Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study

Abstract

20 Ghana has made significant stride towards universal health coverage (UHC) by implementing the 21 National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC 22 indicators in Ghana from 1995 to 2030 and makes future predictions up to 2030 to assess the 23 probability of achieving UHC targets. National representative surveys of Ghana were used to 24 assess health service coverage and financial risk protection. The analysis estimated the coverage 25 of 13 prevention and four treatment service indicators at the national level and across wealth 26 quintiles. In addition, this analysis calculated catastrophic health payments and impoverishment 27 to assess financial hardship and used a Bayesian regression model to estimate trends and future 28 projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based 29 inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 30 health service indicators are projected to reach the target of 80% coverage by 2030. Across 31 wealth quintiles, inequalities were observed amongst most indicators with richer groups 32 obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all 33 regions will achieve the 80% coverage target with high probabilities for prevention services, the 34 same cannot be applied to treatment services. In 2015, the proportion of households that suffered 35 catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure 36 were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to 37 reduce to less than 0.5% by 2030. Inequality measures and subnational assessment revealed that 38 catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant 39 improvements were seen in both health service coverage and financial risk protection as a result 40 of NHIS. However, inequalities across wealth quintiles and at the subnational level continue to 41 be cause of concerns. Further efforts are needed to narrow these inequality gaps. 42 Introduction 43 Universal Health Coverage (UHC) is a concept in which all people receive the quality, essential 44 services they need without experiencing financial hardship [1,2]. The First Global Monitoring 45 Report formulated by World Health Organizations (WHO) and World Bank identified three 46 dimensions: population, health services, and financing through risk pooling mechanism to track 47 UHC progress [1]. Since its integration into the recently adopted Sustainable Development Goal 48 (SDG) 3, member countries of the United Nations (UN) have committed to achieve UHC by 49 2030 [3]. This commitment consists of two targets: a minimum of 80% essential health service 50 coverage for all people, regardless of socioeconomic status, and 100% financial risk protection 51 from out-of-pocket (OOP) payments for health care [1]. UHC is a key mechanism to ensure 52 affordability and equity as well as to guarantee resilient hea...