PILOT PROGRAM BASED BUDGET (PBB)

(1)

FINAL DRAFT

REPUBLIC OF GHANA

FOR 2013-2015

(2)

MINISTRY OF HEALTH

November 2012

Page 2

TABLE OF CONTENTS

PART A: STRATEGIC OVERVIEW OF THE MINISTRY OF HEALTH ... 3

1.

GSGDA Policy Objectives ... 3

2.

Goal ... 3

3.

Core Functions ... 3

4.

Strategic Policy Objectives ... 4

5.

Policy Outcome Indicators and Targets ... 5

6.

MDA Summary – Expenditure Estimates by Budget Program, Economic Classification and Projects ... 6

PART B: BUDGET PROGRAM SUMMARY ... 7

PROGRAM 1: Management and Administration ... 7

PROGRAM 2: ... 28

PROGRAM 3: Health Service Delivery ... 52

PROGRAM 4: Human Resources for Health Development and Management ... 75

PROGRAM 5: Health Sector Regulation ... 84

PART C: FINANCIAL INFORMATION ... 99

Annexure 1: Summary of Expenditure by Program, Economic Classification and Funding Source... 99

Annexure 2: Expenditure by Program and Sub Program ... 100

Annexure 3: Expenditure by Project and Program ... 101

Annexure 4: Expenditure by Funding and Program ... 102

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MINISTRY OF HEALTH

November 2012

Page 3

PART A: STRATEGIC OVERVIEW OF THE MINISTRY OF

HEALTH

1.

GSGDA Policy Objectives

The GSGDA contains five (5) Policy Objectives that are relevant to the

Ministry of Health

These are as follows:



Bridge the equity gaps in access to health care and nutrition services and ensure sustainable

financing arrangements that protect the poor



Improve governance and strengthen efficiency and effectiveness in health service delivery



Improve access to quality maternal, neonatal, child and adolescent health services



Prevent and control the spread of communicable and non-communicable diseases and

promote healthy lifestyles



Expand access to and improve the quality of institutional care, including mental health

service delivery

2.

Goal

To have a healthy and productive population that reproduces itself safely

3.

Core Functions

The core functions of the Ministry of Health are:



Provision of leadership and Governance



Policy formulation, development and coordination



Provision of Health Care Services



Regulation of the Health facilities and professions



Development of human resource for the Health sector

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MINISTRY OF HEALTH

November 2012

Page 4

4.

Strategic Policy Objectives

The MDA has adopted the following strategic policy objectives to guide its

efforts to fulfill the national policy objectives:



Bridge equity gaps in access to health care and ensure sustainable financing arrangements that

protect the poor



Strengthen governance and improve the efficiency and effectiveness of the health system



Improve access to quality maternal, neonatal, child and adolescent health and nutrition

services



Intensify prevention and control of communicable and non-communicable diseases and

promote healthy lifestyles

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MINISTRY OF HEALTH

November 2012

Page 5

5.

Policy Outcome Indicators and Targets

Outcome

Indicator

Description

Unit of

Measurement

Baseline

Latest status

Target

Year

Value

Year

Value

Year

Value

Infant Mortality Rate - Number of deaths occurring in the first year of life per 1,000 live births 2008 50 - - 2013 35 Under-five mortality rate - Number of deaths occurring in the first five years of life per 1,000 live births 2008 80 - - 2013 40 Under-five malnutrition rate - The proportion of children under-five whose weight for age is less than two standard deviations from the median of a reference group < 2 SDs 2008 13.9% - - 2013 8% Maternal mortality ratio - Number of maternal deaths per 100,000 live births 2008 451

-

- 2013 226

HIV prevalence

among young

people aged

15-19 years old Percent of blood samples taken from pregnant women that test positive for HIV

2008 1.9%

-

- 2013 < 2%

HIV prevalence

among young

people aged

20-24 years old 2008 2.2%

-

- 2013 < 2%

HIV prevalence

among young

people aged

25-29 years old 2008 3.7%

-

- 2013 < 2%

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MINISTRY OF HEALTH

November 2012

Page 6

6.

MDA Summary – Expenditure Estimates by Budget Program, Economic

Classification and Projects

Expenditure By Budget Program

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

BP1 Management and

Administration

-

BP2 Strategic National Health

Program

-

BP3 Health Service Delivery

358,950,282 348,634,612 342,259,942

BP4 Human Resource for Health

Development

-

BP5 Health Sector Regulation

-

Total Expenditure

Expenditure by Economic

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

21 Compensation of Employees

-

22 Use of Goods and Services

-

25 Subsidies

-

26 Grants

-

27 Social Benefits

-

28 Other Expenses

-

Capital Expenditure

31 Non-Financial Assets

-

Total Expenditure

Expenditure by Program and

Projects

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

BP1 Management and

Administration

-

BP2 Health Policy and

Performance Monitoring

-

BP3 Strategic National Health

Program

-

BP4 Health Service Delivery

358,950,282 348,634,612 342,259,942

BP5 Human Resource for Health

Development

-

(7)

MINISTRY OF HEALTH

November 2012

Page 7

PART B: BUDGET PROGRAM SUMMARY

PROGRAM 1: Management and Administration

1. Budget Program Objectives



To provide an efficient and effective leadership in the management of the health sector



To improve planning, management, monitoring and evaluation in the delivery of health

services



To establish norms, guidelines, standards and system accountability for the regulation of

the sector

2.

