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HEALTH SERVICE PROVISION IN GHANA

HEALTH SERVICE PROVISION IN GHANACCESS,OTTLENECKS,OSTS, ANDQUITYA B CEAssessing Facility Capacity and Costs of CareThis report was prepared by the Institute for HEALTH metrics and Evaluation (IHME) in collab-oration with GHANA s Ministry of HEALTH , the GHANA HEALTH SERVICE (GHS), the GHANA UNICEF office, and UNICEF. This work is intended to help policymakers understand the costs of HEALTH SERVICE delivery and HEALTH facility performance in GHANA . The numbers may change following peer review. The contents of this publication may not be reproduced in whole or in part with-out permission from : Institute for HEALTH metrics and Evaluation (IHME). HEALTH SERVICE PROVISION in GHANA : Assessing Facility Capacity and Costs of Care. Seattle, WA: IHME, for HEALTH metrics and Evaluation 2301 Fifth Ave., Suite 600 Seattle, WA 98121 USAT elephone: +1-206-897-2800 Fax: +1-206-897-2899 Email: 2015 Institute for HEALTH metrics and EvaluationPhoto credit: Chapman flickr photostream, Koforidua, GHANA , April 20124 Acronyms6 Terms and definitions8 Executive summary12 Introduction16 ABCE study design21 Main findings HEALTH facility profiles Personnel and outputs SERVICE PROVISION and pharmaceuticals Trends in facility expenditures and revenues Efficiency and costs of care45 Conclusions and policy implications48 ReferencesHEALTH SERVICE PROVISION IN GHANAC ontentsAssessing Facility Capacity and Cost

This report was prepared by the Institute for Health Metrics and Evaluation (IHME) in collab - oration with Ghana’s Ministry of Health, the Ghana Health Service (GHS), the Ghana UNICEF

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Transcription of HEALTH SERVICE PROVISION IN GHANA

1 HEALTH SERVICE PROVISION IN GHANACCESS,OTTLENECKS,OSTS, ANDQUITYA B CEAssessing Facility Capacity and Costs of CareThis report was prepared by the Institute for HEALTH metrics and Evaluation (IHME) in collab-oration with GHANA s Ministry of HEALTH , the GHANA HEALTH SERVICE (GHS), the GHANA UNICEF office, and UNICEF. This work is intended to help policymakers understand the costs of HEALTH SERVICE delivery and HEALTH facility performance in GHANA . The numbers may change following peer review. The contents of this publication may not be reproduced in whole or in part with-out permission from : Institute for HEALTH metrics and Evaluation (IHME). HEALTH SERVICE PROVISION in GHANA : Assessing Facility Capacity and Costs of Care. Seattle, WA: IHME, for HEALTH metrics and Evaluation 2301 Fifth Ave., Suite 600 Seattle, WA 98121 USAT elephone: +1-206-897-2800 Fax: +1-206-897-2899 Email: 2015 Institute for HEALTH metrics and EvaluationPhoto credit: Chapman flickr photostream, Koforidua, GHANA , April 20124 Acronyms6 Terms and definitions8 Executive summary12 Introduction16 ABCE study design21 Main findings HEALTH facility profiles Personnel and outputs SERVICE PROVISION and pharmaceuticals Trends in facility expenditures and revenues Efficiency and costs of care45 Conclusions and policy implications48 ReferencesHEALTH SERVICE PROVISION IN GHANAC ontentsAssessing Facility Capacity and Costs of CareCCESS,OTTLENECKS,OSTS, ANDQUITYA B CE2 About IHMETo express interest in collaborating or request further in-formation on the Access, Bottlenecks, Costs, and Equity (ABCE) project in GHANA , please contact IHME:Institute for HEALTH metrics and Evaluation2301 Fifth Ave.

2 , Suite 600 Seattle, WA 98121 USAT elephone: +1-206-897-2800 Fax: +1-206-897-2899 Email: Institute for HEALTH metrics and Evaluation (IHME) is an independent global HEALTH research center at the Univer-sity of Washington that provides rigorous and comparable measurement of the world s most important HEALTH prob-lems and evaluates the strategies used to address them. IHME makes this information freely available so that poli-cymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population this reportHealth SERVICE PROVISION in GHANA : Assessing Facility Ca-pacity and Costs of Care provides a comprehensive yet detailed assessment of HEALTH facility performance in GHANA , including facility capacity for SERVICE delivery and costs of care. This report provides expanded results from the preliminary findings presented at the GHANA HEALTH Summit in April 2013. A preliminary policy report was dis-seminated at that time, titled Access, Bottlenecks, Costs, and Equity: Assessing HEALTH System Performance and Bar-riers to Care in GHANA .

