Health Systems Strengthening through Social Accountability

Bertram van der Wal / SNV

Although Ghana has almost reached the Abuja goal (15% of national budget allocated to health), outcomes on basic health indicators related to especially maternal and child care remain off target.

Key factors hampering progress are related to infrastructure, human resources for health (HRH), financial access and insufficient performance of the health system. The SNV Ghana Health team produces a series of cases analysing specific challenges, potential solutions and necessary partnerships.

This case is a follow up from the case "Ghana Coalition of NGOs in Health; diagnosing competencies of Ghana's key to accountability and health promotion" by Eunice Agbenyadzi (2010). It is a story which describes the development of a funding proposal for the European Commission (EC) based on challenges related to a weak civil society to hold local and national governments accountable for a human resources for health crisis in Ghana.

The challenge of civil society in holding local and national government accountable on Human Resources for Health

Ghana is facing a HRH crisis, as there are only 1.07 health professional against the needed 2.5 health professionals per 1000. There are huge differences between districts and facilities within a district in terms of HRH: the availability in right size and skills-mix, retention of HRH and quality of care – often it is not always clear to what results they are accountable. This shortage and significant distribution imbalance of health workers is affecting the provision of health care, especially for women and children living in the poorest areas of Ghana.

In Ghana, the existing mechanisms to hold health authorities accountable on the results of their HRH policies – both upstream (policy-making level) as downstream (operational level) - are inadequate. Although Ghana has a vibrant civil society and active media, civil society organisations' (CSO) and non-state actors' (NSA) ability to sit at the table with policy makers as equals in terms of knowledge on HRH issues is currently lacking (1st challenge). Also, CSO/NSA working on health rarely have effective skills and approaches to bring about a solution to promote collaboration between allies (2nd challenge). Many case studies on social accountability point to the overriding problem of access to information and the low readability of information when it is available (3rd challenge). This is no different in Ghana.

End of 2009 the Coalition of NGOs in Health and SNV became partners. In 2010 we finalised an inventory and scanning of all 405 members to produce a national database. This intervention was complemented with trainings of the Coalition‟s committee on advocacy. SNV recommended that the Coalition‟s structure should fit its strategic objectives. Thus, we decided that further support would focus on (i) facilitating the formation of working groups around selected thematic issues and (ii) mobilisation of resources for knowledge and skills development of such working groups.

Year of publication: 
SNV Case story collection
Themes and sectors: 
Health sector
Themes and sectors: 
Public administration
Case story length: 
4 pages

The above is a summary or extract from the original source material. For the complete case story, please see the address given above.