Budget Program Description

To ensure that the broad objectives of the Health Sector are met, the Management and

Administration program combines all the system-wide activities that are required to deliver

quality health care to the population of Ghana. These include functions such as General

Management, Health Information, Statistics and Technology Communication Management,

Health Policy Formulation, Planning, Budgeting and Monitoring and Evaluation, Finance,

Procurement, Supply and Logistics and Internal Audit.

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MINISTRY OF HEALTH

November 2012

Page 8

3.

Budget Program Summary : Expenditure by Sub-Program, Economic

Classification

Program 1: Management and Administration

Expenditure By Budget Sub-Program

2011 2012 2013 2014 2015

Actual Budget Est. Outturn

Budget Indicative Indicative

GH₵ GH₵ GH₵

BSP1.1 General Management _- _- _-

BSP1.2 Health Information, Statistics and Technology Communication

Management - - -

bsp1.3 Health Policy Formulation, Planning, Budgeting, Monitoring and

Evaluation - - -

BSP1.4 Finance _- _- _-

BSP1.5 Procurement, Supply and

Logistics - - - BSP1.6 Internal Audit _- _- _- Total Expenditure Expenditure by Economic Classification 2011 2012 2013 2014 2015

Actual Budget Est. Outturn

GH₵ GH₵ GH₵

Current Expenditure

21 Compensation of Employees _- _- _-

22 Use of Goods and Services _- _- _-

25 Subsidies _- _- _- 26 Grants _- _- _- 27 Social Benefits _- _- _- 28 Other Expenses _- _- _- Capital Expenditure 31 Non-Financial Assets _- _- _- Total Expenditure Expenditure by Projects 2011 2012 2013 2014 2015

Actual Budget Est. Outturn

GH₵ GH₵ GH₵

- - -

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MINISTRY OF HEALTH

November 2012

Page 9

BUDGET SUB-PROGRAM SUMMARY

PROGRAM 1: Management and Administration

SUB-PROGRAM 1.1: General Management

1.

Budget Sub-Program Objectives



To provide overall leadership to and management of the overall health sector



To facilitate conducive working conditions for MOH Headquarters



To ensure adequate performance appraisal, capacity development and staff career

progression.

2.

Budget Sub-Program Description

General Management ensures the overall leadership and management of the sector through the

facilitation of appropriate legal framework within which health services are provided. It also

oversees the coordinating activities of the Ministry and its agencies through the issuance of

directives that are consistent with the policy direction of the Ministry. It provides administrative

support in the areas of transport and logistics management. It also manages the properties of the

Ministry in addition to looking after personnel matters involving career development,

progression, succession and welfare.

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MINISTRY OF HEALTH

November 2012

Page 10

3.

Budget Sub-Program Results Statement

The table indicates the main outputs, its indicators and projections by which the Ministry

measures the performance of this sub-program. The past data indicates actual performance whilst

the projections are the Ministry’s estimate of future performance.

Main Outputs Output Indicator

Past Years Projections

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015

Directors and unit heads meetings organised Number of local management meetings held - 41 52 71 80 80 International committee meetings hosted and attended

Number of International committee meetings

Hosted - - 3 5 - -

Attended - - 10 15 17 20

Encounter with the

press organised Number of press _{encounters held} 70 60 70 70 70 70

4.

Budget Sub-Program Operations and Projects

The table lists the main Operations and Projects to be undertaken by the sub-

program.

Operations Projects (Investment)

Administrative supervisory support Procure office furniture, computers and accessories

Estate management Building of 40ft container for storing of unserviceable

items that are to be auctioned

Transport management Two (2) pick-ups, 1 VVIP vehicle and 2 motor bikes for

dispatch of letters Inter-Ministerial/Sectorial collaboration

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MINISTRY OF HEALTH

November 2012

Page 11

5.

Budget Sub-Program Summary: Expenditure by Economic Classification

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

-

25 Subsidies

-

26 Grants

-

27 Social Benefits

-

28 Other Expenses

-

Capital Expenditure

-

Total Expenditure

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MINISTRY OF HEALTH

November 2012

Page 12

SUB-PROGRAM 1.2: Health Information, Statistics and Technology

Communication Management

1.



To develop standards, policies and guidelines for information automation and operational

research



To establish a computer network support systems and maintain the MoH website



To develop a repository of routine and non-routine information

2.

This sub-program is responsible for the development of standards, policies and guidelines for

health information and technology communication of the health sector. It coordinates the

development of a repository of routine and non-routine information to inform decision-making.

It further establishes computer and network support systems and maintains the Ministry’s

corporate website as a central broadcast facility for the sector, as well as generates, collates,

stores and disseminates information.

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MINISTRY OF HEALTH

November 2012

Page 13

3.

