2023-05-17-世界银行-加纳社会保护计划支出和家庭福利（英）_152页_5mb

Summary of Social Protection Program Spending and Household Welfare in Ghana

Core Content

This study evaluates the performance of Ghana's main social protection programs in terms of spending, coverage, incidence, and effectiveness in reducing poverty and inequality. It also explores the relationship between social assistance program participation and adverse covariate shocks, particularly weather-related risks.

Key Programs

Ghana's social protection programs include:

• Livelihood Empowerment Against Poverty (LEAP): An unconditional cash transfer to vulnerable groups and low-income households in high-poverty areas.
• Labor-Intensive Public Works (LIPW): A public employment scheme targeting poor rural areas during agricultural off-seasons.
• Ghana School Feeding Programme (GSFP): Provides cooked lunches to students in high-poverty areas.
• National Health Insurance Scheme (NHIS): A subsidized health insurance program with universal intent.
• Social Security and National Insurance Trust (SSNIT): Offers pensions to formal sector workers.

Spending and Coverage

• Total Social Protection Spending: Amounted to 1.4% of GDP, with social insurance (SSNIT and NHIS) accounting for the majority.
• Social Assistance Spending: Only 0.2% of GDP, far below international averages.
• Coverage Rates:
  • LEAP: 1.5% of the national population, 6.7% of the extreme poor.
  • GSFP: 6% of the national population, 10% of the extreme poor.
  • NHIS: 30–40% of the national population, based on administrative data.
  • SSNIT: 0.4–0.7% of the national population, targeting formal sector workers.
• LEAP+ Coverage: Adjusted for underreporting, LEAP+ covers 4.1% of the national population and 17.9% of the extreme poor.

Effectiveness

• LEAP:
  • 69% as effective as a perfectly targeted program at reducing the Gini index.
  • 65% as effective at reducing the poverty gap.
  • 33–35% as effective at reducing poverty severity.
• LEAP+: Similar effectiveness to LEAP but slightly higher.
• GSFP:
  • 57% as effective as a perfect program at reducing inequality.
  • 48% as effective at reducing the poverty gap.
  • 24–28% as effective at reducing poverty severity.
• NHIS:
  • 28% as effective as a perfectly targeted program at reducing the Gini index.
  • 22% as effective at reducing the poverty gap.
  • 11–16% as effective at reducing poverty severity.
• SSNIT Pensions:
  • Increase inequality and have no effect on reducing poverty.

Program Design and Implementation

• LEAP and GSFP use proxy means testing (PMT) and geographic targeting to reach the poor.
• LIPW combines geographic targeting, self-selection, and community selection.
• NHIS is intended to be universal, but registration and renewal barriers limit its reach.
• SSNIT primarily serves formal sector workers, who are not typically poor.

Shocks and Program Participation

• LEAP and LIPW participation is correlated with drought risk.
• Flood risk correlation is less clear.
• Weather-related shocks are a significant concern for households in poor and drought-prone areas.
• Programs are indirectly targeted at these areas due to their poverty focus.

Challenges and Limitations

• Low Benefit Levels: All programs except SSNIT provide small benefits relative to household consumption and poverty lines.
• Underreporting: Survey data underreports beneficiaries and spending for all programs.
• Fiscal Constraints: Current macroeconomic and fiscal conditions limit the ability to increase coverage and benefit generosity.
• NHIS Delays: Slow payment to healthcare providers undermines the scheme's effectiveness.
• SSNIT Limitations: Only available to formal sector workers, limiting its impact on the poor.

Conclusion

While Ghana's social protection programs have positive design features, their overall impact on poverty and inequality is modest due to low spending levels and limited coverage. LEAP and GSFP are the most effective, but even their effects are small. SSNIT pensions are generous but not accessible to the poor, and NHIS is intended to be universal but faces implementation challenges. Fiscal and administrative constraints hinder the potential for reform and expansion.

Key Findings

• Ghana's social protection spending is low, with social insurance dominating.
• LEAP is the most targeted and effective program, but still has modest impacts.
• GSFP has a high concentration among the poor but limited impact on poverty and inequality.
• NHIS is underfunded and underperforming, with registration barriers and slow payments.
• SSNIT pensions are not pro-poor and increase inequality.
• Weather-related shocks are linked to program participation, particularly in drought-prone areas.
• Underreporting in survey data affects coverage and effectiveness estimates.
• Reforms to LEAP and GSFP could improve targeting and impact, but low benefit levels limit poverty reduction potential.

Recommendations

• Increase benefit generosity and expand coverage to improve poverty and inequality reduction.
• Address NHIS registration and payment delays to enhance access to healthcare.
• Improve data collection to ensure accurate coverage and spending estimates.
• Enhance targeting mechanisms to ensure better alignment with vulnerable populations.