Private Sector Participation in the Provision of Quality Drinking Water in Ghana's Urban Areas: Are People Willing to Pay?

Access to clean drinking water is not only a fundamental human right, but also claims a big stake in economic growth, poverty reduction and sustainable development. With an increase in population, rapid urbanization and increasing income levels, the demand for water outstrips public water supply in developing countries. As a result, private water production has been promoted in developing countries to achieve greater efficiency and expansion in order to supplement public water supply. This study used the contingent valuation method to survey households in three cities in Ghana to estimate their willingness to pay in a bid to evaluate a policy of better water supply for urban areas in Ghana. It was found that more than 80% of the respondents favour some form of private sector engagement in water quality improvement. Also, the mean willingness to pay for water quality improvement is about GH¢13.42 (US$12) per month. Given the mean household monthly water bill of GH¢10.82, these results indicate that there is demand for water quality improvement and the general view is that private sector engagement is likely to provide these services. However, the same policy measure will marginalize the poor in terms of access to water. Therefore, private sector participation in water delivery, with a corresponding complementary government programme to promote access to water among low income households, would deliver the double dividends of water quality and universal access, which characterize the debate on private sector engagement in water provision in Ghana

Advancing the application of systems thinking in health : provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme; a systems approach

As countries work towards Universal Health Coverage, there is a need to design, implement, and manage provider payment methods reforms, but from a systems perspective, rather than traditional linear models. The wider national context as well as characteristics of the health system into which the payment method is introduced shape and modify supply behaviour and incentives. Assuring equitable universal access to essential health services without financial hardship requires resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The study describes provider behaviour related to supply of health services to insured clients in Ghana

Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis

Background: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes.Objective: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana.Methods: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider’s perspective.Results: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched.Conclusion: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana.Keywords: perinatal asphyxia; low-birth-weight; time-driven activity-based costing; process of careFunding: Authors received no external funding for the stud

Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana’s health insurance claims data

Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana’s National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019- February 2020) relative to the target/pandemic period (March 2020 - February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95$21 – $25, p=0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana

Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

Background: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. Method: Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. Results: We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. Conclusion: The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised

Additional file 3: Table 6. of Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Mean cost adjustment rate between the paper- and electronic-based reviews. (DOCX 17 kb

Additional file 2: Table 5. of Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Difference in adjustment rate by healthcare facility type (electronic-based claims review). (DOCX 18 kb

Additional file 1: of The “Universal” in UHC and Ghana’s National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country

Data collection tools-The Universal in UHC. Primary data collection tools. Informed consent form. Focus Group Discussion and Key Informant interview guides. (DOCX 136 kb