Health Illness and Health promotion
Many countries across the world have enshrined in their constitution the right to quality
healthcare for all its citizens. This is clear indication of the important of healthcare in a country.
Different countries have different healthcare system that aid in provision of quality healthcare
services to the citizens. A healthcare system is the sum total of institutions, organizations and
resources whose primary purpose is to improve health service delivery. This report focuses on
healthcare systems, policies and concepts relating to Ghana healthcare system. Likewise, an in
depth analysis of Ghana National Health policy is delineated and compared with UK National
Health Service (NHS).
Rationale for selecting Ghana
Ghana is one of the developing countries in Africa that has made strides in ensuring that
its citizens access to quality health service at moderately low costs. The country has entrenched
in its constitution a right for all citizens to access to healthcare. However, regardless of this, the
country is grappling with numerous challenges such as poverty and high prevalence of
preventable diseases. The rationale for selecting this country is to determine the gap in healthcare
service and finding appropriate ways of bridging the gap to allow accessibility to quality
healthcare service by all. For instance, in 2009, the rate of infant mortality averaged 51 percent
per 100 life births. Statistics also indicated that only 4.5% of the country’s GDP in 2003 went to
healthcare services provision. The governance problems such as corruption have also dragged
the country health system behind. There is rampant corruption in the Ghana ministry of health,
health service and even in the National Health scheme. Therefore, this discussion aims at
HEALTH ILLNESS AND HEALTH PROMOTION 2
identifying these loopholes and providing an appropriate way forward that will allow the
workability and implementation of the National Health Policy.
Sources of information
In compiling this report, information from various credible source of information were
consulted. Secondary sources about the health status of Ghana were relied upon which helped in
creating understanding of the functioning of the Ghana National Health policy. National Health
Policy of Ghana document substantiated the discussion and argument about health in Ghana.
Additional information about the healthcare status of Ghana was obtained from credible
Ghanaian websites. This journal article, ‘A Historical-Cum-Political Overview of Ghana’s
National Health Insurance Law,’ was instrumental in this study. It helped me to get political
views about the National health insurance law. Politics is important in Ghana when it comes to
formulating laws and policies that are applied to all the citizens. Blanche, Fink and Osei-Akoto
studies was also fundamental in providing more insightful information on the national health
insurance scheme. The national health insurance in Ghana has been instrumental in ensuring that
most Ghanaians access to quality and affordable healthcare. However, many people due to their
economic status are unable to take such covers. This journal, “Access to Health Care for
Undocumented Migrants: A Comparative Policy Analysis of England and the Netherlands,’ by
Grit et al (2012) provides an insight on various factors that come into play on how the migrants
without documents access to health facilities. Attention they deserve is not given to them and this
impact on their health. The journal article, ‘Patients’ Rights and the National Health Service in
Britain, 1960s-1980s,’ helps in creating understanding of the UK health system. Between 1960s
and 1980s, every Britain had the right to access to medical healthy freely. Such policies have
helped to make the health standards of UK citizens high. The article, ‘How Will the U.S.
HEALTH ILLNESS AND HEALTH PROMOTION 3
Healthcare System Meet the Challenge of the Ethno geriatric Imperative?’ provides sufficient
information on the ways various healthcare systems can provide their services or accommodate
the elderly. Therefore, the article was important in finding out the best ways of formulating the
health care system to ensure that all citizens are able to access to better health services. Further
information on the health insurance was retrieved from the World Health, an international Non-
government organization that deals with issues pertaining to health. This source provided
valuable information about the various healthcare insurance schemes adopted by various
countries. These were sourced from online scholarly libraries on the websites and on the
organizations websites. Therefore, they have high level of credibility because the information
and sources are authoritative. These sources were resourceful and enabled success of the report
as adequate information on healthcare systems was retrieved.
Analysis of Ghana healthcare system
Ghana over the years has faced many challenges in providing healthcare services to its
population. The county economic growth and the rate of poverty could not allow it to provide
and sustain such programmes geared to promoting health living (Ministry of Health Ghana
2007). Therefore, these challenges compelled the government to set up a national health policy to
allow accessibility to quality and affordable health services.