3 Results from 2013 have not changed; rather, researchers have now completed analyses on fa-cility levels of efficiency and costs of care, which were not available at the time of the 2013 GHANA HEALTH Summit. This report includes the results from the 2013 publication, as well as the additional analyses mentioned presented in this report were produced through the ABCE project in GHANA , which aims to collate and generate the evidence base for improving the cost- effectiveness and equity of HEALTH systems. The ABCE project is funded through the Disease Control Priorities Network (DCPN), which is a multiyear grant from the Bill & Melinda Gates Foundation to comprehensively estimate the costs and cost-effectiveness of a range of HEALTH inter-ventions and delivery platforms. Data collection in GHANA also was supported by ABCE project is a collaborative study with IHME, Gha-na s Ministry of HEALTH (MOH), the GHANA HEALTH SERVICE (GHS), GHANA UNICEF office, and UNICEF.

4 At IHME, Christo-pher Murray, Emmanuela Gakidou, Michael Hanlon, Santosh Kumar, Kelsey Moore, and Annie Haakenstad had key roles in the project. At the MOH, the project was led by Kwakye Kontor. Evelyn Ansah, Ivy Osei, and Bertha Garshong served as the ABCE project leads for GHS. At the GHANA UNICEF of-fice, the project was led by Anirban Chatterjee, who was the in-country principal investigator (PI), and Jane Mwangi. Data collection was conducted by a team of research associates from GHS. Analyses were jointly conducted by several re-searchers at GHS and IHME, including Roy Burstein, Brendan DeCenso (now of RTI International), Kristen Delwiche, Laura Di Giorgio, Samuel Masters (now of UNC-Chapel Hill), Allen Roberts, and Alexandra Wollum. This report was written by Nancy Fullman of ABCE project in GHANA is a collaboration between the GHANA MOH, GHS, the GHANA UNICEF office, UNICEF, and IHME at the University of Washington in the United States. We are most grateful to these organizations, especially for their willingness to facilitate data access and provide crucial content knowledge.

5 Additional survey input and cooper-ation were provided by the Clinton HEALTH Access Initiative (CHAI) and Instituto Nacional de Salud P especially thank all of the HEALTH facilities and their staff, who generously gave of their time and facilitated the sharing of the facility data that made this study possible. We are also most appreciative of the patients who partic-ipated in this work, as they, too, were giving of their time and kindly willing to share their experiences with the field research team. The quantity and quality of the data collected for the ABCE project in GHANA are a direct reflection of the dedi-cated field team. It is because of their months of hard work, traveling from facility to facility and interviewing staff and pa-tients, that we are able to present these findings today. We are immensely grateful to the ABCE GHANA field number of IHME research fellows contributed to data collection and verification in GHANA . We appreciate the work of Miriam Alvarado (now of Chronic Disease Research Centre of Barbados), David Chou (now of Columbia Uni-versity), Michael Freeman, and Thomas Roberts (now of Stanford University).

6 At IHME, we wish to thank Kelsey Moore, Annie Haaken-stad, and Aubrey Levine for managing the project; Ellen Squires for data support; Patricia Kiyono for managing the production of this report ; Adrienne Chew and Kate Muller for editorial support; and Dawn Shepard for graphic for this research came from the Bill & Melinda Gates Foundation. UNICEF provided financial support for facility data collection in LamivudineABCE Access, Bottlenecks, Costs, and EquityACT Artemisinin-based combination therapyAIDS Acquired immunodeficiency syndromeAL Artemether-lumefantrineARV Antiretroviral (drug)AS+AQ Artesunate-amodiaquineAZT/ZDV ZidovudineCHAI Clinton HEALTH Access InitiativeCHPS Community-based HEALTH planning and servicesCMS Central Medical StoresC&C Cash and carryDAH Development assistance for healthDEA Data Envelopment AnalysisDCPN Disease Control Priorities NetworkDHMT District HEALTH Management TeamDHS Demographic and HEALTH SurveyEFV EfavirenzELISA Enzyme-linked immunosorbent assayGDP Gross Domestic ProductGHS GHANA HEALTH ServiceGOG Government of GhanaHIV Human immunodeficiency virusAcronyms 5 IGF Internally generated fundsIHME Institute for HEALTH metrics and EvaluationIPTp Intermittent preventive therapy during pregnancyLMIC Lower-middle-income countryMICS Multiple Indicator Cluster Survey MOH Ministry of HealthMMR Maternal mortality ratioNCD Non-communicable diseaseNHIA National HEALTH Insurance AuthorityNHIS National HEALTH Insurance SchemeNVP NevirapineRDT Rapid diagnostic testRMS

