R4D partnered with the Ghana Health Service and National Health Insurance Authority to develop and cost a package of high-impact preventive and health promotive services and inform their inclusion in the national health insurance scheme.
The Challenge: Advancing UHC in Ghana
Ghana has long embraced primary health care (PHC) as the pathway to achieving universal health coverage (UHC). In recent years, the country has prioritized expanding preventive and health promotive services.
To support this goal, the Government of Ghana developed an Essential Health Services Package outlining 438 services intended to be universally accessible by 2030. More than half of these services — 236 in total — are preventive and promotive. However, analysis comparing this package with the National Health Insurance Scheme (NHIS) benefits package revealed a significant gap: 177 preventive and promotive services were not covered by NHIS.
This mismatch posed a serious risk to Ghana’s UHC agenda since the NHIS is the country’s largest purchaser of health services.
The Opportunity: Prioritizing Key Preventative and Promotive Health Services
To address this gap, the Ghana Health Service proposed a focused approach: prioritizing a subset of high-impact preventive and promotive services that could meaningfully strengthen primary health care in a sustainable way. Rather than attempting to finance all uncovered services at once, the aim was to identify those with the greatest potential to address leading causes of mortality and morbidity, respond to disease burden, and demonstrate evidence-based effectiveness.
Building on R4D’s long-standing engagement in health system strengthening in Ghana, the government sought R4D’s technical expertise to develop and cost a Health Preventive and Promotive Benefits Package.
R4D’s Work: Advancing Ghana’s PHC Agenda
R4D partnered with the Ghana Health Service to co-create a Health Preventive and Promotive Benefits Package (HPPBP) and with the NHIA to cost it and assess the budget implications to inform decisions on the inclusion of preventive and promotive services within NHIS.
Developing the package of prioritized services
Working alongside government counterparts, R4D helped facilitate a consultative process led by the Ghana Health Service to identify and prioritize preventive and promotive services. This work drew on national and subnational stakeholder engagements, document reviews, and peer learning exchanges with countries such as Kenya and Colombia.
Services were prioritized using agreed health impact criteria, including relevance to leading causes of mortality and morbidity, disease burden, and evidence of effectiveness. The process resulted in a prioritized package of 68 preventive and promotive services, spanning maternal and newborn health, family planning, immunization, nutrition, school health, communicable disease prevention, non-communicable disease prevention (including mental health), and other priority areas.
Costing the package
Once the package was defined, R4D supported a costing process coordinated through an interagency technical working group chaired by the National Health Insurance Authority (NHIA). The methodology built on the Joint Learning Network’s costing framework, adapted to the Ghanaian context.
The approach moved beyond traditional normative costing, incorporating marginal costing and utilization assumptions aligned with clinical guidelines and NHIS payment rates. Costs were estimated for facility-based, community-based, and school-based services, with scenarios accounting for differences across age groups, population risk profiles, and patterns of service use. The result was a realistic cost benchmark for delivering prioritized preventive and promotive services.
Conducting a budget impact analysis
R4D also collaborated with government partners to conduct a budget impact analysis to assess the feasibility of integrating the HPPBP into NHIS. The analysis examined total annual costs in relation to current health spending, drawing on population estimates, NHIS utilization rates, and recent provider payment data, and distinguishing costs across service delivery platforms.
This analysis helped clarify the financial implications of inclusion, while accounting for existing donor-funded services and current purchasing arrangements.
Informing Ghana’s Free PHC initiative
The costed HPPBP is now informing ongoing discussions around Ghana’s Free Primary Health Care initiative, a key priority of the current government. By serving as a ready benchmark, the package supports quicker and more integrated decision-making about which preventive and promotive services can be financed, reducing the need for parallel costing exercises and strengthening primary health care planning. R4D is also supporting the government to define a Provider Payment Mechanism and carry out a budget and sustainability impact analysis for Free PHC.