The national health policy of Ghana aspires to achieve the vision of Ghana of becoming a
middle income by the year 2015. Health stirs socio-economic development and therefore is an
important pillar in the national and international development framework (Government of Ghana
2013 para. 4). Health is a human right and a key driver to development and wealth creation.
HEALTH ILLNESS AND HEALTH PROMOTION 4
Ghana health policy theme is creating wealth through health. The importance of health
has been exemplified in various forums and policies and strategies such as millennium
declaration and the Ghana macroeconomics and heath initiative report 2005 (Ministry of Health
Ghana 2007). A country stands to benefit in investing in good health and nutrition as health
lifestyle and environment plays a role in improving the socio-economic development.
Furthermore, the policy draws on the wider determinants of health by focusing on good nutrition,
recreation, physical exercise and rest and personal hygiene. Health system will incorporate and
recognize both private and public health provider to ensure accessibility to quality health care
interventions that aims at preventing injuries and diseases as well as foster health of disabled and
the sick (Sarpong et al 2010, p. 191). Last is to ensure that there is promotion of a vibrant local
health industry, which supports efficient, effective and sustainable service delivery, creating jobs
and contribution to wealth building and attainment of the national development objectives.
To ensure all citizens’ access to health service the government introduced a National
health Insurance scheme (NHIS) as a social protection policy with the aim of improving the
quality of health services (Blanchet, Fink & Osei-Akoto 2012, p. 76). This coverage has
continuously grown increasing subscription rate. The districts in Ghana have a functional district
mutual health insurance scheme (DMHIS) with an estimate of 17% of the population registered
and therefore legal for coverage. They therefore end up paying less or none for their services.
The healthy policy in Ghana for long period has received challenges. Some of these challenges
include poor geographical access, which includes inadequate investment in health facilities
relative to the need, lack of communication equipment, hard to reach communities and
suboptimal spatial distribution of health facilities. The cash and carry system of paying for health
services remains a financial barrier to many especially the poor. An exemption policy that target
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pregnant mothers, children and specified diseases was implemented along with cash and carry
programme but because of inadequate funding, clear specification, implementation and
operational difficult contributed to its failure to operate efficiently. Other changes include social
economic barriers such as gender and organization delivery.
Outcome of the Ghana national healthy policy
Health policies in Ghana have improved the overall health status of the entire population.
Many people are able to access to quality medical care through the assistance of various
programs such as National health Insurance scheme (NHIS). The policy has also helped in
reducing premature mortality and disability. The policy has also improved the overall level of
responsiveness and promoted fair financing.
Analysis of the pressures on the healthcare delivery
Even with the implementation and operation of the policy, various pressures concern the
delivery of health services to the patients. Some of these concerns are on the integrity of
institutions (Penchansky, Thomas 1981, p. 127). If though money is invested in health sector,
services provided do not match the money provided. Government officials squander public
money preserved for health functions and this derails the delivery of these health services.
Therefore, this has tended to cause some rift in the operation of these funds. The patient safety,
the efficiency of clinics and the overall quality of the Ghana health system has also come under a
lot of criticism. Many people feel that the quality provided is not enough or equivalent to the
amount of money they invest for their insurance coverage. Questionable sustainability of the
overall healthcare system, spiraling cost and ever increasing number of people that are uninsured
are yet some of the major concerns that are putting pressure on the delivery of healthy services
HEALTH ILLNESS AND HEALTH PROMOTION 6
(Evans, Tandon, Murray & Lauer 2001, p. 23). Many people in Ghana are not able to get
insurance because, they do not have the financial strength to do the same and this has increased
the number of people that are not insured and therefore unable to receive quality healthcare.
Nevertheless, there are some challenges or concerns, which have tended to derail the
achievement of the set objectives. They are worth concerns and need to be evaluated for
amicable solution to ensure that the spirit of the policy is realized.