The table indicates the main outputs, its indicators and projections by which the Ministry

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Health Information Systems enhanced Number of research proposals reviewed - 1 1 1 2 - Number of research publications produced - - 1 1 2 - Number of research agenda developed - - - 1 - - Number of staff trained in statistical analysis - - 1 1 2 - Percentage of data repository completed - 20 35 50 - - Information and Communication Technology environment improved Number of ICT maintenance visits conducted 1 2 1 2 2 -

Number of ICT staff

trained 1 - - 2 2 -

Number of internet service and anti-virus contract renewed 1 1 1 1 1 - Re-designed corporate website - - 1 - 1 - Number of intranet and electronic documentation systems conducted - - - 1 - - Number of IT penetration at health facilities conducted - - - 1 - -

(14)

MINISTRY OF HEALTH

November 2012

Page 14

4.

Budget Sub-Program Operations and Projects

program.

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

Operations Projects (Investment)

Strengthen information and technology management Procurement of ICT equipment

Create enabling environment for health information systems

and research Acquisition of 4 X 4 Toyota Pick up

Assess operational capacity in M&E

Monitor use of DHIMS2 by regions and districts Scale up electronic medical records systems Strengthen Medical Records Management (MRM) Performance monitoring

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MINISTRY OF HEALTH

November 2012

Page 15

SUB-PROGRAM 1.3: Health Policy Formulation, Planning, Budgeting,

Monitoring and Evaluation

1.



To develop and update sector policies in line with new evidence and priorities



To co-ordinate the preparation and implementation of the Sector’s Medium Term

Development Plan (HSMTDP), Annual Programme of Work (APOW) and the Medium

Term Expenditure Framework (MTEF) Budget



To mobilise and optimally allocate and disburse resources



To address infrastructural gaps in health service delivery



To monitor the implementation of key health sector programmes in accordance to agreed

performance frameworks



To evaluate major health sector programmes to ascertain its cost effectiveness and benefit

to the general public

2.

The sub-program coordinates the analysis, development and implementation of sector policies

and priorities based on new evidences and past experience. It involves setting the strategic

direction and development of the health sector medium term and annual operational plans which

provide the basis of expenditure for the sector for a particular fiscal year. It includes capital

budgeting, investment appraisals, internal and external resource mobilization and capital projects

management. It also involves national health accounting and liaising up with MoFEP to ensure

timely disbursements of funds to the sector and flow of funds to the agencies.

The sub-program further allows performance of the health sector to be assessed through in-depth

program monitoring and periodic evaluations. This is conducted using annual and independent

sector reviews, holistic assessments of agreed core sets of sector-wide indicators, milestones and

logical frameworks.

The sub-program also encompasses public private sector collaboration, promotion of healthy

lifestyles and development of policies and programs for the alternative and traditional medicine.

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MINISTRY OF HEALTH

November 2012

Page 16

3.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015

Health policy reviews conducted

Number of policies

reviewed - - 1 4 6 8

HSMTDP (2014 - 2017) and Annual 2013 Sector Program of Work prepared, printed and disseminated HSMTDP approved at Business meeting by 30th November - - 30th November - - Annual Program of Work 1 1 1 1 1 1

Budget administration and management

Percentage budget

execution achieved 70 75 78 85 90 95

Capital Investment Plan 2014-2018 developed, printed and disseminated

Capital Investment Plan approved at Business meeting by 30th November - - 30th November - -

Health sector programs and activities monitored and reviewed Number of reports generated 4 4 4 6 6 6 Number of monitoring and evaluation visits carried out 2 2 2 8 8 8 Report on evaluation of free maternal care - - - 1 - - Number of In-depth reviews conducted - - - 2 2 2 Performance reporting strengthened Number of Agencies providing timely reports on implementation status of planned programs and activities. 2 2 2 12 17 17

Healthy lifestyle practices inculcated in the health sector & general public

Number of healthy lifestyle campaigns conducted

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MINISTRY OF HEALTH

November 2012

Page 17

PPP funding resources identified and mobilized

Percentage of resources mobilized 60 80 100 100 - - Facilitate Batch – to –Batch quality control 60 80 100 100 - - Availability of health information on traditional medicine improved Percentage of selected candidate products for R&D

60 80 100 100 - -

Policy on the up-scaling of commercially important

medicinal plants policy book developed

Percentage of identified rare and commercially important medicinal plants

- 38 80 - - -

4.

Budget Sub-Program Operations and Projects

program.

Operations Projects (Investment)

Policy analysis, development and implementation Renovation of offices of the planning and budget unit,

office equipment and machines.

Planning and budgeting Procure 1 Number station wagon

Public financial management Monitoring and evaluation

Capital investment and project management Resource mobilization

National health accounting Healthy lifestyle promotion Public private sector collaboration

(18)

MINISTRY OF HEALTH

November 2012

Page 18

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

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MINISTRY OF HEALTH

November 2012

Page 19

SUB-PROGRAM SP 1.4: Finance

1.



To ensure efficient and prudent management of the finances of the sector.



To prepare timely, relevant and reliable financial reports for the Health Sector

2.

This sub-program aims at ensuring a prudent financial management system throughout all

agencies under the Ministry. It guarantees compliance with accounting, treasury and financial

rules and regulations as prescribed by the FAR. It further enhances the effective management of

the sector funds through regular and timely release of funds to the Ministry and its Agencies.

