TheHealthReport25: Towards the attainment of Universal Health Coverage (UHC) – Ghana’s promise onto itself

In April 2001, African Union (AU) member states met in Abuja. Their mission was to address HIV/AIDS, Tuberculosis, and other infectious diseases. They pledged to allocate at least 15% of national budgets to healthcare.

However, Ghana's health sector budget has fallen short of this target. In 2022, the allocation was only 7.6%, half of the Abuja target. For 2023, it is expected to drop further to 6.7%. This decline is projected to continue due to harsh economic conditions.

Historically, the private sector contributes more to Ghana's health sector. In 2021, total national health expenditure was $2.4 billion. The private sector accounted for an impressive 58%, while the public sector contributed only 42%.

The UN Universal Health Coverage (UHC) declaration aims for everyone to access needed healthcare by 2030 without financial hardship. Unfortunately, global progress towards UHC has stagnated since 2015 and halted in 2019.

Ghana also has promises from its National Health Policy and the UHC Roadmap (2020-2030). By 2030, all Ghanaians should have access to timely healthcare services regardless of their ability to pay.

The UHC Roadmap outlines several objectives:
- Provide universal access to efficient healthcare services.
- Reduce preventable maternal and child deaths.
- Improve access to clinical and public health emergency services.

Key priority areas include:
- Focusing on vulnerable groups like children and women.
- Minimizing out-of-pocket payments for healthcare.
- Establishing public/private partnerships for better service delivery.
- Decentralizing health system management for effective service delivery.
- Re-prioritizing domestic financing for health.

Primary Health Care (PHC) is emphasized in this Roadmap. It aims to strengthen maternal and child services and manage non-communicable diseases effectively. This aligns with the Astana Declaration of 2018 promoting PHC as a means toward achieving UHC.

The Roadmap acknowledges many challenges in the health sector:
- Uneven access and poor delivery systems.
- Lack of essential infrastructure.
- High rates of avoidable maternal deaths.
- Low vaccination coverage for some diseases.

Experts have highlighted these issues in interviews and articles related to this Health Report. Honorable Dr. Nyakotey noted funding shortages in his constituency. Dr. Thomas Baah discussed limited NHIS coverage affecting practitioners like himself.

To address these challenges, the government plans six key interventions under the UHC Roadmap:

Intervention 1: Optimize Delivery of Essential Services
This includes improving access to outpatient care and preventive services like immunizations.

Intervention 2: Improve Management of Clinical Emergencies
Strengthening emergency management systems is crucial after lessons learned from Covid-19.

Intervention 3: Enhance Quality of Care
This involves creating quality assurance frameworks and upgrading healthcare infrastructure.

Intervention 4: Improve Human Resource Performance
Decentralizing management will help attract practitioners to underserved areas.

Intervention 5: Institutional Reforms
Enhancing collaboration between sectors will improve efficiency within public healthcare systems.

Intervention 6: Strengthen Health Policy Financing
The government plans a ‘Health in All Policies’ approach integrating health into all policy-making areas.

Despite these promising policies, many Ghanaians remain unaware of them. This lack of awareness allows leaders to escape accountability easily. If citizens do not know what has been promised, they cannot hold leaders accountable.

This situation creates a vicious cycle where new governments introduce new policies that often go unnoticed by citizens. Such obscurity can hinder potential private sector investments as well.

It is vital that we consistently shed light on our nation's health sector issues. Transparency ensures accountability and inspires action toward sustainable change—goals this year's Health Report aims to achieve moving forward.

BY Makafui Aikins
Co-founder/CEO, Nvame