Ghana Social Protection Assessment and Public Expenditure Review


Book Description

For most of the last two decades, Ghana's economy has been on a high growth path, which has been accompanied by significant reduction in poverty. Despite this progress, large macroeconomic imbalances threaten growth and continued poverty reduction. Rapid economic growth and poverty reduction has been accompanied by growing inequality in terms of income and geographical areas. The Government of Ghana (GoG) has a comprehensive national social protection strategy (NSPS) in place and is finalizing the national social protection policy. Given existing macroeconomic challenges, resources allocated to social protection programs should be used in the most cost-effective and pro-poor manner. This assessment aims to contribute to the rationalization of social protection public expenditures, building on recent work by the GoG. This report updates the analysis on core social assistance programs, active labor market programs, social insurance schemes including the national health insurance scheme, and general fuel and electricity subsidies. To establish a more effective and sustainable social protection system, the report recommends addressing the following four challenges: consolidating the substantial gains achieved to date and building a stronger program portfolio; strengthening expenditure management; expanding well-targeted programs and rationalizing poorly targeted programs; and ensuring the sustainability of key programs.




Ghana Social Protection Assessment and Public Expenditure Review


Book Description

For most of the last two decades, Ghana's economy has been on a high growth path, which has been accompanied by significant reduction in poverty. Despite this progress, large macroeconomic imbalances threaten growth and continued poverty reduction. Rapid economic growth and poverty reduction has been accompanied by growing inequality in terms of income and geographical areas. The Government of Ghana (GoG) has a comprehensive national social protection strategy (NSPS) in place and is finalizing the national social protection policy. Given existing macroeconomic challenges, resources allocated to social protection programs should be used in the most cost-effective and pro-poor manner. This assessment aims to contribute to the rationalization of social protection public expenditures, building on recent work by the GoG. This report updates the analysis on core social assistance programs, active labor market programs, social insurance schemes including the national health insurance scheme, and general fuel and electricity subsidies. To establish a more effective and sustainable social protection system, the report recommends addressing the following four challenges: consolidating the substantial gains achieved to date and building a stronger program portfolio; strengthening expenditure management; expanding well-targeted programs and rationalizing poorly targeted programs; and ensuring the sustainability of key programs.




Rationalizing Social Protection Expenditure in Ghana


Book Description

This report has been prepared in the context of the Ghana Social Opportunities Project that seeks to support Ghana to rationalize its social protection expenditure. The Report analyses expenditure in terms of its sustainability, robustness, efficiency and effectiveness in preventing or reducing poverty, social exclusion and ill health. It includes an analysis of the current structure of social expenditure and makes recommendations as to how the Government can redirect its resources to the most effective areas and reducing expenditure on less effective activities, in order to increase coverage of the poor and vulnerable despite fiscal constraints.







Securing Development


Book Description

Securing Development: Public Finance and the Security Sector highlights the role of public finance in the delivery of security and criminal justice services. This book offers a framework for analyzing public financial management, financial transparency, and oversight, as well as expenditure policy issues that determine how to most appropriately manage security and justice services. The interplay among security, justice, and public finance is still a relatively unexplored area of development. Such a perspective can help security actors provide more professional, effective, and efficient security and justice services for citizens, while also strengthening systems for accountability. The book is the result of a project undertaken jointly by staff from the World Bank and the United Nations, integrating the disciplines where each institution holds a comparative advantage and a core mandate. The primary audience includes government officials bearing both security and financial responsibilities, staff of international organizations working on public expenditure management and security sector issues, academics, and development practitioners working in an advisory capacity.




Evaluating Public Spending


Book Description

World Bank Discussion Paper No. 318. Analyzes the condition needed for achieving sustainable private sector growth in the Visegrad countries--the Czech Republic, Hungary, Poland, and the Slovak Republic. The analysis focuses on the legal and regulatory framework and institutional capacity, the privatization of state enterprises, and private sector development.




Public Expenditure Analysis


Book Description

Focuses on the public sector in developing countries. Provides tools of analysis for discovering equity in tax burdens as well as in public spending and judging government performance in its role in safeguarding the interests of the poor and disadvantaged. Outlines a framework for a rights-based approach to citizen empowerment - in other words, creating an institutional design with appropriate rules, restraints, and incentives to make the public sector responsive and accountable to an average voter.




Development Centre Studies Can Social Protection Be an Engine for Inclusive Growth?


Book Description

The potential role of social protection in the development process has received heightened recognition in recent years, yet making a strong investment case for social protection remains particularly challenging in many emerging and developing countries. This report challenges us to think deeply about the economic rationale for social protection investments through an inclusive development lens. It helps us understand the links between social protection, growth and inequality; how to measure those links empirically; social protection’s impact on inclusive growth; and how to build a more solid economic case for greater social protection investments.




Ghana National Health Insurance Scheme


Book Description

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.