The sub-program also seeks to uphold expenditure control and management of assets register. It

involves the preparation of timely, relevant and reliable financial reports for management

decision making and external scrutiny. This is to ensure accountability and transparency in the

use of public funds within the sector

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MINISTRY OF HEALTH

November 2012

Page 20

3.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Financial monitoring visits Number of financial monitoring visits to agencies 4 5 5 8 8 8 Quarterly financial reports prepared and validated for the sector Number of financial report prepared and Validated. 4 4 4 4 4 4 Timely submission of Financial reports 31st March 31st March 31st March 31st March 31 st_March ₃₁st_March

4.

Budget Sub-Program Operations and Projects

program.

Operations Projects (Investment)

Financial management and accounting. Procurement of vehicles

Financial monitoring and reporting

Office equipment Expenditure control

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MINISTRY OF HEALTH

November 2012

Page 21

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

(22)

MINISTRY OF HEALTH

November 2012

Page 22

SUB-PROGRAM SP 1.5: Procurement, Supply and Logistics

1.

This sub-program is mandated to perform the following objectives:



To undertake needs assessment and planning of all health commodities and logistics

required to support health service delivery



To prepare and implement annual sector procurement plans



To develop and implement policies to ensure that all goods and services procured meet

required quality and safety requirements



To ensure that appropriate infrastructure exists to support optimum receipt storage and

appropriate distribution of all goods procured throughout the supply chain



To manage the entire procurement and supplies process



To develop and implement a designed system for debt collection for the Central Medical

Stores and Regional Medical Stores

2.

This sub-program undertakes the procurement, logistics and supplies functions of the Ministry. It

involves national quantification and forecasting of health commodities, sector-wide procurement

planning and implementation and contract management. It ensures quality assurance for goods

and services procured. Further, it provides country-wide appropriate warehousing for health

commodities. Moreover, it affords monitoring of debt recovery of the medical stores so that they

are not distressed.

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MINISTRY OF HEALTH

November 2012

Page 23

3.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Affordable and Quality Health Commodities procured on time Percentage of health commodities procured 75 88 90 95 95 98

4.

Budget Sub-Program Operations and Projects

program.

Operations Projects (Investment)

National Quantification and Forecasting of Health Commodities

Procurement of Medical Equipment

Sector-Wide Procurement Planning and Implementation Procurement of Vehicles and Spare Parts

Quality assurance Procurement of Office Equipment and Accessories

Warehousing

Debt Recovering Monitoring Contract Management

(24)

MINISTRY OF HEALTH

November 2012

Page 24

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

(25)

MINISTRY OF HEALTH

November 2012

Page 25

SUB-PROGRAM SP 1.6: Internal Audit

1.



To provide an independent, objective assurance and special audit assignments designed to

add value and improve operations.



To monitor compliance and value for money within the sector through internal control

mechanisms

2.

The operations carried out under this sub-program include conducting routine audit inspections,

performance audit and special investigations in the BMCs under the Ministry. It also allows

pre–audit as a preventive measure; post–audit to correct excesses; and follow ups on

implementation of internal, external and financial monitoring audit recommendations within the

agencies. It determines whether the internal control mechanisms of the MOH are effective,

efficient and economical.

The sub-program further enables the Ministry to compile and produce all audit report to the

Minister, IAA and other stakeholders. It also prints Strategic Internal Audit Plan, Manual and

Program. Additionally, it determines through quality assurance / assessment, monitoring and

supervisory visits whether:



There is a judicious use of the Ministry’s finances;



Procurement is within the annual programme of work as planned and approved;



Accounts and statements are prepared according to FAR, ATF regulations and accepted

accounting standards;



All cash inflows and outflows are appropriately receipted;



Malfeasance and other irregularities have occurred and

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MINISTRY OF HEALTH

November 2012

Page 26

3.

measures the performance of this sub-program. The past data indicates actual performance whilst

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Audit inspections an d investigations Number of audit inspections and investigations conducted - 20 16 20 25 30 Audit and compliance reports Number of Reports produced - 6 6 8 10 12

Performance Audit Number of audits

conducted - - - 2 4 8

Quality Assurance of IAU

Number of

reviews carried out - - - 5 7 10

Monitoring and supervisory visits made to all agencies Number of visits carried out - 2 1 4 4 4

4.

Budget Sub-Program Operations and Projects

program.

Operations Projects (Investment)

Conduct Audit Inspections and Investigations

Procurement of 10 pick-up Vehicles

Compilation of Audit and compliance Report Procurement of 2 Cross Country Vehicles

Conduct Performance Audit Procurement of 6 laptops and accessories

Quality Assurance Review Monitoring and supervisory visits

(27)

MINISTRY OF HEALTH

November 2012

Page 27

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

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MINISTRY OF HEALTH

November 2012

Page 28

BUDGET PROGRAM SUMMARY

PROGRAM 2: Strategic National Health Program

1.

Budget Program Objective

To define cost-effective and context-specific interventions for key strategic national health

programmes in order to reduce morbidity and mortality.

2.

