Health Policy and Planning
Volume 29 Issue 3 May 2014
http://heapol.oxfordjournals.org/content/current

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme
Emmanuel Ankrah Odame1,*, Patricia Akweongo2, Ben Yankah3, Francis Asenso-Boadi3 and Irene Agyepong2
Author Affiliations
1Public Health Unit, Ridge Regional Hospital, Ghana Health Service, Box 473, Accra, Ghana, 2School of Public Health, University of Ghana, Box LG13, Legon-Accra, Ghana and 3National Health Insurance Authority, No. 36-6th Avenue, Ridge Residential Area, Private Mail Bag Ministries, Accra, Ghana
Accepted February 28, 2013.
Abstract
Objective: Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes.
Methods: Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective.
Findings: A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme—without a commensurate growth on the amounts generated annually—is an increasing threat to the sustainability of the fund.
Conclusions: Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.