The third Sustainable Development Goal (SDG 3) adopted by the United Nations focuses on ensuring healthy lives and promoting wellbeing for all at all ages through Universal Health Coverage (UHC). The World Health Organization (WHO) asserts that realizing this vision necessitates establishing a sustainable financing system, making health supply chain financing a key priority in the health ecosystem. Both the WHO financing framework and the Abuja 2001 Declaration have outlined minimum funding thresholds to guide member states in their investments toward UHC.
Ghana, recognizing the importance of improving its healthcare financing system, has implemented various policy interventions over the years. Notably, the introduction of the National Health Insurance Scheme in 2003 exemplifies Ghana’s commitment to UHC. However, despite these policy interventions, Ghana’s investment efforts in the health sector have proven insufficient to reach UHC, highlighting the need for policy reforms for healthcare financing.
This study employs a mixed methods approach to assess the effectiveness of current healthcare financing mechanisms in Ghana to gain insights that can be used to shape and inform health financing policies in the country. It aims to highlight the financing deficiencies hindering the achievement of UHC goals and propose alternative models for policy consideration. The study draws on interviews with 50 practitioners, to complement secondary data obtained from the Ministry of Health and the World Bank database for analysis.
Analysis of the healthcare system in Ghana reveals three principal financing mechanisms: (1) government budget allocations, Internally Generated Funds (IGF) involving the National Health Insurance Scheme (NHIS); (2) private/mutual health insurance; (3) Out-of-Pocket (OOP) Payments, (4) donor funding, and support from philanthropists. Over the years, these mechanisms have significantly influenced the quality of healthcare in Ghana. The results also revealed a financing gap within Ghana’s health supply chain. The identified funding gap indicates a shortfall in meeting the Abuja 2001 target and progressing toward UHC, emphasizing the urgent need for increased healthcare investment in Ghana.
Again, evidence of consistent funding support from donors and development partners was observed, constituting an average of 16% between 2010 and 2022. This underscores the significance of donor support from Ghana’s development partners over the years. However, the findings indicate a noticeable decline in donor funding, particularly between 2018 and 2022. This diminishing trend in donor support to the health sector since 2018 signals Ghana’s gradual shift toward self-financing in the health supply chain. While commendable, this transition necessitates a deliberate strategy including leveraging innovative technologies to enhance efficiency and accountability in healthcare financing, to not only make up these shortfalls but also sustain self-financing efforts and reduce catastrophic OOP payments.
Finally, the identified funding inadequacies highlight the necessity of exploring alternative financing schemes to complement the existing models. Two proposed financing models were identified for policy considerations: extension of the NHIS to encompass optional premium packages, and revitalization of private and community mutual/religious-based health insurance plans. These strategies emerge as potential avenues for maximizing revenue generation, pooling resources, and facilitating the purchase of healthcare services.