The program coordinates and manages strategic national health programs relating to maternal,

neonatal and child health, communicable and non-communicable diseases, occupational health

and safety and research. It includes implementation of specific policies and programs aimed at

conducting operational research and other interventions. It involves surveillance and disease

control systems for communicable diseases consistent with national, bilateral and international

expectations. It further provides technical support for the Regional Public Health reference

laboratories.

Additionally, it provides support, monitoring and evaluation of EPI programs and projects in

collaboration with the Regions, Districts and other health program implementing agencies with

a view of promoting program effectiveness and efficiency. The programme also supports the

procurement of drugs and vaccines and effective allocation of resource for efficient service

delivery.

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MINISTRY OF HEALTH

November 2012

Page 29

3.

Budget Program Summary : Expenditure by Sub-Program, Economic

Classification

Program 2: Strategic National Health Program

Expenditure By Budget

Sub-Program

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

BSP1 Strategic Implementation and

Operational Performance

BSP 2Maternal, Neonatal and Child

Health and Nutrition

BSP 3 Communicable Disease

BSP 4 Non Communicable Disease

BSP 5 Occupational Health and

Safety

BSP 6 Research

Total Expenditure

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

Expenditure by Projects

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Total Expenditure

(30)

MINISTRY OF HEALTH

November 2012

Page 30

PROGRAM 2: Strategic National Health Programs

SUB –PROGRAM SP 2.1 Strategic Implementation and Operational

Performance

1.



To provide support and guidance for the implementation of various health intervention



Conduct operational research and information to serve as basis of scaling up health

intervention



Provide human and technical support for implementation national strategic programmes.

2.

Budget Sub-Program Description

The sub program provides leadership, support and coordination of health service delivery

programs and other strategic interventions aimed at scaling health outcomes. The strategic

performance management program coordinates all policies, provide information, conducts

operational research for improving specific health interventions, indicators and outcomes.

It also ensures the allocation of resources to national, regional, district and sub district level

for the implementation of service delivery activities. It also enhances the procurement of

drugs and other equipment for health service delivery especially for the regional hospitals,

district hospitals and health centres.

Key in the mandate of this sub program is the delivery of health administration for

implementation of various health programs and health service delivery activities. The strategic

implementation management also liaises with the Human Resource Directorate of the

Ministry of Health to provide adequate human resources with the requisite skills and capacity

for the implementation of health service programs and activities.

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MINISTRY OF HEALTH

November 2012

Page 31

3.

measures the performance of this sub-program. The past data indicates actual performance

whilst the projections are the Ministry’s estimate of future performance.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Capacity building program on research carried out Number of research staff trained - - 20 50 60 70 APOW GHS

developed Developed by - - End of June End of June End of June End of June

Policy Briefs produced Policy Briefs produced by - - End of April End of April End of April End of April Annual Reviews conducted Annual Review Report completed by - - - End of April End of April End of April GHS Financial Statement GHS Financial Statement Completed

(32)

MINISTRY OF HEALTH

November 2012

Page 32

4.

Budget Operations and Projects

The table lists the main Operations and projects to be undertaken by the

program

Operations Projects (Investment)

Assess Operational Capacity in M&E Remodelling of Workshops into Offices, Construction of

2-Storey Office Block, Paving of Yard and Improvement of Drainage System at LFC

Monitor use of DHIMS2 b y regions and districts GHS Learning Centre at Pantang

Scale up Electronic Medical Records Systems Construction of GHS Office Complex - Precontract

Activities and Construction of Fence wall Strengthen Medical Records Management (MRM)

Remodelling of 4-Storey Office Block for Centre for Disease Control including Rehabilitation of Access Road Performance monitoring

Rehabilitation of No. 18 Bungalow at Labone, Accra for GHS Headquarters

Report writing Reconstruction of Offices for Nutrition Unit

Conduct Operational Research as per the National Research Agenda

Outstanding Bills and Payment of Retention Organise an annual National Research Dissemination Forum

Organize an annual Stakeholder meeting with other Research Institutions involved in Health Research

Strengthen the Documentation Centre at the National Level Conduct Operational Research as per the National Research Agenda

Organise an annual National Research Dissemination Forum Coordinate 2014 Planning and Budget Process

Review and finalize GHS gender mainstreaming operational guidelines for service providers ( ensuring that the guidelines include information on gender specific rights and obligations of clients and services providers and other emerging issues) Disseminate guidelines to Regional and District levels Train /sensitize all RHMT members on gender dimensions in health (to be able to render gender sensitive health services.

Organise routine visit to regions with council members to monitor the progress of work on MNCH and other programmes

Undertake a monthly feature article in the dailies, weekly radio discussion about MNCH and other prevailing health issues

Deploy Active Directory Domain Services (ADDS) manage users, computers and other objects on the network

Install, configure and monitor user activities on the network, behavioural measures (e.g. patch status, virus infection, password resets, social engineering)

Install and configure smart scalable switches to manage the network properly and prevent penetration of unauthorized users

Organise routine visit to regions with council members to monitor the progress of work on MNCH and other

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MINISTRY OF HEALTH

November 2012

Page 33

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

programmes

Undertake a monthly feature article in the dailies, weekly radio discussion about MNCH and other prevailing health issues

Organise quarterly financial validation of returns from regions and districts.

