2023-10-02-世界银行-加纳社会保障项目支出和家庭福利（英）-2023-139页_139页_4mb

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 their impact on household welfare, poverty reduction, and inequality mitigation. It focuses on five key programs: the Livelihood Empowerment Against Poverty (LEAP) program, the Labor-Intensive Public Works (LIPW) program, the Ghana School Feeding Programme (GSFP), the National Health Insurance Scheme (NHIS), and the Social Security and National Insurance Trust (SSNIT) pension scheme. The analysis is based on government administrative data and recent national household survey data (GLSS 2016–17).

Main Programs and Their Characteristics

LEAP Program

• Description: Provides unconditional cash transfers to households with vulnerable individuals (orphans, elderly, pregnant women, mothers of infants, and persons with disabilities) and low proxy means test (PMT) scores in high-poverty areas.
• Financing: Jointly funded by the government and donors.
• Coverage: 1.5% of the national population, 6.7% of the extreme-poor population. When adjusted for underreporting, it increases to 4.1% of all Ghanaians and 17.9% of the extreme-poor population.
• Effectiveness: Benefits are concentrated among the poor (concentration coefficient = -0.53), and the program has a modest impact on poverty and inequality.

LIPW Program

• Description: A public employment program in rural areas during the agricultural off-season, targeting the poorest individuals through geographic, self-selection, and community-based mechanisms.
• Financing: Fully funded by donors.
• Coverage: Limited to poor areas, with a national coverage rate of around 1.5% (not specified in detail).
• Effectiveness: Program benefits are relatively low in value, and coverage remains limited.

GSFP Program

• Description: Provides cooked lunches to preprimary and primary students in high-poverty areas.
• Financing: Funded through general government revenues.
• Coverage: 6% of the national population (administrative data), 10% of the extreme-poor population (survey data). Among students in targeted areas, coverage is 61% overall and 64% for the extreme-poor.
• Effectiveness: Benefits are more concentrated than average consumption, with a concentration coefficient of -0.22.

NHIS Program

• Description: A universal health insurance scheme, intended to cover all Ghanaians, with no premiums for children under 18, adults over 70, and indigent individuals.
• Financing: Primarily through a 2.5% National Health Insurance Levy on VAT, supplemented by SSNIT and other contributions.
• Coverage: Ranges from 30% to 40% of the national population, based on administrative data. It covers 10% of the extreme-poor population.
• Effectiveness: NHIS benefits are less concentrated than LEAP and GSFP (concentration coefficient = 0.19), but still more concentrated among the poor than overall consumption. However, it faces challenges in timely payment to providers, which undermines its effectiveness.

SSNIT Pension Scheme

• Description: Provides retirement, disability, and survivor pensions to formal sector workers.
• Financing: Funded by contributions from members and employers.
• Coverage: 0.4% to 0.7% of the national population (administrative data), 5.2% of those aged 60 or older (survey data).
• Effectiveness: SSNIT benefits are more generous than other programs and are highly concentrated among the poor (concentration coefficient = -0.54), but the program is limited to formal sector workers, who are not typically poor.

Key Findings

• Spending Levels: Ghana spends about 1.4% of GDP on social protection programs, with social insurance (primarily NHIS and SSNIT) accounting for most of this spending. Social assistance spending is only 0.2% of GDP, far below international averages.
• Program Targeting: Most social assistance programs are well-targeted to the poor, especially in high-poverty areas. However, coverage rates are generally low, and benefit amounts are modest compared to consumption levels and poverty lines.
• Effectiveness: Despite targeting the poor, the effects on poverty and inequality are modest due to low spending and limited coverage. The LEAP program is the most effective in reducing poverty and inequality, followed by GSFP and NHIS.
• Underreporting: There is significant underreporting of program participation in the GLSS data. Adjusting for this, the coverage of LEAP increases to 4.1% of the national population and 17.9% of the extreme-poor population.
• Weather Shocks: The study examines the relationship between social assistance program participation and exposure to adverse weather shocks. It finds that LEAP and GSFP beneficiaries are more likely to live in areas with high drought risk, indicating a link between vulnerability and program access.

Policy Implications

• Need for Expansion: Increasing coverage and benefit levels could enhance the effectiveness of social assistance programs, especially in reducing poverty and inequality.
• Fiscal Constraints: The current fiscal and macroeconomic situation limits the ability to expand program spending significantly.
• NHIS Challenges: The National Health Insurance Scheme is the most universal but faces issues with timely payment to service providers, which hampers its ability to deliver services effectively.
• SSNIT Limitations: While SSNIT pensions are more generous, they are limited to formal sector workers, who are not typically the poorest segment of the population.

Conclusion

Ghana's social protection programs have made some progress in targeting the poor and addressing vulnerability, but their overall impact on poverty and inequality is limited due to low spending and coverage. The LEAP program is the most effective, while NHIS is the most universal but suffers from operational inefficiencies. The study recommends further reforms to improve targeting, benefit levels, and program efficiency to better support vulnerable populations and align with international standards.