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Presentation by: DR EMMANUEL ANKRAH ODAME PPME-MOH

Sustainability of recurrent expenditure on public social welfare programs: expenditure analysis of the free maternal care programme of the Ghana NHIS. Presentation by: DR EMMANUEL ANKRAH ODAME PPME-MOH. Outline of Presentation. Background Methods Results Discussion Conclusion

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Presentation by: DR EMMANUEL ANKRAH ODAME PPME-MOH

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  1. Sustainability of recurrent expenditure on public social welfare programs: expenditure analysis of the free maternal care programme of the Ghana NHIS Presentation by: DR EMMANUEL ANKRAH ODAME PPME-MOH

  2. Outline of Presentation • Background • Methods • Results • Discussion • Conclusion • Acknowledgement

  3. Acknowledgements • Prof. Irene Agyepong • Dr Afisah Zakariah • Mr Sylvester Mensah • Mr. Nathaniel Otoo • Mr Ben Yankah • Dr Patricia Akweongo • Dr Francis Asenso-Boadi • Mr Emmanuel Owusu-Ansah

  4. Background • Sustainability of public social welfare programs has been of concern in development circles • Free maternal care programme(FMCP) launched with a start up grant in 2008 form British Government • The NHIS received US$20 million in 2008 and US$10million in 2009, afterwards NHIS was expected to fund it

  5. Methods • Retrospective and descriptive • Relied on secondary data from a review of routine health records of provider facilities and the NHIS • Study period January to December,2009 in one sub metro • It had all 3 levels of provider facilities(B,C,D) • Data analysed with Stata version 9

  6. Results • 62% of all claim was for Antenatal care(ANC) • 60% of claims was from regional specialist hospital(RSH) • Regional specialist hospital average claim expenditure was higher than the overall average • Average ANC claim expenditure was lower at the RSH than at the Government polyclinic(GP) • Average spontaneous vaginal delivery (SVD) claim expenditure was higher at the Government Maternity Home(GMH) than at GP and RSH

  7. Results • Total claims expenditure showed ANC as the component with the highest claims expenditure • SVD was the component with the highest claim expenditure at the RSH • British Government grant in 2009 was about half the expenditure incurred in 2008 for maternal health services • In 2009,FMCP expenditure was 23% of the total claims expenditure • NHIA expenditure exceeded income in 2009, giving a deficit

  8. Discussion • Impossible to create a health system free of all tensions relating to financial sustainability Financial sustainability are coming from several fronts • Failure from onset to look at long term financial sustainability • International development partners should also be responsible in promising financial guarantees • Inadequate attention to claims expenditure cost containment • Lack of adequate attention to provider payment mechanism

  9. Discussion • Gatekeeper system not being adhered too • Medicines can be a major cost driver • Levels of care and gatekeeper systems are important cost containment mechanisms

  10. Conclusion • Avoid a dependency on donor promises to replace careful long term fiscal evaluation and planning • Critical attention should be paid to issues of strategic purchasing of the services • There are incentives an disincentives inherent in different provider payment mechanisms • Careful attention must be paid to design with this in mind

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