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MINISTRY OF HEALTH

November 2012

Page 34

SUB-PROGRAM SP 2.2: Maternal, Neonatal & Child Health and Nutrition

1.



To reduce the major causes of maternal and neonatal deaths



To improve adolescent health



To reduce the major causes of child mortality and morbidity

2.

The sub-program interventions take account of improving family planning services, sustaining

coverage of antenatal care, scaling up of skilled maternal deliveries and comprehensive

essential and intensive obstetric care in all health facilities. It also ensures mainstreaming of

gender in reproductive health care services.

The sub-program further incorporates child health interventions such as scaling of Integrated

Management of Childhood illness in health facilities. The sub-program further entails

improvement of child survival and development by ensuring that all children are fully

immunized. It ensures availability of quality information on adolescent sexual reproductive

health services. An essential component of the sub-program is the High Impact Rapid

Delivery intervention (HIRD), and Millennium Accelerated Framework (MAF).

(35)

MINISTRY OF HEALTH

November 2012

Page 35

3.

measures the performance of this sub-program. The past data indicates actual performance

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Institutional infant mortality rate Baseline to be established 1% 1.0% 0.8% 0.8% 0.5% 0.5% Maternal mortality rate per 100,000 live births Deaths per 100,000 live births 451 226 181 181 181 181 Improved antenatal care Percentage of pregnant women attending at least 4 antenatal visits 62.4 70.0 74.6 80.1 - - Family planning services

Total couple years of protection (CYP)

Short Term 1,056,715.4 - 1,300,000 1,400,000 1,500,000 1,600,000 Long Term 329,399 - 360,000 420,000 480,000 540,000 Improved child immunization Percentage of children immunized by age 1 -BCG 95 95 95 98 98 98 Percentage of children immunized by age 1 - Penta 3 90 90 90 95 95 95 Percentage of children immunized by age 1 – Penvar 3 90 90 90 95 95 95 Percentage of children immunized by age –Rotarix 3 - 90 95 95 95 95

(36)

MINISTRY OF HEALTH

November 2012

Page 36

Percentage of children immunized by age 1 -OPV1 93 95 95 98 98 98 Percentage of children immunized by age 1 -OPV 3 90 90 90 95 95 95 Percentage of children immunized by age 1 – Measles 90 90 90 95 95 95 Percentage of children immunized by age 1 -Yellow Fever 90 90 90 95 95 95 Percentage of children aged 6 MTHS to 59mths receiving at least one dose of Vitamin A 70 75 78 80 80 Family planning service Percentage of clients (15-24 years) who accepted FP service 10 12 14 15 16 17

(37)

MINISTRY OF HEALTH

November 2012

Page 37

4.

The table lists the main Operations and Projects to be undertaken by the

sub- program.

Operations Projects (Investment)

Upgrade the skills of trained Maternal and Neonatal health service providers-(Implement child health policy, adolescent policy

Remodelling of Workshops into Offices, Construction of 2-Storey Office Block, Paving of Yard and Improvement of Drainage System at LFC

Organize a ToT for pharmacists over 5 days - 4 persons per region for 10 regions

GHS Learning Centre at Pantang Develop / review & produce leaflets, radio spots on healthy

eating and healthy lifestyle

Construction of GHS Office Complex - Precontract Activities and Construction of Fence wall

Conduct Community Health & Nut Service & 1st weighing (Implement national nutrition policy

Remodelling of 4-Storey Office Block for Centre for Disease Control including Rehabilitation of Access Road Increase FP service and Skilled delivery

Rehabilitation of No. 18 Bungalow at Labone, Accra for GHS Headquarters

Implement recommendation of report on EmONC Reconstruction of Offices for Nutrition Unit

Strengthen implementation of life saving skills at district and sub-district level and build Regional Resource teams

Outstanding Bills and Payment of Retention Raise awareness on socio-cultural barriers to access to

maternal and new born care

Increase number of midwives trained and expand training in midwifery to CHO

Increase access to safe blood for expectant mothers and new born

Enhance training schools’ curriculum to produce cadres of staff with skilled mix in the areas of midwifery, obstetric care, child health and health promotion

Implement the MAF plan

Increase the uptake of EPI services MLM Training for District Maintain cold chain

(38)

MINISTRY OF HEALTH

November 2012

Page 38

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

(39)

MINISTRY OF HEALTH

November 2012

Page 39

SUB-PROGRAM SP 2.3: Communicable Diseases

1.

Budget Sub-Program Objective

To improve prevention, detection and case management of communicable diseases

2.

Budget Sub-Program Description

The sub program will scale up and sustain efforts aimed at eradicating and eliminating

targeted disease.

This includes;



HIV /AIDS, TB, Malaria diseases targeted for eradication



Diseases targeted for elimination such as Polio, Guinea worm, Oncho etc.



Enhance early detection reporting and treatment of communicable disease. Specific focus

will be on strengthen surveillance and epidemics preparedness with respect to cholera,

meningitis, yellow fever and any emergent diseases.

