the GFF process will feed into the regulatory tactical document – Health Sector Medium-Term Strategic Plan (HSMTDP) (2018-2021). In terms of alignment, the sequenced interventions in the investment case will find its way into the next HSMTDP (2022-2025).
The M&E Framework to support the UHC Roadmap is also outstanding and WHO has provided funds to get this completed asap. We had to postponed this in March due to COVID-19. This process will help us set milestones, targets in the short -medium- Long-term within the 10-year period, as well as provide touch point for other related costing work, more especially when the plan is to use One-Health Tool.
The health sector annual activities are captured in the MoH’s Programme of Work (PoW). So ideally, 2021 activities should be influenced by the output of the UHC POP-C being developed now for implementation in 2021 and beyond, incorporated into existing operational mechanisms.
Updates on GFF Process/UHC POP-C
The UHC POP-C/Investment Case Taskforce has recruited a led consultant to coordinate the development of the POP-C. For each priority area, a thematic consultant is being hired to sequenced key priorities/reforms and strategies/strategic shifts needed to achieve the UHC roadmap through desk reviews and interviews, synthesis of available data/literature, etc. The consultants are expected to state objectives, sub-objectives, activities, indicators, outputs, outcomes, etc. for achieving and monitoring these shifts and changes. The work should also indicate implementation arrangements, coordination and accountability mechanisms at all levels – central, sub-national.
The TASKFORCE, working with the led-consultant will consolidate the work of the thematic consultants into an investment case for Ghana – prioritized interventions of the UHC Roadmap, fully funded for implementation.
Resource Mapping & Expenditure Tracking: A separate consultant as indicated above, has also been hired for the RMET (which will cover COVID-19), to work with a Technical Working Group made up of Government employees and DPs. On the MoH, it’s being led by the NHA Focal person, Kwakye Kontor (head of Planning and Budgeting), which is a good thing as we discuss how best to collaborate and support the RMET with our NHA work.
Costing: Last week, a TWG was inaugurated to start the costing of the UHC Roadmap and the POP/Investment Case. There were confusions around the sequencing of the activities – if we have to cost the POP/Investment case, then it makes sense to wait for the work of the thematic consultants to be completed. However, the MoH’s position is that the TWG should rely on the HSMTDP/Costing as a baseline to develop a framework budget (back-of the envelope costing for each priority area), making assumptions around targets and milestones with input from the M&E team. Once the POP/Investment case/interventions are validated by the country stakeholders, the Costing TWG will then cost the sequenced interventions/POP/investment (in theory, by the MoH’s current position, POP should represent a sub-component of the UHC roadmap costed framework). One-Health Costing Tool came up as the possible tool for the comprehensive costing framework. For the POP interventions, most likely we will use an ABC methodology (standard vrs. marginal costing – under discussion)