Essential Health Service Package for PHC in Ghana PDF

ESSENTIAL HEALTH SERVICE PACKAGE FOR PRIMARY HEALTH CARE IN GHANA POLICY BRIEF ESSENTIAL HEALTH SERVICE PACKAGE FOR PRIMARY HEALTH CARE IN GHANA Background builds trust with families and communities to promote the hea...

ESSENTIAL HEALTH SERVICE PACKAGE FOR PRIMARY HEALTH CARE IN GHANA POLICY BRIEF ESSENTIAL HEALTH SERVICE PACKAGE FOR PRIMARY HEALTH CARE IN GHANA Background builds trust with families and communities to promote the health In recent years, the Universal Health Coverage (UHC) movement and wellbeing of communities, while proving timely treatment. In a has gained global momentum, with the World Health Assembly PHC-focused system, people the receive care they need to stay and the United Nations General Assembly calling on countries to healthy. It follows that primary health care builds the backbone of accelerate scale up efforts towards universal access to affordable an effective health-care system and can reduce the growth in cost and quality healthcare services. of care, lower inequalities in access and reduce disparities in health outcomes. Studies show interventions that focus on primary health Ghana’s experience under the Millennium Development Goals and care, particularly at community level, are more cost effective, and failure to achieve MDG 4, 5 and 6 — on reducing maternal deaths, more equitable than those that focus solely on facility service infant mortality and HIV — further affirmed that improvements in delivery at higher levels of the health system (1). Furthermore, health outcomes cannot be attained outside the context of a these interventions are linked to higher patient satisfaction and strengthened health system. The disproportionate support of reduced aggregate health care spending. (1) vertical health policies and programmes has caused fragmentation in Ghana’s health system and inequities in service delivery, which Ghana is widely considered to have a high-performing primary has led to the marginalisation of the indigent and other vulnerable health care system with the Community-based Health Planning groups, who’s needs are too often neglected in health system and Services (CHPS) and the National Health Insurance Scheme planning. (NHIS) frequently cited as exemplary approaches to service delivery and health care financing. Despite these achievements, Universal health coverage (UHC) ensures that people have access there are significant gaps in access to affordable and respectful, to the healthcare they need without suffering financial hardship. quality care The outcomes of this help to drive better health and development. overall in any country setting. UHC is characterised by suitable The Alliance for Reproductive Health Rights (ARHR) and a coalition geographical access to care for all Ghanaians; adequate preventive of Ghanaian NGOs advocating for PHC as a pathway to UHC have health services; effective social services; and appropriate levels of identified a number of critical opportunities for advancing PHC in financial access for the populace. This begins with a strengthened Ghana including the development, adoption and financing of an and effective primary health care system. Essential Health Services Package. Improving primary health care (PHC) has long been recognised as Essential Health Services Package (EHS) a key to achieving health for all. A strong primary health care An essential health package (EHS) is a guaranteed minimum list of system not only delivers high quality care and services, it also public health and clinical services that the government provides or aspires to provide to all citizens in an equitable manner (2). An EHS Including preventive services in the NHIS package could is central to a country achieving its health improvement and significantly increase the contribution of public and private service financial protection goals. Increasingly seen as a tool of health providers to the health sector and holistically contribute to national policy, EHS can direct government resources towards interventions health improvement. At present private healthcare service providers that aim to address equity challenges and local disease burdens, in offering NHIS services are not incentivised to provide promotive or the most cost-effective way. Currently, there is no PHC policy in preventive care within their operational areas. According to Ghana. The Ministry of Health (MoH) are yet to define a consolidated Awoonor et al. (2016), their operations are largely based on cost primary health care package outlining the content of primary health recovery and making a profit to pay salaries, purchase medical care in Ghana and the appropriate financing arrangements. supplies and expand and maintain infrastructure (3). There is hence little to no incentive to provide preventive services if the public An analysis of Ghana’s EHS indicates that, unlike other countries, health system — the system that primarily finances health care Ghana does not have a specified EHS package, but has defined services in the country — does not bare the cost. multiple packages of health services in various government programs including CHPS; National Health Insurance Scheme Mental health and EHS (NHIS); Newborn