(40)

MINISTRY OF HEALTH

November 2012

Page 40

3.

measures the performance of this sub-program. The past data indicates actual performance

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 HIV/AIDS Number of new HIV positive cases diagnosed - 19,402 21,869 18,769 - - Number of HIV+ cases receiving ARV therapy (cumulative) - 63,861 78,919 - - - Guinea Worm Number of guinea worm cases seen <_ 20 0 0 0 0 0 Proportion of guinea worm cases contained 100% 100% 100% 100% 100% 100%

Polio Non Polio

AFP rate. ≥2/100,000 ≥2/100,0 00 ≥2/100, 000 ≥2/100, 000 - - Malaria Proportion of OPD cases that is due malaria (total) 35% 32.5% 30.0% 28.0% 26.0% 24.0% Proportion of OPD cases that is lab confirmed malaria. (microscopy + RDTs) 30% 40% 45% 60% 75% 90% Proportion of admissions due to lab confirmed malaria (all ages) 10.0% 8.0% 9.0% 6.0% 4.0% 2.0%

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MINISTRY OF HEALTH

November 2012

Page 41

Proportion of deaths due to malaria (all ages) 15% 12.0% 10.0% 8.0% 6.0% 4.0% Malaria case fatality rate (under 5 years) 1.3% 1.2% 1.1% 1.0% - - Proportion of pregnant women on IPT- P (at least two doses of SP) 42.5% 45.0% 50.0% 56.0% 60% 65% Percentage of children under 5 using ITN 50% 65% 70% 75% 80% 85% TB cases improved TB case notification rate 55/100,000 58/100,0 00 62/100,000 75/100,000 - - Increase case notification and treatment for tuberculosis Treatment success rate - 87 90 90 90 -

Treat all cases of HIV+ with ARVs proportion of HIV+ patients on ARTs 51,814 65,914 80,014 - - -

(42)

MINISTRY OF HEALTH

November 2012

Page 42

4.

sub- program.

Operations Projects (Investment)

Implement supplementary immunization activities for polo and yellow fever

Procure vaccines for immunization

Implement national strategic plans to reduce malaria case fatality among pregnant women and children

Implement national strategic plan to increase TB case detection and cure rate

Maintain status and validate elimination of guinea worm and polio

Review and make ready emergency response plans for disease of epidemic potential (CSM, HINI)

(43)

MINISTRY OF HEALTH

November 2012

Page 43

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

(44)

MINISTRY OF HEALTH

November 2012

Page 44

SUB-PROGRAM SP 2.4: Non Communicable Diseases

1.



To improve prevention, detection and case management of non-communicable diseases



To increase awareness and promote healthy lifestyles

2.

The sub-program involves creating awareness of NCDs (Cancers, cardiovascular diseases,

diabetes, asthma and injuries, sickle cell disease) and their risk factors. It strengthens

structures for coordinating national response. It improves surveillance of NCDs risk factors,

national capacity to manage and identifies persons at risk. It establishes screening centres,

provides quality clinical care including palliative care and promotes compliance with care.

The sub-program further aims at reducing risk factors related to health with strong emphasis

on health lifestyles and environment. The specific interventions embody promotion of

regenerative health and nutrition. There are also community focus interventions that place

premium on behaviour change, school health programs, and feeding and physical exercise.

3.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Management of non-communicable disease Percentage of OPD cases that is Hypertension 4.0 4.2 4.5 5.0 5.5 6.0 Percentage of OPD cases that is diabetes 0.8 0.9 1.0 1.2 - - Percentage of OPD cases that is Sickle

(45)

MINISTRY OF HEALTH

November 2012

Page 45

4.

sub- program.

Operations

Projects (Investment)

Promote healthy lifestyle awareness among the general

population Refurbishment of Health Promotion office

Promote traditional food technologies to improve

bioavailability of micronutrients Procure equipment for HPD HQ

Advocate for the passage of the National Tobacco Control

Legislation Procure office furniture and ICT equipment

Implement Regenerative Health and Nutrition Develop national strategy to reduce use of alcohol Conduct a workplace health impact assessment Management of non- communicable diseases

Establish National NCD Epidemiology Reference Group Expand screening programmes for selected non-

communicable diseases: hypertension, diabetes, sickle cell and selected cancers.

Increase effective clinical management of NCDs

Provide education on family health, health promotion, and disease prevention

Develop/reprint IE&C/BCC materials (counselling cards, brochures, posters and booklets) and distribute to regions. To conduct in depth interviews & focus group (FG)

discussions to understand issues around male involvement in family planning.

Develop materials / strategies (Nutrition Advocacy& strategy, Nutrition Policy, Review of Anaemia Control Strategy, Post NID Strategy, SSFF)

To identify one district in a region and make it a Model HP district

To strengthen the ICC-HP at all levels

Finalization and review of the Health Promotion policy and the development of a strategic plan

Provide vehicle to strengthen transport at HPD HQ and for M&E

(46)

MINISTRY OF HEALTH

November 2012

Page 46

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

(47)

MINISTRY OF HEALTH

November 2012

Page 47

SUB-PROGRAM SP 2.5: Occupational Health and Safety

1.



To promote safe and healthy work environment, work practices and procedures in order to

minimize work-related injuries and illnesses



To ensure safe disposal of medical waste

2.

