Implementation of Ghana's Health User Fee Policy and the Exemption of the Poor: Problems and Prospects

Like many other African countries, Ghana has been implementing a cost-sharing policy in its health sector since the 1990s. The adoption of this policy and the consequent charging of user fees for health services was due to stagnating economies and associated budgetary constraints and increasing gaps between supply and demand for basic social services that have been characteristic of African countries since the 1970s. The main objectives for the adoption of cost-sharing policies have been to improve both quality and access to health services. Studies focusing on the experience of African countries with the implementation of user fees indicate varying findings on the impact of user fees on their health delivery systems. The access of the poor, in particular, has been adversely affected, according to the findings of a number of studies. Policies, such as targeting the poor, have not been effectively implemented to mitigate the impacts of the user fee policy on their access. This paper examines the problems associated with granting exemption to the poor in Ghana. It also discusses the prospects of considering the poor in alternative policies that may be adopted in future. Its main findings indicate that a number of shortcomings of policy adoption, particularly the lack of specification of criteria by which the poor can be identified, make it difficult for health workers to grant exemptions. Further findings show that declining government budget allocations and supplies might have made it imperative for the facility manager to be more concerned about collecting revenue than attending to financial access of the poor. The study, however, suggests that despite the shortcomings of the targeting policy and its implementation, it should continue to be an important component of health policy, considering the vast inequalities in income in the population.