HEALTH SUMMIT 19 th – 23 rd November 2007 DRAFT FIVE-YEAR CIP III (2007 – 2011)

1. HEALTH SUMMIT19th – 23rd November 2007DRAFT FIVE-YEAR CIP III (2007 – 2011) PREPARED BY POLICY, PLANNING, MONITORING & EVALUATION (PPME) DIRECTORATE, MOH IN COLLABORATION WITH MAP CONSULT LIMITED & INTEGRITAS

2. Review of CIP II - Projects Infrastructure

3. Review of CIP II - Projects

4. Review of CIP II - Projects Equipment Overall, the achievements for equipment included: • the equipping of a large number of Health Centers, District Hospitals (including new ones such as Begoro & Sogakope) and Regional Hospitals (including new ones such as Sunyani, Ho & Cape Coast); • the extension of Physiotherapy services; and • a number of completed projects at KBTH and KATH.

5. Review of CIP II - Financials

6. Review of CIP II - Lessons • Resources Actual expenditure exceeded the $126 million forecast by $186 million. Attributable to improved data capture (from comprehensive budgeting) new funding sources, and increased external aid • Projects About 30% achievement against plan in completed projects for Infrastructure and Transport and a lot are still ongoing.

7. CIP III (2007 – 2011) POLICY FRAMEWORK CIP III is to respond to the strategic objectives of 5Y POW: - Promoting healthy lifestyle and healthy environment; - Increasing access to quality health, reproduction and nutrition services; - Strengthening health system capacity; and, - Ensuring good governance and sustainable financing. Four key components of CIP III: • Civil works (infrastructure); • Medical equipment; • Transport; and • Information and Communication Technology (ICT).

8. CIP III - KEY CHALLENGES 1 • The increasing demand for health services in response to the NHIS and the need to scale up achievement of health related MDGs; • Rapid urbanisation with its attendant pressures on limited health facilities • Inadequate emergency and epidemic preparedness of health facilities & the increasing demand to expand the NAS to all regions and districts; • Threats to quality of care arising out of deteriorating health infrastructure and obsolete equipment; • Disruption of the health services from the devastating effects of the recent floods.

9. CIP III - KEY CHALLENGES 2 • Inadequate funds for the backlog of capital investments contributing to the several uncompleted/abandoned projects as well as outstanding payments and huge commitments on maintenance contracts; • Ageing of vehicles and relatively slow deployment of ICT affecting service delivery and management; • Understanding the health service capacity needs of the newly created districts;

10. CIP III – Policy Thrust The focus of the CIP III is derived from the Strategic Objective 3 of the HS POW (2007-2011)which aims at: strengthening health system capacity to expand, manage and sustain high coverage of services

11. CIP III – Over-arching Principles Under the CIP III, a cautious approach to infrastructure development will be pursued in order to keep the project and recurrent cost implications of investments within the resource envelope for the period. Specific attention will be paid to the completion of existing projects while transport and equipment renewal and Planned Preventive Maintenance plans will be vigorously pursued. ICT will be deployed to improve health information systems.

12. Objectives of CIP III Components • Increase geographical access to well maintained health facilities and health enhancing infrastructure with emphasis on deprived and peri-urban areas; • Provision of training institutions to respond to the human resource requirements of the sector; • Maintain and Provide health facilities with functional equipment; • Increase vehicle availability for service delivery and supervision; • Generate and use evidence for decision making, programme development, resource allocation and management through research, statistics, information management and deployment of ICT

13. CIP III Resource Envelope Methodology 3 alternative methods considered for projecting resource envelope • Projections from 2007 Budget; • Projections from 2006 actual expenditures; and • Projections based on proportion of total sector revenue. Projections from 2006 actual expenditures selected as the preferred forecast method, and from this method two scenarios were Developed - the High Case and the Low Case. Total resources projected for the CIP III Period • The High Case Scenario - $510.9 million • The Low Case Scenario - $361.9 million (see tables below)

14. CIP III Resource Envelope (contd.) Limitations in Forecast Models • Some uncertainties over the NHIF’s future investment plans. • Models do not include revenue from financial credits, grants and earmarked funds, as these are difficult to predict. • At time of planning 2007 Half-year actual investment expenditure was not available to validate the budgeted allocations for 2007. • The current energy crisis could impact on the capital projections in the following ways: • More government funds could be channeled into solving the energy crisis. • Expected general slowdown in economic activity which will impact on the amount of income for the NHIF. • Less IGF for investment, since a higher proportion of it may be used for fuel to run generators in the major hospitals.