The focus of occupational health will be on improving client focus services, patient safety and

clinical practices. Key interventions include establishing functional Occupational Health Units

in facilities, strengthening quality assurance teams in facilities and improving customer care

programs. It also establishes standardized adverse event reporting systems.

3.

Main Outputs

Output Indicator

Past Years

Projections

2010

2011

2012

Budget

Year

2013

Indicative

Year

2014

Indicative

Year

2015

(48)

MINISTRY OF HEALTH

November 2012

Page 48

4.

sub- program.

5.

Budget Sub-Program Summary: Expenditure by Economic Classification

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

Operations Projects (Investment)

Monitoring and Implementation of Occupational Health

Policy No projects

Development of IEC material on workplace HIV/AIDS for health sector

Development of regional workplace HIV/AIDS implementation programmes by regions

Periodic monitoring and annual reviews of implementation of workplace HIV programme

Procurement of waste disposal materials, equipment and personal protective equipment (Capital investments)

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MINISTRY OF HEALTH

November 2012

Page 49

SUB-PROGRAM SP 2.6: Research

1.



To undertake operational research



To strengthen evidence-base for policy development and planning

2.

The health sector has a number of research departments such as the Centre for Scientific

Research into Plant Medicine (CSRPM), Kintampo, Dodowa, Adabraka and the Navrongo

health research centres which are involved in extensive research activities.

The sub-program takes into account research and development of herbal medicines, cultivation

of medical plants and analysis of herbalist products. It also seeks to standardise research

procedures and conduct operational research using the national research agenda. Additionally,

it involves the documentation of research findings and statistics in the sector.

(50)

MINISTRY OF HEALTH

November 2012

Page 50

3.

whilst the projections are the Ministry’s estimate of future performance.

Main Outputs Output Indicator

2010 2011 2012 Budget Year 2013 Indicative Year 2014 Indicative Year 2015 Access to Herbal medicines improved Number of Herbal medicines produced 7m (Assorted) 10m (Assorted) 13m (assorted) 18m (Assorted) 25m assorted 30m Number of Herbal medicines formulated 5 5 6 4 8 10 Number of Herbalist products analyzed 391 456 154 308 462 500 Number of Medicinal plants cultivated and maintained 10,000 (assorted plants) 10,000 (assorted plants) 10,000 (assorted plants) 10,000 (assorted plants) 11,000 (assorted plants) 12,000 (assorted plants) Number of research publications 6 8 8 10 10 10 Number of patients attended to by the Clinic 13,000 16,267 18,234 21,880 26,256 31,507

Support for research in the Health sector enhanced Number of research proposals reviewed - - 2 2 3 - Number of research publications - - - - - Number of health research agenda developed

On going On going On going 1 - -

Number of Staff developed in statistical analysis 1 1 1 1 1 - Number of Health information developed 1 1 1 1 -

(51)

MINISTRY OF HEALTH

November 2012

Page 51

4.

sub- program.

5.

Classification

2011

2012

2013

2014

2015

Actual

Budget

Est.

Outturn

Budget

Indicative

GH₵

Current Expenditure

25 Subsidies

26 Grants

27 Social Benefits

28 Other Expenses

Capital Expenditure

Total Expenditure

Operations

Projects (Investment)

Research and development of Herbal medicines

Procurement of production plant and equipment (Decoction bottling line, Tea Bagging machine, Encapsulation machine etc.

Production of safe, effective and quality herbal medicine Acquisitions Laboratory equipment

Clinical care with the use of herbal medicine Construction, rehabilitation Administration Block

Cultivation of medicinal plants Pharmaceutics and quality control Lab established

Analysis of Herbalists’ products Refurbishment of Head Department Offices

Provision of Administrative services(CSRPM) Acquisition of one 4 X 4 Toyota Pick up

Standardized research procedures Rehabilitations of 3 Research Laboratories

Conduct Operational Research as per the National Research Agenda

Organise an annual National Research Dissemination Forum Organize an annual Stakeholder meeting with other Research Institutions involved in Health Research

(52)

MINISTRY OF HEALTH

November 2012

Page 52

BUDGET PROGRAM SUMMARY

PROGRAM 3: Health Service Delivery

1.

Budget Program Objective

To deliver cost-effective, efficient, affordable and quality primary, secondary and tertiary

health services

2.

Health Service Delivery is one of the key programs of the Ministry of Health. This program is

to deliver cost effective, efficient and affordable and quality health services at the primary,

secondary and tertiary levels of care. The services are delivered at all levels of the health

system in the form of preventive, promotive, curative and rehabilitative care.

Delivery of health services, whether community-based, outreach or institutional are organised

through district and regional health services, the teaching hospitals, the psychiatric hospitals,

ambulance service, blood transfusion service and faith-based organisations. There are three

main sub-programs under this program namely the district health services, secondary and

tertiary health services and the specialised hospitals and services. Services include inpatient

and outpatient, diagnostic, health education, and promotion and outreach interventions.

The services are delivered in all the 230 districts across the country with DHMTS and the

district hospitals being the main organized units. Polyclinics exist to provide front line services

in the urban centres, but in the rural areas Health Centres and CHPS Compounds are the

facilities that provide services as close to the people as possible.