7 Regional Medical StoresTDF TenofovirUNICEF The United Nations Children s FundVAT Value-added tax6 Constraint: a factor that facilitates or hinders the PROVISION of or access to HEALTH services . Constraints exist as both supply-side, or the capacity of a HEALTH facility to provide services , and demand-side, or patient-based factors that affect HEALTH -seeking behaviors ( , distance to the nearest HEALTH facility, perceived quality of care given by providers).Data Envelopment Analysis (DEA): an econometric analytic approach used to estimate the efficiency levels of HEALTH facilities. District sampling frame: the list of districts from which the ABCE district sample was : a measure that reflects the degree to which HEALTH facilities are maximizing the use of available resources in pro-ducing sampling frame: the list of HEALTH facilities from which the ABCE sample was drawn. This list was based on a 2011 Ministry of HEALTH (MOH) Needs bed-days: the total number of days spent in a facility by an admitted patient.

8 This statistic reflects the duration of an inpatient visit rather than simply its visit: a visit in which a patient has been admitted to a facility. An inpatient visit generally involves at least one night spent at the facility, but the metric of a visit does not reflect the duration of : tangible items that are needed to provide HEALTH services , including facility infrastructure and utilities, medical sup-plies and equipment, and equivalent visits: different measures of patient visits, such as inpatient bed-days and births, scaled to equal a comparable number of outpatient visits. This approach to standardizing patient visits is informed by weights generated through Data Envelopment Analysis (DEA), capturing the use of facility resources to produce inpatient bed-days and births relative to the production of an outpatient visit. Conversion to outpatient equivalent visits varied by facility, but on average, we estimated the following: 1 inpatient bed-day = outpatient visits 1 birth = outpatient visitsOutpatient visit: a visit at which a patient receives care at a facility without being admitted (excluding patients presenting for ART services ).

9 Outputs: volumes of services provided, patients seen, and procedures conducted, including outpatient and inpatient care, ART visits, laboratory and diagnostic tests, and : a channel or mechanism by which HEALTH services are fee: a monetary payment made at a facility in exchange for medical and definitions 7 TERMS AND DEFINITIONSR egional referral hospitals: hospitals that provide more specialized care and the next level of referral for more compli-cated cases, in addition to general inpatient care, outpatient services , laboratory care, and hospitals: district hospitals that serve geographically defined areas and are considered first referral facilities, pro-viding a range of clinical services , including emergency services , inpatient care, laboratory testing, and centers: HEALTH facilities that provide basic curative and preventive services , as well as reproductive HEALTH ser-vices. Polyclinics, which are larger and tend to offer more services , were considered HEALTH centers for the ABCE project in GHANA .

10 These facilities are considered GHANA s main point of contact for primary care HEALTH planning and services (CHPS): a clearly defined area within a subdistrict wherein a commu-nity HEALTH officer provides community-based HEALTH services , including home visits to clients residing in the CHPS zone. Established in 2003, the CHPS program focuses on providing HEALTH services to GHANA s rural areas. For the ABCE project in GHANA , reproductive and child HEALTH facilities were also grouped with clinics: HEALTH facilities that focus on providing reproductive and family planning : HEALTH facilities that dispense drugs and operate separately from associated hospitals or types in Ghana11 Descriptions of GHANA HEALTH facilities came from Saleh et al. 2012 and Couttolenc IN GHANAG8hana s Ministry of HEALTH (MOH) states that its vision is creating wealth through HEALTH for all Ghanaians through proactive policies that support improved HEALTH and vitality.


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