Mr. Speaker, I beg to second the motion and in doing so present the Report of the Committee on Health.
The honourable Minister for Finance and Economic Planning presented the Budget Statement and Economic Policy of the Government for the 2005 fiscal year to the House on Thursday, 24th February,
Pursuant to Standing Orders 140 (4) and 178, the draft Annual Budget Estimates of the Ministry of Health was referred to the select Committee for consideration and report.
A meeting was held to consider the draft Annual Budget Estimates with the hon. Minister of Health, Directors of the sector Ministry and the Schedule Officer of the Ministry of Finance and Economic Planning.
The Committee acknowledges their representation and commends them for their assistance.
2.0 Reference Documents
The underlisted documents were used as reference materials:
i. The 1992 Constitution of Ghana; ,
ii. The Budget Statement and Economic Pol icy of the Government of Ghana for 2005 Financial Year;
iii. The Medium-Term Expenditure Framework (MTEF) for 2005- 2007 and the Annual Estimates for 2005 (Volume 29) of the Ministry of Health;
iv. The Annual Estimates of the Ministry of Health for 2004,
v. The State of the Nation Address by H.E. Mr. John Agyekum Kufuor, President of the Republic of Ghana to the First Session of the Fourth Parliament of the Fourth Republic; and
vi. The Standing Orders of the Parliament of Ghana.
3.0 Mission Statement of the Ministry of Health
The Ministry of Health has the following as its Mission Statement:
i. The development and promotion of proactive policies for good health and longevity;
ii. The provision of universal access to basic health services; and
iii. The provision of quality health
services that are affordable and accessible.
The Ministry operates by the objectives cited below, in pursuance of its policy within the Medium-Term Expenditure Framework (MTEF):
i. To increase geographical and financial access to all basic services for all people living in Ghana;
ii. To provide better quality care in all health facilities and outreach centres;
iii. To improve efficiency at all levels of the health sector;
iv. To foster closer collaboration and partnership between the health sector on one hand and communities, other sectors and the private sector;
v. To increase overall resources in the health sector yearly;
vi. To bridge equity gaps in access to quality health services; and
vii. To ensure sustainable financial arrangements that protect the poor.
5.0 Review of the Ministry's Performance in 2004
5.1 Funds Allocated
5.2 The House approved the sum of one trillion, four hundred and forty-nine billion, four hundred and sixty-two million cedis (¢1,449,462,000,000) under Heads 160-165 for the operational expenditure of the Ministry of Health for the year under
5.3 This was made up of one trillion, two billion, nine hundred and sixty-nine million cedis (¢1,002,969,000,000) for recurrent expenditure and twenty-four billion, five hundred and three million cedis (¢24,503,000,000) for capital expenditure. External support totalled four hundred and twenty-one billion, nine hundred and ninety million cedis
5.4 Programme of Work for 2004
5.5 The major thrust of health care delivery in 2004 was on:
Disease Prevention and Control;
Improving emergency prepared- ness;
Improving health service delivery;
Providing support for financing arrangements for the protection of the poor and the vulnerable; and Implementing s trategies for reducing brain drain of key health personnel.
5.6 Some Achievements of the Ministry in 2004
The Ministry was able to meet its target of commencing the provision of Anti-Retro Viral (ARV) therapy for HIV/ AIDS patients in four health facilities. 2,028 people living with AIDS were able to get ARV therapy as against the estimated figure of 2,400 for the full year. The Committee noted that the targeted figure of 2,028 was provisional and that the actual figure would be obtained when the 2004 review for the sector is completed in April this year.
5.7 On Tuberculosis (TB) control, personnel in both public and private health institutions were trained in the diagnosis and management using the Direct Observed Treatment Short Course (DOTS) strategy. As at the end of 2004, 74 districts out of the targeted 80 districts had TB diagnosis centres. National TB cure rate of 61 per cent was achieved as against an estimated cure rate of 55 per cent for the year.
5.8 Buruli ulcer surveillance was integrated into the routine surveillance system. Thirty sentinel surveillance sites were established and five training sessions were held for plastic surgeons anaesthetists, surgical teams and nurses involved in surgical management of the disease from 11 districts.
5.9 On surveillance, sixty-four Emergency Medical Technicians were trained and posted to Accra, Kumasi and Nkawkaw. A new monthly surveillance form using electronic data templates was developed and used by the regions to send data to headquarters in Accra.
5.10 On human resource develop- ment, the Ghana College of Physicians and Surgeons was established and training commenced for residents. Construction and expansion works commenced on sixteen Health Training Institutions as part of measures taken by the Ministry to increase intake of students. Two new Community Health Schools were also set up in Tanoso and Fomena.
5.11 An amount of ¢10 billion was released from the HIPC Funds to four districts for the construction of 18 Community Health Planning and Services (CHPS) compounds. Four district hospitals earmarked for upgrading were completed.
6.0 Total Budgetary Allocation for the Ministry of Health for 2005
An amount of four trillion, two hundred and nine billion, six hundred and ninety million cedis (¢4,209,690,000,000) has been allocated to the Ministry of Health in this year's budget. Details of the composition are indicated in Appendix A.
7.0 Programme for 2005
For the 2005 fiscal year, the Ministry will sustain the gains in 2004 and scale up priority health interventions. These include:
7.1 Service Delivery
Service provision shall lay emphasis on TB, HIV/AIDS, Malaria, Guinea- worm eradication, Polio eradi- cation, Buruli Ulcer, Oncho and Leishmaniasis and Repro-ductive and Child Health Care. Community-Based Health Planning Services (CHPS) will be emp- hasised in the four most deprived regions and hard to reach areas. Skills of Community Health Officers will be enhanced.
