Cost recovery in Ghana

This Health Policy and Planning paper investigates the impact on health care seeking behaviour of the “cost-sharing” policies introduced in Ghana between 1985 and 1992, drawing on focus group discussions and in-depth interviews. Under these policies, patients were asked to pay partly for consultations and diagnostic procedures, and fully for drugs supplied. Participants in the study reported that, although they would prefer to attend orthodox clinics than use traditional healers or self-medication, they were restrained by high user charges and the cost of drugs. The study indicates that the policies led to an increase in self-medication, “wait-and-see” strategies, and other behaviours aimed at cost-saving. Advice was sometimes sought from drug stores on what to purchase for a particular illness, leading to longer delays in reporting diseases to hospitals or clinics. At the same time, there was a perception that the drug supply situation and general health service delivery had improved in government facilities.

The paper advocates enhanced training of drug peddlers and attendants in drug stores, especially in rural areas. It also argues that user fee exemption criteria need to be worked out properly and implemented so that the very needy are not precluded from seeking health care at hospitals and clinics.