health; Maternal and Reproductive Health; and The World Health Organization (WHO) predicts mental health illness Adolescent Sexual and Reproductive Health. The extent to which could be the leading global cause of years of life lost to disabilities these EHS packages align with national health priorities is difficult to by 2020, surpassing AIDS and heart diseases. Mental health is a establish as there is limited data on the link between NHIS priority on the national development agenda, yet it remains one of operations and the EHS. According to a crosswalk analysis of Ghana the most neglected areas in Africa (4). Mental health is EHS conducted by Health Finance Group (HFG), about 60 percent conspicuously missing from the EHS package of both the CHPS and of the EHS package is not covered by the NHIS (2). NHIS. The landscape of mental health in Ghana is dire, with extreme treatment gaps and scarcity of resources — including finances, Preventive and promotive care services and the EHS personnel and specialist facilities. Exasperating the inequity of The predominant focus of the NHIS on curative services greatly access to mental health services is the lack of facilities catering to undermines the key principles of PHC, and ultimately UHC. For this marginalised group; Ghana has only three government instance, the NHIS benefits package excludes health promotion, psychiatric hospitals, all of which are located in the southern part of health education and other preventive services. Essential services the country. Notwithstanding systemic and structural challenges, including family planning counselling, outreach services and other Ghana can make progress in this area by focusing on the task-shifted activities that focus on promotive and preventive health intersection of mental health and primary health care. Integrated services at CHPS compounds, are non-reimbursable. Similarly, the primary mental health services at community level are cost of monitoring activities is also non-reimbursable. This block of complimentary to secondary and tertiary mental health care in services, however, constitutes a significant proportion of the CHPS Ghana (5). To fulfil the Sustainable Development Goal (SDG) 3 — EHS package, which largely defines Ghana’s primary health care which insists on the promotion of healthy lifestyles and ensured strategy. Comparatively, the NHIS is less supportive of primary wellbeing for all persons across the lifespan — the government of health care and overall UHC targets. Ghana must reassess the inclusion of primary mental health services in the wider EHS policy and position this service within the NHIS References benefit package. 1. Atun R (2004). What are the advantages and disadvantages of restructuring a health care system to be PHC system development more focused on primary care services? Copenhagen, Unresolved staffing norms as well as the misalignment between WHO Regional Office for Europe (Health Evidence Network facility classification and the posted cadre of health staff challenges report) PHC system reform. For example, although a Physicians Assistant (Level B) is qualified to prescribe a broader range of services and 2. Wright, J., Health Finance & Governance Project. July medicines, patients who receive such prescriptions at a Level A 2015. Essential Package of Health Services Country facility must pay for them as Level A facilities are not typically Snapshot: Ghana. Bethesda, MD: Health Finance & entitled to claim reimbursements for such medicines and services Governance Project, Abt Associates Inc. under the NHIS. Clear guidelines indicating which basic health services should be provided at all levels of care will greatly 3. Awoonor-Williams J. K, Tindana P, Dalinjong A. P, Nartey H, contribute to attaining health for all Ghanians. Akazili J. (2016). Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the EHS package is thus an important aspect of health system reform goals of Primary Health Care? Perspectives of key and development; delivery of the service package cannot be stakeholders in northern Ghana. BMC International Health achieved independent of a robust and well-structured health care and Human Rights (2016) 16:21 DOI 10. system. 1186/s12914-016-0096-9 Conclusion 4. Yankyera et al. (2017) ARHR recommends that Ghana’s government develops a national primary health care strategy or policy which will provide the 5. WHO (2007). Integrating mental health services into framework for the realisation of universal health coverage, by way of primary health care. Geneva, PHC, in Ghana. Ghana’s Ministry of Health should define an (http://www.who.int/mental_health/policy/services/en/index essential health services package for primary health care which.html, accessed 4 September 2007; Mental Health Policy, aligns with the national priorities outlined in the current Health Planning and Service Development Information Sheet, Sector Medium Term Development plan and complies with SDG 3. Sheet3). Most critically, this EHS package must be aligned with the NHIS benefits package to ensure the cost of services are covered and guarantee access to primary health care in Ghana. Alliance for Reproductive Health Rights (ARHR) +233 54 2753676 9 Apple Street, East Legon, Accra www.arhr.org.gh