Ghana: Health System Constrained in Its Fight Against HIV-Aids
Fighting HIV/AIDS in Ghana
The health system in Ghana is constrained in its fight against the HIV/AIDS menace by limited skilled health workforce and unsustainable financing. For instance, as at 2009 Ghana had only 2064 doctors (10,000 population per 1), 13,564 nurses/midwives (10,000 population per 6), 1,798 pharmacists, 558 medical assistants and 15,549 allied health professionals currently in Ghana.
Deficiencies in human resources for health and poor access to health services to most of the rural communities have a negative effect in the achievement of expected outcomes of the national HIV and AIDS control strategy. There was a total workforce of 49,138 manning 172 hospitals, 1056 health centres, and 361 maternity homes (public, private and mission).
"These deficiencies impinge strongly on HIV prevention, treatment, care and support interventions."
These are contained in the National HIV and AIDS Strategic Plan 2011-2015 recently released by the Ghana AIDS Commission.
Years ago, the Cash and Carry System of paying for health care at the point of service was a key financial barrier to health care access for the poor and the vulnerable. To remove the financial barrier to health services, the government initiated the National Health Insurance Scheme in 2001, abolishing the Cash and Carry System and thus limiting out of pocket cash payment at the point of payment.
Although the NHIS makes provision for the poorest and most vulnerable people to be identified and exempted from making financial contributions to the system but access to Anti Retroviral Therapy (ART) by persons living with HIV is not covered.
The 2008 National AIDS spending Assessment (NASA), the strategic plan revealed, showed that expenditure on treatment and care increased from 17% in 2005 to 40% in 2007 but suffered a decline in 2008 to 24%.
The other challenges facing the health sector, the strategic plan disclosed, included weak procurement and supply management systems as well as inadequate monitoring and evaluation (M&E) system.
The strategic plan explained that, procurement of medicines and supplies including antiretroviral drugs were currently undertaken by Ministry of Health (MOH) and a private firm. Forecasting and managing appropriate stocks of the essential medicines and supplies have been inefficient because of uncoordinated supply chain management systems thereby creating interruptions in supply of medicines and supplies.
"There is a lack of robust drug logistics management information system to direct the distribution of medicines and supplies from the centre to the lower levels."
According to the National Strategic Framework (NSF II), even though Ghana AIDS Commission has facilitated development of a National Monitoring and Evaluation Framework to guide HIV and AIDS coordination activities, the weak capacities in M&E at national, regional and district levels, among HIV stakeholders and implementing partners continue to affect prospects for harmonizing M& E strategies.
M&E coordination structures of regions and districts, civil society organizations, PLHIV, private sector and research and training institutions, among many others implementing HIV and AIDS interventions, are not functioning properly because of lack of human and institutional capacity, the Strategic Plan further noted.
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