Health care and Impact Investing in Ghana
The health sector is one of the critical sectors of every country and governments all over the world pay particular attention to it. This is because productivity, to a large extent, depends on the health of the work force. Ghana has decentralised her healthcare services in the public sector to the district levels through the Ghana Health Service (GHS).
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The Ministry of Health (MOH) and the GHS are the two government institutions that define the public sector health system in Ghana. The MOH is responsible for sector-wide policy formulation and monitoring and evaluation of progress in achieving sector targets, and the GHS is responsible for service delivery.
The GHS was created in 1996 to facilitate planning and management of the decentralisation of the health sector and to give more authority to the Regional and District Health Services. The push for this division of responsibility came as early as the 1980s when health sector performance had noticeably deteriorated after the country’s economic decline in the late 1970s (World Bank, 2011).
Ghana’s healthcare system is organised into four main categories of delivery systems: public, private-for-profit, private-not-for-profit and traditional systems and self-medication (Abor et al., 2008).
According to WHO, due to the unavailability and expensive nature of the public and private sector healthcare delivery in Africa, about 80 per cent of the population used traditional medicine for primary health care as at 2003. In Ghana, as in other countries, WHO collaborates with the government to integrate this type of medicine into orthodox medicine (WHO, 2003).
Common diseases
The common diseases in Ghana include malaria, HIV/AIDS, diarrhoeal diseases, lower respiratory infections and perinatal conditions. According to the World Resource Institute (2008), these are the five most common diseases and these account for 50 per cent of all deaths in Ghana and 68 per cent of deaths among children under 14 years.
Malaria, a curable illness, continues to be the disease claiming the highest number of victims. According to a report published in 2005 by the Integrated Regional Information Network (IRIN), about three million Ghanaians seek treatment for malaria each year. Tuberculosis (TB) has also long been among the six killer diseases listed by the Ministry of Health. TB accounts for about 40 per cent of AIDS deaths in Africa (Ghanaian Chronicle, April 29 2008).
The government, through the MOH, the National Health Insurance Authority (NHIA), the medical and dental council, the Ghana pharmacy council and the GHS is seen as the main investor in the country.
The second category of investors in Ghana comprises private entities such as the ISODEC, the National AIDS Control Programme, the coalition of NGOs in health, etc.
The third and last category is made up of international donors and NGOs such as the World Health Organisation, the world bank, UNICEF, African Development Bank, etc. One major impact investor, among others, in the health industry in Ghana is the Sweden Ghana Medical Centre. The centre specialises in the treatment of cancer and this has reduced the number of people who had to travel abroad for cancer treatment, thereby reducing cost.
Constraints
Despite the effort being made by both impact and non-impact investors in the healthcare industry in Ghana, the industry is still faced with a number of challenges. These have severely constrained the performance and quality of services in the sector. One of the main challenges facing the health sector is inadequate infrastructure and lack of appropriate equipment and facilities. Apart from the lack of such simple facilities, sophisticated equipment for complicated surgeries and operations are lacking in most public medical establishments.
Another challenge is the lack of sufficient medical personnel. According to Dr Linda Van Otoo, the Director of Health Service in the Greater Accra Region, as reported on citifmonline (2014), the doctor-to-patient ratio in Ghana was 1:15,259 per year. According to the report, midwives and nurses also attend to about 6,000 and 1,400 patients respectively in a year. This obviously retards efficient health care delivery. Another major constraint to the development of Ghana’s health sector is the insufficiency of finances for the sector.
Investment opportunities
These deficiencies, however, provide significant opportunities for impact investment. One of the major impact investment opportunities in the country concerns financing health sector infrastructure. Khasem (2010) suggests alternative financing as a remedy for the lack of adequate funds in the sector. Specifically, private sector engagement, public private partnerships (PPPs) and turnkey project approaches were recommended to assuage the current state of affairs regarding funds for infrastructure in the sector.
It may be imprudent to continue to depend on government in the face of all these challenges. Currently, there are only about four major educational training institutions for doctors and related medical professionals. On the other hand, training institutions for doctors and related highly specialised and skilled staff are very few. There are only about four of these in the country. All of them are affiliated to the public universities.
Another opportunity for impact investment lies in the local production of more effective medicines as an alternative to foreign imported drugs. There are significant opportunities for pharmacists to undertake further research into herbal and traditional medicines. Some of such alternative medicines are more effective with less complications and adverse side effects.
Electronic health (e-health) services also serve as an opportunity. At the moment, most of the poeple have basic mobile phones with an increasing proportion using smart phones with more enhanced features. When such facilities are appropriately integrated with information and communication technologies, medical services can be provided to an increasing number of potential patients.
The writer is with the GIMPA Centre for Impact Investing (GCII)
www.gcii.gimpa.edu.gh