6 July 2012

Ghana: CSO Kicks Against World Bank's Cost Recovery Health Policy

The Ghana Free Universal Access to Health Care Campaign (GFUAHCC), Civil Society Organisation (CSO), has noted with concern the World Bank's suggestion of cost sharing as a means of bringing financial sustainability to the National Health Insurance Scheme (NHIS).

The Campaign is particularly against the World Bank's recommended use of co-payments for some covered services and sections of the populations (who are able to pay) as a strategy for increasing NHIS revenue and directing utilisation towards more cost effective services. However, the Bank doesn't say which services or medicines should attract co-payment.

The recommendation is contained in the Bank's report on "Health Financing in Ghana at a Crossroads".

In that report, the World Bank argues that the NHIS Basic Benefit Package (BBP) is financially unsustainable, and that it needs to consider cost-sharing if it is to continue providing the comprehensive BBP. The Bank is, in addition, unhappy that the NHIS is highly subsidised and that about 46 per cent of the 65 per cent of NHIS members who are exempted from premium payment belong to high income groups and could be drawn in to pay premium.

It argues that government cannot afford any significant increases due to Ghana's fragile fiscal space and that the NHIS is inefficient and increasing government resource to it will give very poor value for money. Besides, Ghana has low revenue raising effort; and external assistance is likely to reduce in the near future due to oil finds.

Additionally, the Bank claims to be aware that Ghana's out of pocket payment (37per cent) as a percentage of total health expenditure is more than the World Health Organisation (WHO) recommended level of 15-20 per cent; and that health related financial protection in Ghana is worse than other Low Middle Income Countries (LMIC). Relative to its health expenditure, the World Bank noted Ghana performed worse on under-5 and maternal mortalities than other LMICs, hence concluded that Ghana is off-track to meeting the Millennium Development Goals (MDGs) on maternal and child health.

Now, the GFUAHCC's case is that by suggesting that Government should not increase the share of financial allocation to the health sector in the face of high maternal mortalities and inadequate health facilities in rural Ghana, the World Bank has clearly exposed its intentions - that even if people are dying, government should not put more resources into the health sector unless the economy grows.

"Unfortunate as these retrogressive suggestions might be, it is not surprising that such prescriptions are coming from the World Bank because its ideologies are deeply rooted in neoliberalism and the related ideologies of individualism and consumerism, which have been powerful negative influences on health over the last half-century," the Campaign observed.

Most worrying, the World Bank suggested that the share of government allocation to the health sector should remain the same and that any additional funds for the sector should come from economic growth or Gross Domestic Product (GDP) and enhanced revenue collection.

The GFUAHCC stated that, these recommendations were being made though the same institution at another breadth noted that Ghana's Health expenditure as a percentage of GDP (4.9%) was below the average of other LMICs; and health expenditure as a per cent of GDP has declined since 1995.

Rhetorically, the GFUAHCC inquires: "why does the World Bank want the Ghana government to reduce expenditure on health when the above indicates a grim situation on population health and financial risk protection?

"In most developing and middle income countries...the underlying economic dysfunction speaks for itself," GFUAHCC stated, adding that, "the legacy of joblessness, food riots, and hunger is commonplace and it's most often related to structural reforms and austerity measures promoted by the International Monetary Fund.

"World Bank and International Monetary Fund [IMF] have played a significant role in reinforcing the rich-poor divide over the past three decades, fostering inequality, suffering, social divisions, and discontent."

The Campaign served notice that "We are not so blinded nor have we a short memory to remember that since the early 1980s there has been a continuous attempt by the World Bank, the IMF to introduce neoliberal programmes to 'solve' the problems of the African economy. From the recommendations of the Berg Report in the early 1980s, to the Structural Adjustment Programmes of the mid-1980s to the mid-1990s, to the Heavily Indebted Poor Country (HIPC) and Poverty Reduction Strategy Papers initiatives of the late 1990s and the early 21st century; each of the neoliberal 'solutions' have failed and failed again.

These failures, GFUAHCC indicated, "have left African countries and peoples, particularly Ghana, with difficult situations in terms of the indices of the quality of life (from falling longevity, collapse of wages to increasing illiteracy)."

"It is still fresh on our minds that at the very start of the AIDS pandemic in the early 1980s the World Bank and IMF Structural Adjustment Programmes (SAPs) called for reduction of government funding in public health initiatives and the introduction of fee-based system of healthcare in societies that were suffering a dramatic fall in their wages and/or prices for their food crops."

GFUAHCC further explained that the neoliberal model of public health as a collection of individual decisions concerning one's own health translated onto a health-care providing market inevitably led to a virulent AIDS-genic environment. The macro disease-vector of the SAPs created the foundation of the epidemic. "This is not just a failure, it is an aggravated failure."

At a time when governments across the world are being urged to invest more in their health sectors and to ensure universal access to health care, it is not a surprise that an institution such as the World Bank has recommended to Ghana to adopt cost-sharing and limited financial injection into health sector. For the World Bank has been noted to be an institution that puts money first before lives, and will always seek to commercialise the health sector at the least opportunity.

The CSO says, in light of the foregoing, it wishes to advise "the World Bank to stay off our health sector, and let the nation Ghana be."

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