What did Ghana do?

Key Points 

• Before and during the Exemplars study period from 2000 to 2018 Ghana implemented policies aimed at reforming its health system via improved governance and financing mechanisms as well as increased utilization of critical primary health care (PHC) services. These interventions improved coverage of key PHC services nationwide and lowered many of the barriers that prevented Ghanaians from accessing health care. Ghana's efforts to improve health system performance and efficiency fall into two main pathways:
• The first pathway enabled health system efficiency through increased resources for health and administrative reform at the national, regional, and local levels.
• The second pathway increased equitable access to quality PHC services by focusing on making PHC services more affordable and prioritizing community-driven and community-led care.

Primary health care is a comprehensive, multisectoral approach to care that has many components and addresses a large and diverse set of health needs. In Ghana, as in every Exemplar country, officials used a combination of interactive, complementary policy levers across the health system’s building blocks—governance, financing, facilities, workforce, supplies, service delivery, and data and information systems—to enable whole-system change.

Two pathways for health system reform in Ghana

In Ghana, Exemplars research identified two ways, or pathways, through which reforms have improved PHC outcomes. Reforms are often complex, with multiple components, and thus they can often operate using multiple pathways. Indeed, efforts to reform PHC in all Exemplar countries have been interactive and complementary, and have evolved and built on each other over time.

• The first pathway enabled health system efficiency through increased resources for health and administrative reform at the national, regional, and local levels.
• The second pathway increased equitable access to quality PHC services by focusing on making PHC services more affordable and prioritizing community-driven and community-led care.

Figure 8 shows the sequence of key PHC system reforms in Ghana since 1990.

Health system improvement does not happen overnight. Over the Exemplars study period, Ghana invested in its PHC system in three phases.

• In the first phase of its PHC strengthening process, Ghana focused on making more government funds available for PHC. Officials also implemented reforms aimed at increasing decision-making authority and capacity at the subnational and service levels of the health system. At the same time, new tools sought to connect all citizens with the formal health system.
• In the second phase of the PHC strengthening process, Ghana focused on making PHC operations more efficient by implementing coordination mechanisms that aligned government and development partner resources around a single set of priorities. Ghana further improved the efficiency of these coordinated efforts by investing in systems for improved health data and information and by fostering a culture of health research and systems improvement.
• Most recently, Ghana’s efforts have focused on implementing mechanisms for financial risk protection and bringing services closer to the community. These reforms aim to make PHC services more affordable and accessible nationwide.

However, these phases were not discrete. They overlapped one another in time, and each set of interventions built on and refined the ones that preceded it. Together they aimed to boost efficiency in health resource allocation and to improve coverage for key primary health services nationwide.