Voluntary Counselling and Testing (VCT), provision of Anti- Retroviral Therapy, prevention of Mother to Child Transmission and promotion of condom use will be scaled up.
The National TB Drug Treatment Policy shall be reviewed to allow treatment at the community level.
National Malaria Control pro- gramme will be given the necessary assistance towards production, promotion and retreatment of
affordable Insecticide Treated Nets and the implementation of new anti- malaria treatment policy.
Efforts at eradicating Guinea-worm will be stepped up and sustained to make Ghana free of Guinea-worm within the next four years.
7.2 Emergency Preparedness and Response
The operations of the National Ambulance Service which is currently on pilot basis in Greater Accra, Ashanti and Eastern Regions will be replicated in the remaining regions.
Accident and Emergency Centres in health institutions will be improved.
Surveillance systems will be strengthened and health personnel will be trained to ensure that the health system responds appro- priately to emergencies and epidemics.
7.3 Human Resource Development
Human resource development will focus on increasing the number of health professionals trained through expansion of existing Training Institutions and the establishment of new schools.
Provision of residential accom- modation for staff will be given prominence as a means of enhancing redistribution of human resources.
Staffing levels of deprived and high- risk areas shall be improved through the provision of the Deprived Area Incentives.
7.4 Capital Investment
Expansion of existing training institutions would be continued.
Implementation of CHPS in deprived regions would be intensified.
The construction and rehabilitation of health centres nation wide would be continued.
Five National Blood Transfusion Centres would be established.
Seven district hospitals would be upgraded.
Rehabilitation of Tamale and Wa Regional Hospitals would be continued.
Provision of new offices for Regulatory Bodies and Ghana Post Graduates Medical College of Physicians and Surgeons. There wou ld be a gene ra l replacement of equipment and vehicles in selected hospitals.
There would be a nationwide construction of staff accommo- dation for health workers.
7.5 Collaboration and Partnership
There will be increased involvement of private health providers, NGOs, District Assemblies, Traditional and Alternative Medicine Providers as well as communities in issues of health service development.
7.6 Health Financing
Financing of health service delivery will focus on full implementation of National Health Insurance Scheme (NHIS) with in-built protection for the poor and the vulnerable.
The exemptions scheme will be sustained within the evolving Health Insurance Scheme and the Provisions of Act 650.
Resource allocations will focus on improving the per capita allocation of resources to the most deprived areas.
8.0 General Observations and Recommendations
8.1 Brain drain of key health personnel continued to be a problem in the health sector. The Committee was apprised of measures taken to mitigate the problem, such as provision of decent accommodation and saloon cars to medical personnel. Indeed, these measures are laudable and likely to slow down the rate of exodus, but in the Committee's view, since the underlying cause/factor for the exodus is economic, the Ghana Health Service would continue to lose its trained personnel to the well-endowed economies till comparable attractive packages are introduced.
As a way of shoring up the dwindling number of health personnel, the Committee recommends for an accelerated expansion of facilities in all existing training institutions in the health sector and a correspondent increase in the intake of freshmen/ students. The issue of bonding students from health institutions should be explored as a mechanism of retaining them in the country at least for some time.
8.2 The Committee noted a shortfall in the Ministry's recruitment budget for 2005. Out of an estimated sum of ¢75 billion, the Ministry of Finance and Economic Planning allocated ¢26 billion, leaving a deficit of ¢49 billion. In view of the critical need for trained health personnel to keep the country's health delivery system going, the Committee is of the view that shortfall in resource allocation would
hamper Ministry's recruitment drive. The Committee urges the Ministry of Finance and Economic Planning to take a critical look at this variance and make adequate supple-mentary provision for it.
8.3 An estimate for Additional Duty Hours Allowance (ADHA) by the Ministry of Health for 2005 fiscal year was pegged at ¢816 billion. The Committee observed that the sum of ¢708 billion was allocated by the Ministry of Finance and Economic Planning, leaving a deficit of ¢108 billion.
Whereas the Committee draws the attention of the Ministry of Finance and Economic Planning to the above- mentioned gap, it recommends for an immediate rationalization of the ADHA.
8.4 The establishment of the National Ambulance Service, though on pilot basis, is a welcome development in Ghana's Health Delivery System. The Committee is in agreement with the replication of the National Ambulance Service in all the regions but urges the Ministry of Health to extend it to all constituencies. 9.0 Conclusion
The Committee recommends to the House for approval, the sum of four trillion, two hundred and nine billion, six hundred and ninety million cedis (¢4,209,690,000,000) under Heads 160-165 for the operational expenditure of the Ministry of Health for the fiscal year ending 31st December,
Maj. (Dr.) (Alhaji) Mustapha Ahmed (rtd.) (NDC -- Ayawaso East): Mr.
Speaker, I rise to support the motion and in doing so, just to make a few comments with regard to disease management, the National Health Insurance Scheme, the Regulatory Bodies and a few other pertinent issues.
Mr. Speaker, malaria still tops the ten major disease that affect our people and for which reason admissions are made in most of our hospitals. In 2003, malaria cases formed 24.6 per cent of all admissions in our hospitals. And in 2004, it formed 26.9 per cent of all admissions. This means that there is an increase of 2.3 per cent. Malaria again is the major cause of deaths in our hospitals, even though in the two teaching hospitals, HIV/AIDS is the leading cause of deaths.