Defining Institutional Arrangements when Linking Financing to Quality in Healthcare in Ghana Stakeholder Engagement Workshop

As countries work towards achieving universal health coverage (UHC), expanding access to health services while maintaining and improving quality of care remains a major priority.  Poor quality of care can prevent countries from achieving the desired improvements in health outcomes and lead to unnecessary costs. Delivering high-quality health services requires ongoing attention to improvement and assurance not only of health service delivery itself, but also of the health system governance that supports the quality of care. Strengthening health governance structures has emerged as an essential component to improve the quality of care, particularly as the quest for UHC is often associated with changing institutional roles and the emergence of new institutions, such as new payers, that may have powerful tools at their disposal to influence quality. Strengthening the roles and clarifying the responsibilities of the payer(s) and improving collaboration and joint planning among other quality stakeholders is critical to maximize this potential. HFG has assisted with this by developing a guide to help governments work through this process.   The purpose of the guide piloted in Ghana was to provide key considerations for policymakers when defining the institutional roles and responsibilities of payers in carrying out strategies for improving the quality of care.  We have identified six strategies that payers can use to improve the quality of care, and mapped them to multiple mechanisms and roles and responsibilities that must be fulfilled for these strategies to be implemented successfully.  The guide provides country examples and emerging best practices in structuring institutional arrangements between the payer and other quality stakeholders for each of the six strategies.  The guide is designed to help countries systematically think through the institutional arrangements for quality, and to re-define and clarify these institutional roles and responsibilities to ultimately strengthen the role of the payer.

HFG partnered with Dr. Ernest Konadu Asiedu, Head of the National Quality Management Unit (NQTC) in the Ghanaian Ministry of Health to co-host a two-day stakeholder engagement workshop in Accra July 20-21, 2018. Over 46 participants representing a variety of government and non-governmental organizations attended the workshop. The Ghana Food and Drug Authority hosted the workshop furthering demonstrating the agency’s ownership and commitment to improving quality.

The aims of the workshop were to:

  • Increase understanding of how linking health financing to the quality of care is impacted by institutional roles and relationships in Ghana,
  • Identify where and how the roles and relationships of institutions can be strengthened to improve the link between health financing and quality,
  • Agree on the most feasible options for improving institutional arrangements to effectively link health financing to quality, and
  • Develop an implementation plan for strengthening existing roles and relationships and/or establishing new arrangements

As a result of this activity, HFG assisted the NQTC in moving further along its path towards strengthening the quality of care, while identifying strategic entry points for the payer to more fully realize its role in quality assurance and quality improvement.


“This workshop offered a platform where the same players can talk together. An effective platform is the technical working group since we complement each other. The HFG Guide is really excellent. At times, people see problems. The Guide will give us the reference and help chart the course. It’s priceless. “

Dr. Fred Adomako Boateng

“There was a definite need for this workshop where everyone can provide input for quality healthcare issues in Ghana. We are still struggling to adequately address the quality needs. Policy is a good start. It’s about educating and training ourselves on the national quality of health policy manual itself.  We need to ensure that the relevant stakeholders have been trained. The main achievements of this workshop has been to bring stakeholders together and discuss how we can address those gaps and recommendations for sealing those gaps.”

Margaret Williams  – Health Facility Regulatory Agency (HeFRA)

HFG Team members Peter Vaz and Adam Koon facilitate a workshop on quality and governance with Dr. Ernest Asiedu from the Ghanian Ministry of Health.

Officials from various divisions within the Ghanaian Ministry of Health participate in HFG’s quality and governance workshop.

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