2011年-世界发展银行全球_Private_Health_Sector_Assessment_in_Ghana_152页_5mb

报告摘要

Summary of Private Health Sector Assessment in Ghana

Core Content

This document presents an assessment of the private health sector in Ghana, conducted by a research team commissioned by the Government of Ghana with funding from the joint International Finance Corporation-World Bank Health in Africa Initiative. The assessment focuses on understanding the role, challenges, and opportunities of the private health sector in contributing to national health goals. It provides a comprehensive analysis of the supply and demand dynamics, the regulatory environment, and the broader business and investment climate affecting the sector.

Main Viewpoints

Role of the Private Health Sector

The private health sector is a significant contributor to health service delivery in Ghana, providing more than half of all health services used by consumers.
Self-financed private (SFP) providers are the largest component of the private sector and supply a wide range of services, including a substantial portion of hospital beds in urban areas.
The private sector is especially important in rural and urban-poor areas, where chemical sellers are the most accessible source of health services.

Demand for Health Services

Consumers across all socioeconomic groups, genders, and regions tend to use private providers for a substantial portion of their health needs, with around 50% of service use directed to private providers.
Access to care has improved over time, with 64% of those who were ill seeking care in 2005-06, compared to 44% in 1999.
Despite the National Health Insurance Scheme (NHIS) coverage, many consumers still pay out-of-pocket, though NHIS has increased the frequency of zero-cost visits.

Supply of Health Services

SFP providers are concentrated in urban areas, while CHAG providers and chemical sellers are more prevalent in rural and underserved areas.
There are challenges in the supply chain, including fragmented pharmaceutical markets and limited suppliers of medical equipment, though private providers do not consider these as major constraints.
The availability of drugs and ORS (Oral Rehydration Solution) is generally higher in urban facilities than in rural ones.

Quality of Care

Consumers perceive private providers as offering better quality, customer service, and shorter waiting times.
Exit poll data show that most patients are satisfied with the quality of care, regardless of provider type, and would return to the same provider.
However, there are concerns about the enforcement of quality standards and the incomplete accreditation of SFP providers.

Business Environment and Investment Climate

The private health sector faces challenges in accessing finance, including high interest rates, short repayment periods, and substantial collateral requirements.
SFP providers struggle with access to credit and weak management skills, which limit their ability to expand and improve services.
There is a need for more business-friendly policies, improved access to credit, and advisory services to support private health providers.

Governance and Policy

The 2003 Private Health Sector Policy (PHSP) is still relevant, but its implementation remains incomplete.
The Ministry of Health (MOH) needs to strengthen its engagement with the private sector and ensure that the Private Sector Unit (PSU) has adequate resources and staffing.
A joint task force involving NHIA, GHS, and private providers is recommended to address NHIS-related issues such as fraud, reimbursement delays, and accreditation.

Key Information

Key Issues Identified

Poor Investment Climate: Limited access to finance and expertise for growth.
Unfavorable Business Environment: Policies and regulations that hinder private sector development.
Fragmentation and Informality: Especially in lower-level care, with poor governance and financial management.
Quality Standards: Lack of enforceable standards and incomplete accreditation.
Skilled Workforce Shortage: Insufficient supply of trained health professionals.
Incomplete Risk Pooling: NHIS coverage is not fully reaching lower-income populations.

Key Opportunities

Public-Private Partnerships (PPPs): The MOH-CHAG partnership is a successful model in Sub-Saharan Africa.
Credit Access: Creating specific lending funds and improving financial literacy among private actors.
Formalization of the Informal Sector: Encouraging registration and regulation of informal health providers.
Equitable Access: Ensuring that both urban and rural populations benefit from private sector services.
Innovative Government Support: Introducing incentives for investment in rural areas and standardizing drug registration.

Key Challenges

Regulatory and Taxation Barriers: While MOH regulations are applied, enforcement is weak.
Out-of-Pocket Spending: Despite NHIS, many consumers still pay directly.
Management and Financial Skills: Private providers lack the capacity to manage and access financial resources effectively.
Collaboration and Coordination: There is a need for better coordination between public and private actors and for involving all stakeholders in policy development.

Options for Action

Stewardship and Governance

Review and revise the 2003 PHSP with stakeholder involvement and establish a realistic implementation framework.
Create an engagement committee with equal representation from public and private sectors to facilitate ongoing dialogue.

Private Health Sector

Encourage the private sector to develop a collective voice for policy advocacy and cross-sectoral issues.

Health Insurance

Establish a joint task force to address NHIS issues like fraud, delays, and slow accreditation.
Implement a centralized claims management system to improve reimbursement efficiency.

Health Business Environment and Investment Climate

Improve access to credit through specific lending funds, training for bank officers, and partial guarantees.
Expand advisory services for private health providers to help them leverage opportunities for growth.

Quality of Care

Strengthen licensing and accreditation processes and provide adequate resources to monitoring bodies.
Finalize a legal framework for a laboratory regulatory body and expedite licensing for rural facilities.

Human Resources for Health

Enhance pre-service and on-the-job training to develop business and professional skills for health workers.

Pharmaceutical Supply Chain

Improve distribution networks and encourage regional standardization of drug registration.
Leverage cross-sector supply chains and assess the impact of international financing and procurement policies on local industry.