15. CIP III Resource Envelope (contd.)

16. CIP III Resource Envelope (contd.)

17. CIP III Expenditure Distribution High Case

18. CIP III Expenditure Distribution Low Case

19. CIP III Infra Targets – High Case

20. CIP III Infra Targets – Low Case

21. CIP III Targets – Equipment, Transport and ICT • Equipment – Maintain existing stock with priority to MDG 5 (Low Case), Provide additional equipment to fill gaps and complete all initiated projects (High Case) • Transport – High Case includes purchase of 1,692 Double Cabin Pick Ups, and 181 ambulances, among others • ICT – High Case provides NHIS & DHMS ICT requirements and at least minimum ICT infrastructure for 30 Sub-Districts, 40 DHMT, 40 District Hospitals, and all Regional Hospitals and RHMT Low Case restricted to NHIS & DHMS ICT requirements

22. Strategic Activities under CIP III (Infrastructure) • Deploying the Investment Planning Model and the SAM framework in the development of annual Capital Investment Plans; • Preparation of detailed annual investment plans by agencies/regions/districts; • Design & implement a framework for routine progress and expenditure tracking system for capital investments; and 4. Collaborate with the District Assemblies to construct and equip CHPS compounds in the sub-districts.

23. Strategic Activities under CIP III (Equip. & Transport) • Improve planned preventive maintenance and management systems; • Mobilise resources to support the replacement of obsolete equipment and to implement medium term vehicle replacement plan targeting over aged vehicles particularly in the deprived districts; • Prioritize provision of equipment that improve quality and make hospitals sustainable entities • Improve efficiency through the development of skills of staff

24. Strategic Activities under CIP III (ICT) 1. Develop and implement a strategic plan for the development of an integrated and consolidated National Health Information System including a link between financial management and service delivery information; 2. Scale up the district-wide system for information management to ensure the availability, accurate and reliable routine service-based data. 3. Implement the Health Sector ICT policy and strategy

25. Estimated Recurrent cost Implications of CIPIII High Case Recurrent Cost Projection Low Case Recurrent Cost Projection 25

26. Managing & Monitoring Implementation of the Plan • Requirements for the successful implementation of the Plan: • Predictability in funding • A planning, budgeting and approval process that can be applied to all proposed new projects • Deployment of the HS Planning model as an inclusive mechanism for project definition and programming, • Procedures and formats for progress and expenditure monitoring that will include local validation of the data reported; and • A realistic plan for assessing and increasing the human resource capacity of the various participating entities to implement the required activities.

27. Acknowledgements The CIP III team wishes to thank all those who facilitated, participated and contributed to this plan, as well as the organizations they represent, for their generous and open discussions, comments and important inputs. The team is particularly grateful to DANIDA for providing technical assistance.

28. CIP Team Members • Dr. E. Addai - Director PPME, MOH • Mr. J.G.K. Abankwa - Head, CIMU, MOH • Mr. Ben. Nkansah - Project Analyst, CIMU, MOH • Dr. N. Adjabu - Head, CEU, GHS • Mr, Sylvester Ziniel - Quantity Surveyor, EMU, GHS • Mr. Hassan Ligbe - Fleet Engineer, GHS • Alhaji Saaka Dumba - Transport Manager, MOH • Mr. P.K. Mensah - Consultant, Map consult Ltd. • Mr. Phillip Cobbina - Consultant, Map consult Ltd. • Mrs. Julie Asante - Consultant, Integritas • Mr. Edem Adzaku - Consultant, Integritas Thank you for your relentless support and facilitation.

29. Thank You