Comparison of UK National health Service (NHS) and Ghana National Health Policy
Ghana is one of the developing countries in Africa, which experiences demographic and
epidemiological transitions, has low standards of living, low industrial development and faced
with various health problems. These health problems includes high infant and child mortality and
poor maternal health and family process, management of communicable diseases such as
HIV/AIDS, malaria, polio and tuberculosis and experiences rising incidences of diseases such as
cancer, obesity and diabetes among others. Others include, changes in maintaining consistent
care, managing overall costs of running healthcare systems, inadequate doctors, specialists and
nurses and geographical locations, low income and social status that hinders people from gaining
access to healthcare (Assensoh & Wahab 2008, p. 289). Therefore, to address these challenges,
Ghana came up with a national health policy that aims at enabling Ghana to realize and achieve
middle-income status by 2015. Both policies seek to ensure that overall health of the population
is improved and that chronic disease as well as communicable diseases is eradicated (Grit et al
2012, p. 37). The different between the Ghanaians policy and that of UK is that that of Ghana
places health at the center of socio-economic development at the same time placing a shift
between the role of health in national and international development framework (Ministry of
Health Ghana, 2007). Therefore, wealth is a human right as well as a driver of development and
HEALTH ILLNESS AND HEALTH PROMOTION 7
an avenue for creation of wealth. While the UK policy does not attach health with wealth
creation and as a driver of development but rather as a human right to be enjoyed by all its
citizens (Mold 2012, p. 2038). National Health Service in UK is used in reference to 3 to 4 UK
publicly funded healthcare system. Majority of the people in UK have subscribed to the NHS and
only 8% have subscribed to private healthcare. NHS developed from National Health Act of
1946 by Aneurin Bevan. The principle of its foundation was to provide comprehensive services
to all the people at free at point of use based on clinical need and not the ability of an individual
to pay (Checkland et al 2012, p. 533). Around three million people are treated through NHS
every week. Rising demand and treatment cost are causing changes to health and social policy in
UK. The cost of accessing to medical is increasing by cover £600 m per year. The elderly and the
prevalence of diseases also increase at rapid rate. For instance, the NHS budget in 2011/2012
was C£106 billion compared to £437 million in 1948. The cost has increased tremendously
because of various factors including increase in population, high cost of living and increased rate
of diseases. There have been changes to the NHS act, which aimed at ensuring that patients are
placed at the center of healthcare, changes emphasis to clinical outcomes instead of meeting
targets and empowering all health professionals to ensure they provide quality services.
Different countries have various policies geared at ensuring that they solve various health
problems. Most of the policies aim at ensuring that appropriate health is provided to ensure that
citizens live positive lives. UK is one of the countries in the world with advanced and efficient
healthcare system (Checkland et al 2012, p. 538). However, it has also some challenges that it
grapples with. The UK policy has been to provide quality and affordable healthcare services to
all its citizens. National Health Service has seen government partner with insurance company to
HEALTH ILLNESS AND HEALTH PROMOTION 8
provide health care to old people and disabled people. The plan has so far achieved much.
Ghana national health policy on the other hand aims to provide quality healthcare as human right
and as a driver for development and wealth creation.
HEALTH ILLNESS AND HEALTH PROMOTION 9
Assensoh, A, & Wahab, H 2008, ‘A Historical-Cum-Political Overview of Ghana’s National
Health Insurance Law,’ African & Asian Studies, Vol. 7 no. 2/3, pp. 289-306.
Blanchet, N, Fink, G, Osei-Akoto, I 2012, ‘The effect of Ghana’s national health insurance
scheme on health care utilization,’ Ghana Medical Journal, Vol. 46 no. 2, pp. 76-84.
Buckle, P 2012, ‘Systems approaches to risk assessing healthcare, how far have we come?,’
Work, Vol. 41, pp. 3847-384.
Checkland, K et al 2012, ‘Commissioning in the English National Health Service: What’s the
Problem?, Journal of Social Policy, Vol. 41 no. 3, pp. 533-550.
European Observatory on Health Systems 2009, ‘Health Systems Profiles. (
D’Souza, S, & Sequeira, A 2011, ‘Information Systems and Quality Management in Healthcare
Organization: An Empirical Study,’ Journal of Technology Management for Growing
Economies, Vol. 2 no. 1, pp. 47-60.
