Universal Health Protection 51
In low income countries, deficits in legal health coverage reach unprecedented dimensions: More than 90 per cent of the population in these countries is legally not
covered.
The relative deficit in per capita health spending in this country group amounts to 92.6 per cent in high-vulnerability countries.
The quality of health services is mirrored in the maternal mortality ratio, which reaches 37.5 per 10,000 live births in low income countries.
In these countries, 82.5 per cent of the population cannot access health services, due to lack of qualified health personnel.
Out-of-pocket expenditure as a percentage of total expenditure amounts to 45.2 per cent in low income countries.
Figure 4.3. The global deficit of effective health coverage 20112012
Source: ILO, 2014
90.3
82.5
92.6 45.2
37.5
20 40
60 80
100
Estimate of the deficit of legal health coverage as a percentage
of total population
Coverage gap due to health professional staff
deficit Benchmark relative | median
value in low vulnerability group of countries - 41,1
Financial deficit | Per capita health spending except OOP
Benchmark relative | median in low vulnerability in low income -
239USD Out of pocket expenditure
Percentage of total health expenditure
Maternal mortality ratio modeled estimate, per 10,000
live births
Low-income economies Lower-middle-income economies
Upper-middle-income economies High-income economies
Universal Health Protection 53
ANNEX I: Country cases
A.I.1 Africa Ghana
Sources: 1 UNDESA: World Population Prospects, 2012. 2 UNDATA, 2011. 3 UNDP: Human Development Indicators, 2011. 4 WHO: Global Health Observatory, 201011. 5 Calculation based on data of Annex III
In recent years Ghana has seen significant progress in economic and social development: over the past decade its GDP per capita more than tripled and poverty fell from 39.5 per
cent in 1998 to 28.5 per cent in 2006 UNDATA, 2012; Ghana Statistical Service, 2008. Redistributive factors such as land ownership, and increased access to education and health
care played an important role in the process of economic growth and poverty reduction ILO, 2013b.
The National Health Service in Ghana came into existence in 1957, offering entitlement to free public health care to all members of the population. Lack of financial sustainability
forced Ghana to revise the system and introduce co-payments in 1985. In 1992, a new reform followed, introducing the “cash-and-carry” system, in which care was provided
only after an initial payment. The result of the reforms was that health services became less affordable and thus less accessible, especially for the poorest members of the population
ILO, 2008.
In order to make health care more accessible for all members of its population, Ghana implemented a National Health Insurance Scheme NHIS in 2005. Ever since, it has made
significant progress towards achieving universal coverage. The greatest virtue of the NHIS is its risk-pooling mechanism and the resulting reduction of the individual burden of
health-care costs. Since the introduction of the NHIS, health financing has been evolving from community-based health insurance plans to a system of district mutual health
insurance schemes mutuelles de santé Schieber et al., 2012.
The current system is coordinated by the National Health Insurance Council. Its Health Insurance Fund receives funding from contributions paid to the Social Security and
National Insurance Trust, the health insurance levy, grants, donations and other sources as
Table A.1 Ghana: Selected development and social health protection indicators
- Total population: 24.26 million
1
- GDP per capita: US1,570
2
- HDI: 0.558 [Rank: 135]
3
- Per capita total expenditures on health as a of GDP: 4.8
4
- Deficit of legal coverage as of population: 26.1
5
- OOP in per cent of THE: 29.1
5
- Per cent of population not covered due to financial resources deficit: 77.7
5
- Staff Access Deficit of population not covered due to lack of professional health staff: 74.1
5
- Maternal mortality rate per 10,000 live births: 35.0
5,4
