Public Health Expenditure for Universal Health Coverage in Ghana

Ghana has made substantial progress toward universal health coverage (UHC) andcompares relatively well in health outcomes among its economic peers. Internationalcomparisons of government current health expenditure suggest that Ghana spends less than the sub-Saharan African norm for its income level. That notwithstanding, Ghana compares favorably with its peers in key health outcomes with a mixed pattern of equity in health service utilization. The trajectory indicates that better health outcomes could be achieved if health spending increases. Public funding through the Ministry of Health’s (MoH’s) budget and the National Health Insurance Scheme (NHIS) constitute the major sources of financing for the health sector in Ghana.. Total government health spending in Ghana almost tripled in nominal terms in 2015-20, but it rose by a modest 12 percent in real terms, and nearly all the increased spending was channeled through MoH instead of through NHIA. On average, 80 percent of the government budget is channeled through the MoH budget, while the share of NHIS spending has declined over the same period from 24 percent to 12 percent. There are preliminary signs that past achievements in financial protection largely attributable to the impact of the NHIS are being eroded. Although the social contract underpinning the establishment of the National Health Insurance Levy is not in question, the recently introduced Statutory Funds Capping Law further threatens the sustainability of the NHIS. There is a need to improve efficiency in the functional allocation of domestic health resources and upscale the use of public financial management (PFM) tools at the national and subnational levels to enhance budget credibility and expenditure tracking. To ensure no one is left behind, deliberate efforts should be made to improve equity in health care utilization and outcomes along income and regional dimensions.