Grit, K et al 2012, ‘ Access to Health Care for Undocumented Migrants: A Comparative Policy
Analysis of England and the Netherlands,’ Journal of Health Politics, Policy & Law, Vol.
37 no. 1, pp. 37-67.
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Government of Ghana 2013, ‘About Us,
Ministry of Health Ghana. (2007). National health Policy; Creating wealth through health.
Mold, A 2012, ‘Patients’ Rights and the National Health Service in Britain, 1960s-1980s,’
American Journal of Public Health, Vol. 102 no. 11, pp. 2030-2038.
Penchansky, R, Thomas, J 1981, ‘The Concept of Access: Definition and Relationship to
Consumer Satisfaction,’ Medical Care, vol. 19 no. 2, pp. 127–40.
Sarpong, N et al 2010, ‘National health insurance coverage and socio-economic status in a rural
district of Ghana,’ Tropical Medicine & International Health, Vol. 15 no. 2, pp. 191-197.
Sirgy, M, Lee, D, & Yu, G 2011, ‘Consumer Sovereignty in Healthcare: Fact or Fiction?,’
Journal of Business Ethics, Vol. 101 no. 3, pp. 459-474.
Reeves, T 2011, ‘Globalizing Health Services: A Policy Imperative?,’ International Journal of
Business & Management, Vol. 6 no. 12, pp. 44-57.
World Health Organization 2008, ‘ Health financing mechanisms: private health insurance ,’
Geneva: World Health Organization. Archived from the original on October 9, 2010.
Retrieved April 11, 2012.
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Yeo, G 2009, ‘How Will the U.S. Healthcare System Meet the Challenge of the Ethno geriatric
Imperative?,’ Journal of the American Geriatrics Society, Vol. 57 no. 7, pp. 1278-1285.
Some key Criteria
Health Care System: Refers to ‘the
sum total of all the organisations,
institutions and resources whose
primary purpose is to improve
Australian Medicare, UK – NHS, Ghanian
Healthcare System e.t.c.
Structural differences in the provision of
health care, (such as the mix of different
resources) can in principle be linked to
differences in performance (WHO WHR,
i.e.Quality provision = Quality performance
Evaluating Health Care Systems on the Basis of
the ‘Building Blocks’ of Healthcare Systems
Keeping health systems on track requires …
coherent investment in the various building
blocks of the health system, so as to provide
the kind of services that produce results
BUILDING BLOCKS OF HEALTH SYSTEMS (WHO, 2009)
Service delivery – effective, safe & quality
Medical products, vaccines and technologies –
equitable access to essential medical products,
vaccines and technologies
Health workforce – responsive, fair and efficient
BUILDING BLOCKS TO HEALTH SYSTEMS (WHO, 2009)
- Health financing – adequate funds for health and
- Health information system – production, analysis,
dissemination and use of reliable and timely
information on health determinants
- Leadership and governance
- effective oversight, coalition-building, regulation,
Evaluating Healthcare Systems On the basis of
THE KEY GOALS OF HEALTHCARE SYSTEMS:
- Improving overall level of health
2.Improving overall level of
- Promoting fair financing
- Improving overall level of
Improving overall level of health is the
defining objective of healthcare systems.
This refers to the ability of the healthcare
system to make the health status of the entire
population as good as possible over people’s
whole life cycle – taking into account
premature mortality and disability.
CRITERIA FOR MEASURING OVERALL LEVEL OF
Calculated using data on epidemiology of major conditions and
population health surveys
Includes Life Expectancy at birth: for example the probability of
dying before age five years or between ages 15 and 59 years (criteria
ranges from low child and adult mortality to high child mortality and
very high adult death rates – comparison on the basis of mortality
The infant mortality rate is a widely used indicator of a population’s
health status because it is associated with education, economic
development, and availability of health services.
