2024-03-23-世界银行-加纳全民健康覆盖的公共卫生支出（英）_82页_2mb

报告摘要

Ghana has made substantial progress toward Universal Health Coverage (UHC), performing better than many SSA peers in health outcomes, despite relatively low public health spending.

Health Financing Mix: Government funding (domestic) constitutes the largest source (≈50%), with the Ministry of Health (MoH) budget dominating (80%) and the National Health Insurance Scheme (NHIS) share declining from 24% to ~12%.
NHIS Challenges: Revenue shortfalls and delayed fund releases (only 6.7% of budget allocated by 2021) threaten NHIS sustainability, leading to claims arrears and informal out-of-pocket (OOP) payments. NHIS now funds non-claim expenditures, diluting its core function.
Equity and Utilization: Health outcomes and service access are inequitable across wealth, region, and gender. Catastrophic health spending is low, but OOP payments affect vulnerable populations.
Economic Context: Ghana’s macroeconomic challenges, including fiscal deficits, high debt, and revenue gaps, constrain health funding, reducing fiscal space.
Immunization and UHC Progress: Childhood immunization coverage is high (~90%), but gaps in essential medicine supply and financing threaten progress.
Public Financial Management (PFM): Weak PFM integration, donor funding fragmentation (≈11% of CHE in 2018), and off-budget transfers hinder transparency and efficiency.

Inadequate Domestic Revenue: Below SSA/LMIC averages, with revenue gaps constraining UHC financing.
NHIS Sustainability: Declining enrollment in vulnerable regions, informal OOP payments, and declining claims-adjustment rates.
Functional Allocation: Line-item budgeting limits discretionary spending, and fragmentation between MoH, NHIS, and donors reduces efficiency.
Health System Gaps: Equipment/staff shortages at primary facilities, limited subdistrict funding, and weak expenditure tracking.

Strengthen NHIS: Ensure timely fund allocation, revise benefit packages to include preventive services, and investigate informal payments.
Enhance PFM: Consolidate budgeting, integrate donor funds into national planning, and deploy GIFMIS and FMAIS at subdistrict levels.
Prioritize Equity: Target NHIS enrollment for the poor using mechanisms like the National Household Registry. Scale up primary care and adjust funding for frontline facilities.
Manage Resource Transition: Develop an implementation plan for "Beyond Aid," with clear timelines for donor phase-out and fiscal space creation.
Strengthen PHC: Reorient NHIS payments toward population-based financing, accelerate NoP implementation, and improve logistics for subdistrict facilities.

展开完整摘要