Do you wonder why some smaller and poorer African states and institutions are able to chart a smarter path for access to health compared to their stronger and richer neighbors? As we commemorate Digital Health Week, we at PharmAccess highlight how partnerships can help countries unlock capacities to innovate their health systems to deliver better value, with examples from Ghana and Zanzibar.
Ghana is not the richest country in Africa but has become a model for health financing and delivery. CHAG (Ghana’s faith-based network of healthcare providers) has only 7% of healthcare facilities in Ghana but delivers 30% of healthcare in the country. Zanzibar, the small island state of the United Republic of Tanzania, has been able to enact a health insurance bill and register and issue digital health cards to the bulk of its citizens within a year.
These states’ secrets partly lie in their ability to foster partnerships to drive smarter approaches. Partnership action is not a new concept, but there is a rapidly growing realization of what deliberate, strategic partnerships for healthcare can achieve in uncertain business and economic times. Effective partnerships mean partners benefit from shared knowledge, skills and resources which enable the co-creation of better outcomes. The partnerships discussed in the article have been made possible by collaboration with key partners such as the Dutch Ministry of Foreign Affairs and the Norwegian Agency for Development Cooperation (Norad).
Ghana – a model for health financing and analytics
In Ghana, the government has built a community-based health insurance scheme into a nationwide insurance, covering about 55% of the population. There is strong political and public support for health insurance. Ghana is perhaps the only country in sub-Saharan Africa where a political party may lose elections by talking badly about health insurance. The most innovative aspect of the insurance scheme is that, unlike most African countries that depend on donors to finance primary healthcare, Ghana finances health insurance primarily from its own sources: 2.5% of all consumption tax and pension contributions go into health insurance.
Ghana’s National Health Insurance Authority (NHIA) contracts both public and private healthcare providers to deliver care, even paying the private providers more than public providers. To ensure better value for patients, NHIA is collaborating with PharmAccess on data analytics and value-based healthcare models. Given the slow progress towards universal health coverage (UHC) worldwide, the transition to value-based care delivery represents a major undertaking for all health systems.
CHAG has been able to build a strong collaboration with key stakeholders in Ghana, creating value for patients and partners alike. CHAG is a non-public actor, but the salaries of the doctors and nurses working in CHAG facilities are paid by the government, enabling CHAG to send doctors to the remotest parts of the country – a crucial step for ensuring health access and equity across the country.
Further, all CHAG’s facilities participate in national health insurance, which provides a steady stream of income for the healthcare providers, enabling them to plan and invest in care quality. Capacity building is critical to CHAG, and collaboration has also ensured the implementation of specific activities to address challenges such has improving quality of care (SafeCare) and access to investments in healthcare infrastructure (Medical Credit Fund).
To enhance better outcomes for patients in Ghana, public and private hospitals are collaborating with PharmAccess and Luscii (a medical technology company) to develop digital care models for diabetes and hypertension. Preliminary results show that about 50% of patients receiving digital care managed to have controlled levels of blood pressure and/or blood glucose over a prolonged period, which is far better than the country’s average control level of 26%.
Zanzibar – health system reform through partnerships
In Zanzibar, strategic partnerships have turbocharged the performance of the Ministry of Health (MoH) to implement reforms for health financing and delivery of better care. Developing the right partnerships that can deliver vital services under a unified brand and prevent fragmentation is important to the long-term sustainability of a health system. The partners that have supported the health financing strategy and insurance bill include PharmAccess, GIZ, Swiss Development Cooperation, WHO and Unicef.
The Zanzibar Health Services Fund has also been operating since August 2023, initially enrolling civil servants for health insurance. With over half of the population earning less than $2.50, PharmAccess is supporting the setting up of a Health Equity Fund and a digital identification of poor people for efficient targeting of insurance subsidies. Also, the issuing of digital health cards is a step towards helping the Ministry of Health to track care utilization, streamline referral system and ensure better allocation of resources.
Since 2021, the Ministry of Health has been prioritizing healthcare quality improvement, in partnership with SafeCare. This includes leveraging digital tools to support quality improvement at the healthcare provider level, while offering real-time data to government to steer fact-based decision-making and inform policy.
Healthcare is complex, requiring coordinated service execution across public and private sectors. Moreover, patient-driven demands for better outcomes and pricing are pushing health systems to optimize their performance. For this reason, ZAPHOA (Zanzibar Private Hospital Owners Association) is collaborating with PharmAccess to expand innovations for service provision among the private health sector, which accounts for 34% of the health facilities on the island.
As populations across sub-Saharan Africa demand optimal access to quality care and payers and providers remain focused on pursuing efficiency given budget and capacity constraints, partnerships that support innovation will be critical to developing an ecosystem that deliver better and affordable healthcare for everyone. Some smaller African states (such as Ghana and Zanzibar) and pioneering institutions have grasped this.