Achievement not measured only by averages or overall levels but by
seeing whether everyone has about the same expectation of life and
distribution of health in the population – an average
Under-5 mortalityUnder-5 mortality rate by income
quintileUnder-5 mortality rate by income quintile in some
Asian countries (Walford, et al 2006)
2.OVERALL LEVEL OF RESPONSIVENESS
Responsiveness is not a measure of how the
system responds to health needs, (which is
reflected in health outcomes) but of how the
system performs relative to non-health aspects
It is beyond an assessment of people’s
satisfaction with the purely medical care they
CRITERIA FOR MEASUREMENT OF OVERALL LEVEL OF
Meeting or not meeting a population’s
expectations of how it should be treated
by providers of care.
Examples include: health workers
rudeness and arrogance in their contact
with patient or waiting times for
non-emergency surgery e.t.c.
DETAILED CLASSIFICATION FOR MEASURING OVERALL
LEVEL OF RESPONSIVENESS:
(A) Respect for persons: includes respect for human beings as
persons –subjective and judged primarily by the patient
Criteria for measuring respect for persons includes:
Respect for the dignity of the person. At the extreme, this means not
sterilizing individuals with a genetic disorder which would violate
basic human rights.
Not humiliating or demeaning patients.
Promoting Confidentiality, or the right to determine who has access to
one’s personal health information.
Autonomy to participate in choices about one’s own health. This
includes helping choose what treatment to receive or not to receive.
(B) Client orientation:
how a system meets
expressed concerns of
patients and their families
as clients of health
systems, (can be directly
observed at health
Criteria for Client
Prompt attention: immediate
attention in emergencies,
and reasonable waiting
times for non-emergencies.
Amenities of adequate
quality, such as cleanliness,
space, and hospital food.
Access to social support networks – family and
friends – for people receiving care.
Choice of provider, or freedom to select which
individual or organization delivers one’s care.
Performance is often poor with respect to choice of
provider and promptness of care.
Countries that perform well on average for
responding to people’s expectations may rank much
lower on the distributional index (Some African and
- Fair financing
Fair financing in health systems means that the risks
each household faces due to the costs of the health
system are distributed according to ability to pay
rather than to the risk of illness: a fairly financed
system ensures financial protection for everyone.
Countries can be compared on the basis of amount of
GDP spent on providing healthcare.
Percentage of GDP spent on healthcare in some
countries – in 2013
Taiwan – 6.9%
Japan – 9.5%
UK – 9.6%
Australia – 9.1%
Germany – 11.6%
Switzerland – 11.4%
Norway – 9.4%
USA – 17.6%
Health expenditure as a share of GDP, OECD countries, 2010
(Source: OECD, 2011)
Paying for health care in households
can be unfair in two different ways.
Exposing families to large unexpected
expenses – unforeseen out-of-pocket
expenditure at the point of utilisation
Regressive payments – Those least able
to contribute, pay proportionately more
than the better-off.
Degree of financial protection: percentage of households with medical
spending greater than 15%
of household consumption in selected Asian countries (Walford, et al 2006)
Health care expenditures – is also measured as a fraction of
Gross Domestic Product (GDP)
Why are healthcare systems mainly compared on the
basis of financing figures??
The widespread availability of historic expenditure figures
The attractiveness of collapsing resource data into a
common unit of measurement
The focus among The Organisation for Economic
Cooperation and Development (OECD) member countries
and other governments on containing health care costs.
Donabedian (1988) Devised a classic model for the measurement of
quality of care
Structure: The characteristics of settings where health care is
Process: Are good medical practices followed??
Outcome: Impact of the healthcare intervention on health status
(a) Physical state of
(a) Vaccine coverage
(a) Direct observation
(a) Exit interviews
(a) Surveys, phone-in
Healthcare systems can also be evaluated on the basis of
access to care:
Penchansky and Thomas (1981) identified the five ‘A’s of access to
Availability – number of local service points from which a client can
Accessibility – travel impedance (distance or time) between patient
location and service points
Affordability – charges in relation to ability to pay for care
Acceptability – client acceptance with the non-medical aspects of
Accommodation – Changes/flexibility to meet needs of client
European Observatory on Health Systems (2009) Health Systems