Assignment Report: Ghana health sector support programme: scenario planning and risk management

Abstract

This review considered possible scenarios for the health sector over the next three years and a range of associated options for future support from the Department for International Development (DFID). The review concludes the best option to be: provision of non-budget support financial aid for primary care. The report makes the following recommendations: DFID should reach a definitive and agreed position with the Ministry of Health (MOH) concerning the reasons for the non-achievement of the existing sector budget support (SBS) performance targets and make an assessment of when/if these targets can actually be achieved. If a decision is made to adopt the option of continuing SBS with a focus on services and strong earmarking of funds for that purpose, then the basis for tranche release should be considered as a first priority. If a decision is made to adopt provision of non-budget support financial aid for primary care, then discussions should be opened with the GHS to agree objectives and management arrangements and to develop a programme delivery plan drawing on those already being developed for the planned World Bank project. DFID should contact the World Bank task manager and consider the possibility of co-funding of its new primary health care (PHC) project. There should be further discussion of the technical assistance plan with the MOH and agreement of its objectives, indicators and allocated responsibilities. DFID should hold the MOH director of policy, planning, monitoring and evaluation (PPME) accountable for its delivery. DFID should encourage the MOH to give priority to achieving ministerial approval and early implementation of the health financing strategy  as a core area for future reform in the sector. DFID should engage more directly and on a systematic basis with the deputy minister to achieve progress with the financing strategy, the primary healthcare policy and workforce optimisation. DFID should revitalise the donor dialogue by encouraging stronger leadership from Government of Ghana including ministerial engagement. Consideration should be given by DFID to increase working with community service organisations on the voice and public accountability aspects of health issues, regardless of which option is chosen for taking forward financial aid