MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Health Workforce
Ghana is challenged by inadequate skill mix, insufficient numbers and improper distribution of its
health workforce. To improve workforce retention, distribution and motivation the government
has initiated several measures. These include additional duty allowance, consolidation of salary
structures, improved training opportunities and other fellowship programmes, as well as loans
towards the purchase of cars or for housing schemes. These measures have led to an increase in
payroll costs, which account for nearly 90% of the GoG health budget, and 47% of total health
budget.
Except for dedicated data managers at regional levels for the HIV/AIDS programme, and technical
officers at the national level, no additional human resources have been recruited under the
projects (accounting for less than 5% of the project costs). Global Fund support has contributed to
programme-related training of the workforce, fellowship trainings and participation in
international workshops/seminars, which improve provider confidence and quality of care.
However, combined with the training burden of national programmes, such activity by GHIs has
tended to overload the system: the NACP annual report observes that scale up of antiretroviral
therapy (ART) services was delayed by the non-availability of staff engaged in ongoing training
programmes.
Medical Products, Vaccines, and Technologies
All informants agreed that Global Fund projects have ensured availability of high quality drugs at
competitive prices through mechanisms like the Global Drug Facility (GDF) and the Green Light
Committee (GLC). The HIV/AIDS programme has developed a logistic management information
system and trained over 265 pharmacists and dispensing technologists on logistic management of
antiretrovirals (ARVs). ARVs are distributed to the ART sites based on their rates of consumption.
Both programmes use the national medical stores and logistic supply chain for the distribution of
drugs, and they are available through pharmacies within the health institutions. The (national)
Public Health Laboratory coordinates the supply of laboratory supplies and consumables.
Although there is clearly a need for additional funds to further strengthen warehouses and
transport, these activities have not been budgeted under the grants, indicating greater ownership
by the national health system.
Information
The demand for health information to monitor performance-based funding (input-process-outputoutcome
and impact) is known to exert great strain on project staff and fragile health systems in
most low-income countries, and Global Fund-supported projects are no exception.
Although the Global Fund project has supported M&E staff at key levels, the burden of reporting
and the emphasis on completeness and timeliness has created vertical programme reporting.
Ghana has invested appreciably in the national Health Management Information System (HMIS),
which is electronic at district level and upwards, but the programmes are reluctant to integrate
them, more out of lack of trust rather than technical obstacles. Integration is made difficult by the
demand for information on innumerable indicators, and also the frequent changes in reporting
formats.
One key informant on the staff of a development partner suggested ironically that it would be
interesting to explore whether the Global Fund or the UN agencies, including WHO, place more
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