MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Ghana: Interactions between Health Systems and
Global Fund supported TB and HIV
programmes
Abstract:
Sai Pothapregada, Rifat Atun *
Ghana, a beneficiary of support from the Heavily Indebted Poor Country Initiative, aims to achieve
middle-income country status by 2015, supported by sustained economic growth and an
articulated health policy goal of ‘Creating Wealth Through Health’. The country has benefited from
large inflows of external resources accounting for nearly 22% of total health expenditure in 2006.
The Global Fund contributes to more than 85% of the National AIDS Control Programme budget
and 95% of funding for the Tuberculosis programme. This external support has been universally
acknowledged as critical for rapid scale-up of disease-specific interventions.
The existing mechanism for donor coordination and tracking earmarked funds under the Sector
Wide Strategic Approach (SWAp) facilitated seamless integration of Global Fund programmes into
existing structures, in line with the national health sector plan. The Global Fund projects have
contributed to strengthening service delivery, availability of anti-TB/antiretrovirals (ARVs) and
capacity building training for the workforce. These projects, however, do not often address other
systemic challenges like institutional density, workforce availability, and availability of essential
drugs. Aligning the Country Coordinating Mechanism (CCM) into the national accountability
framework, integrating parallel and often demanding reporting requirements, and exploring
alternatives to the competitive proposal-based funding mechanism to ensure predictable funding,
have all been identified as critical areas for deliberation and action.
Background
The Republic of Ghana is centrally located in West Africa and is bordered on the east by the
Togolese Republic, on the north and northwest by Burkina Faso, and on the west by the Republic
of Côte d’Ivoire. Ghana is home to 23.5 million people, and has experienced an average annual
population growth of 2.2% since 2001[1]. Since 1997, Ghana’s economy has sustained an average
real GDP growth of more than 5%, with a 6.3% growth in 2007 [1]. The government now explicitly
aims to achieve middle-income status by 2015 and is well ahead of schedule in achieving the key
poverty-related Millennium Development Goals (MDGs). However, Ghana has not shown similar
progress on its human development indicators – it ranked 142 out of 179 countries on the UN
Human Development Index in 2006 [2].
Health care is provided by a multitude of players. The Ministry of Health (MOH), which is
represented by the Ghana Health Service and teaching hospitals, owns approximately 49% of total
health facilities. The private sector owns approximately 21%. Christian Health Association of Ghana
(CHAG) institutions own 8% while private maternity homes own approximately 17%. .Distribution
of health facilities and staff favours the affluent regions in south Ghana. It is estimated that more
than 70% of the population rely on traditional medicine, even though this has not yet been
adequately integrated into the formal health sector [3].
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