Ghana’s Health Care Arithmetic – Where is the Money Going to?

By: Kwaku A. Danso

For many years the government of Ghana has been collecting a tax revenue called NHIL, National health Insurance levy, of 2.5% of the value of all goods and services in Ghana towards health care. Nobody has ever given a clear account of moneys collected and the government still does not have an open disclosure of how these funds are applied. In most every country in the civilized world, it would indeed be considered fraudulent and criminal to collect money for a specific purpose and divert the moneys elsewhere.

Ghana’s annual Budgets that I have studied for almost 20 years reads like story books with a few numbers sprinkled, and no specifics or tables one can measure performance with. The World Bank counterparts who give our nations loans are happy to keep piling up debt, knowing that our leaders and finance Ministers only barely have an understanding of the mathematics of loan amortizations and compound interest, and how our debts pile up!

In a report posted on Ghana Leadership Union forum of August 9, 2009, we read: A message titled: “281 more cars for doctors”. The report read:

“The Ministry of Health has presented 281 saloon cars to the Ghana Health Service for distribution to health workers. This is the second batch in a consignment of 600 vehicles under government’s hire purchase programme for health professionals. The program is intended to alleviate transportation difficulties facing health professionals, especially doctors.”

In a presentation communication that no one knows if it’s a true joke, the Health Minister Dr. George Sepah Yankey was reported to have told the doctors as professionals to reciprocate the gesture. He added:

“We want to demonstrate to all health professionals that we are concerned and we care for their working conditions and environment. We believe and we hope that by virtue of what we’re doing today all the recipients will be motivated and encouraged to do their best,” Dr Yankey said.

It is quite unfortunate that in a nation that lacks good physicians to take care of people, and Ministers have no shame in travelling to South Africa and Europe for their health care needs, we make joke about the Arithmetic of human health care and paying doctors. The report said that “on a lighter side Dr Yankey said he is happy the gesture by government is sending doctors smiling” He said “I was just talking to some of the recipients and they were full of smiles,” he said.

A member of our GLU forum asked if the Professor President Mills has started delivering slowly, and here are my comments to share:

I think the Prof has started delivering slowly, especially in the last week or so news about the Vice President talking about decentralization, talking about Commission of Inquiry on Ghana@50, etc. These are the advice I gave the government since they took office and should have been started within the first 2 months, but let’s say he just woke up or was not feeling well and is better now.

I however think that there is something missing in our nation’s financial management when we don’t manufacture cars but want to buy them for officials every 3-4 years and not give them the money instead. There has been no study done to suggest that Doctors of other officials would rather not take the extra $800 per month or more that the car financing would cost. An Average car costing $25,000 financed for 48 months at market rate of interest in Ghana would cost about $800 per month. Why can’t officials buy their own choice of cars and rent or build their own houses, and be paid appropriate and competitive wages! The cost to the government of the 600 cars at say $25,000 comes to $15,000,000. If we borrow that from the World Bank with a payment over ten years at 8% interest, that comes to $181,991 per month for 120 months, or a total of $21,838,967 by the time we finish paying.

Why not try and finance the cost of the vehicles from our own collection of revenue and be done with! For God’s sake, if we have a nation that claimed a Gross Domestic revenue or product of $16 Billion for 2008, and 2.5% NHIL collected on all goods and services sold and imported into the country. Assume we collect on only 50% of the products and services, which comes to 2.5% of the 50% of the non-remittance GDP. (We need to deduct the remittances that were reported to be about $6.1 Billion for 9 months or $8.1 Billion). The 2.5% of 50% of $8 Billion = 2.5% x $4 Billion = $100,000,000 (One hundred million!).

If only 50% of all goods and services in the country attract NHIL and taxes and the rest are in the informal sector, we should receive $100 Million towards the National health Insurance levy alone. Even if only 25% of the goods and services we produce in Ghana and import collect the NHIL, we still have a sizable $50 million to pay the doctors an extra $800 per month or only $5.76 million! Let’s put another $5 Million for our Nurses also.

This is the simply mathematics of Ghana that those of us who deal with numbers in our professions don’t understand. What are the politicians using the moneys they collect for?

This is what makes me think that the Presidents we have and their Ministers and Bank of Ghana officials are either lying or the corruption is so endemic only a total re-engineering of the nation will make Ghana work again! This is the title of my next book, but who is reading anyway! We can only do our best when those embedded in the system act like their feet are in cement and abhor change!

Let the Mills administration start a door and culture of openness in government as the President promised. All revenue sources including taxes on cars, NHIL sources, income taxes, etc, should be listed on a Website that the people can see and read. There is nothing secret about our revenues and expenses. Then let us all put our minds together as intelligent human beings and stop the disgraceful deficit spending and borrowing every year! We need to learn to balance our budget, town by town, district by district, and give power to the people to make their own budgets and elect their own city council and executives! We need to learn to live within our means, as other nations and states like California within a nation of USA do! Budgeting and the Arithmetic of finance is the challenge that makes or breaks some leaders! If we collect $100 million per year for NHIL and can’t pay our doctors $10 million, then the Minister and the President ought to explain what the moneys are used for!

From: Danso, Kwaku A.