Towards increasing financial resources for effective health delivery - a case study of Ejisu-Juaben District of Ghana

A region’s greatest asset is its human resource and that the level of health of such an invaluable resource base is very crucial for development. It is for this reason that the quest for improving the health status of the people has attracted the attention of governments worldwide. Unfortunately with the increasing decline in the global economy, developing countries in general have been hardest hit to the extent that the need to provide enough health facilities cannot be entirely met by governments alone. District health institutions in Ghana under the decentralisation policy; have been given full financial autonomy in the delivery of health care. They have been assigned various revenue sources to exploit if they are to implement effectively the health programmes and projects in a more self-reliant manner. However, the revenue inflows from these sources to district health institutions lag far behind expected. This is basically due to inadequacy of revenue from the existing source and financial mismanagement of the limited resources. Ejisu-Juaben District is no exception as far as poor revenue mobilisation and inadequate financial inflows from the centre are concerned. Using the district as a case study, the financial inflows to health institutions and management of these financial resources are examined to unravel the various bottlenecks accounting for this phenomenon; so that strategies for improvement can be designed. In this connection the study analysed available financial data of health institutions in the district to ascertain the past financial inflows of the various sources to the district in both nominal and real terms and the existing financial management procedures. The analysis was supplemented with formal interviews with key members of District Health Management Team (DHMT), Hospital Management Team (HMT) and health personnel at the sub-district level. The major fiscal issues examined include the financial sources available, analysis of these sources in terms of their size, contribution of each source over a period of time for health provision, determination of the gap in financial resources and the existing internal control procedures relating to management of financial resources in the district. The study revealed among others that, financial allocations over the years considered have increased in nominal terms. However, in real terms they have fallen drastically. The factors responsible for this scenario include the inadequate revenue from the existing sources and the low revenue base, lack of comprehensive monitoring system for revenue collection and reporting. Low rates charged by health institutions for services rendered, lack of scientific criteria for revenue budgeting and the imposition of financial ceilings also account for inadequate health revenue to the district. There is also inadequate revenue collection staff, high default rate in the payment of user fees and irregularity and delay in the release of central government and donor funds. Practical strategies designed to address the problems identified include; 1. Introduction of Community Financing Scheme 2. Implementation of Compulsory Health Insurance Scheme 3. The establishment of National Health Fund 4. Upward review of existing low user fees 5. Comprehensive monitoring of revenue operation 6. Recruitment of revenue collectors 7. Improvements in expenditure control 8. The need for output oriented plans and budgets 9. Ensuring greater financial accountability in health institutions 10. Institutionalising donations as a potent source of health revenue In sum, it is expected that the implementation of the recommendations made would help improve tremendously the financial in flows to the district thereby increasing the effectiveness of health institutions to implement health programmes and projects necessary for socio-economic development.

Source: KNUST