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Investments in digitisation, malaria, maternal health and TB are highly cost-effective, top economists find

The Directors of the Policy Planning Monitoring and Evaluation Directorates (PPMEDs) from all 18 ministries in Ghana have been presented with a prioritized list of 79 policy interventions for the country’s future development.

Posted by Copenhagen Consensus Center on Thursday, November 19, 2020

The National Development Planning Commission (NDPC) will use the evidence-based research from the Ghana Priorities project to help secure a consensus across many stakeholders for Ghana’s development plan so that the nation will get the most value for every cedi spent.

Dr. Ralph Nordjo, manager of the Ghana Priorities project, and Dr. Felix Addo-Yobo, Director, Development Policy at NDPC, shared the findings from the panel of eminent economists at the NDPC’s headquarters in Accra.

After more than a year of research, 28 teams of economists from Ghana and abroad recently presented their findings on policy proposals across all sectors of government to the Eminent Panel, which included the following: Minister for Finance Mr. Ken Ofori-Atta, Minister for Planning Prof. George Gyan-Baffour, former Finance Minister Prof. Kwesi Botchwey; Prof. Augustin Fosu from the Institute of Statistical, Social and Economic Research (ISSER), University of Ghana; Prof. Ernest Aryeetey, Secretary-General of the African Research Universities Alliance (ARUA); Prof. Eugenia Amporfu from the Kwame Nkrumah University of Science and Technology (KNUST); and Prof. Finn Kydland, a winner of the Nobel Prize in Economic Sciences.

 Eminent Panel Ranking

Rank Intervention Benefit-cost ratio
1 Digitized property and business fees 9
2 Universal malaria testing and health facility treatment 133
3 Strengthen community health system (GEHIP) 38
4 Land titling program 91
5 TB patient education for adherence 190
6 Logistics for faster and more accurate TB testing 166
7 Active TB case finding in high-risk groups 38
8 Ambulance maintenance in rural areas 21
9 Preventive malaria medicine for children in Guinea Savannah 14
10 Complimentary infant feeding promotion 36
11 Breastfeeding promotion 24
12 Micronutrients and calcium in pregnancy 18
13 Management training for medium-sized firms 10
14 Incentive schemes for health workers in remote areas 21
15 Health worker home visits for pregnant and newborn 28
16 Doubled R&D spending 1.5
17 Build warehouses to reduce post-harvest losses 1.8
18 Vocational education 1.3
19 Revamp irrigation schemes 1.5
20 Increase mechanization through tractor services 2.8
21 Extend fertilizer subsidies 4.4
22 Hybrid maize seed subsidies 3.6
23 Enforcement by-laws and latrine subsidies in urban areas 4.2
24 OPV maize seed subsidies 2.3
25 Organize all 1-3 graders according to the learning level 8
26 Depression screening and treatment 7
27 Apprenticeships 2.4
28 Community dialogues on schooling & early marriage 3.8
29 Support weaker 1-3 graders with teaching assistants 6
30 Raise and sustain coverage of malaria bed nets 44
31 Monitoring devices on trawl ships 21
32 Expand school feeding 4.8
33 Management consultants for large manufacturers 6
34 Emergency obstetric and neonatal care (EmONC) 6
35 Electricity grid for less remote communities 4.5
36 Family planning for married women 34
37 Capital grants for micro-enterprises 7
38 Biogas to energy plants 4.7
39 Anxiety disorders screening and treatment 4.6
40 Replacement of illegal gears 5
41 Improved cookstoves promotion to reduce urban air pollution 8
42 Credit reference bureau 12
43 Subsidize urban toilet constructions 5
44 Expanded rural LPG distribution for cooking 2.1
45 Conditional asset transfer for girls enrolled in school 2.7
46 Revamp rail network for rural transport 1.5
47 Solar microgrids for more remote communities 1.7
48 Feeder roads for rural transport 1.2
49 Family planning for unmarried women 29
50 Electricity grid for more remote communities 1.1
51 Poverty graduation 1.8
52 Sludge to energy plants 5
53 Mass screening and treatment of hypertension 3.3
54 Comprehensive fecal sludge treatment plants 2.9
55 Improved cookstoves promotion to reduce rural air pollution 9
56 Stabilization ponds for remote areas 4.4
57 Compulsory SRH education for high school boys and girls 2.2
58 Fishing Licenses and Aquaculture 1.2
59 Subsidize private senior high schools to increase seats 1.5
60 Eliminate NHIS premiums for the poor 2.1
61 Increased cash transfers (LEAP) 1.6
62 Diesel microgrids for more remote communities 1.8
63 Reduced LPG tax for cooking 1.9
64 Reduced industrial electricity tariff 1.9
65 Storm drain widening 1.8
66 Rural community-led total sanitation with latrine subsidies 1.7
67 Rural community-led total sanitation 1.3
68 Formalize mining co-operatives 1.2
69 Increased microfinance 1.6
70 Free school uniforms for girls 2.9
71 Urban bus rapid transport system 1.5
72 Schizophrenia screening and treatment 1.6
73 Home garden and poultry training 1.4
74 Retention ponds in Accra 1.3
75 Localized solid waste management by community members 1.1
76 Social housing construction 1.0
77 Ferries and ports on Volta 1.2
78 State-sponsored alumina industry 1.1
79 Special Economic Zones <1

Multiple health interventions were chosen by the Eminent Panel among the top-ten priorities. Dr. Samuel Nii-Noi Ashong, Senior Policy Advisor at the Finance Ministry pointed out that 

health is critical. A healthy population, including that of the active workforce, is important for economic development,”

With benefits as high as 190 cedis for every cedi invested, the panel prioritized three tuberculosis initiatives among the most promising policy pursuits. Similarly, two malaria initiatives made the top-ten, with universal malaria testing and health facility treatment promising benefits 133 times greater than the investment required.

The economic case to invest in malaria is highly compelling. Treatment is low cost and highly effective. In Ghana, as in other countries, this illness needs to be treated with greater urgency," said Prof. Aryeetey.

Nobel laureate Prof. Kydland highlighted that

five percent of all deaths in Ghana are caused by tuberculosis, according to WHO estimates. Yet, we have very effective and cheap opportunities to reduce this number significantly. There is a strong case for investing more in better TB testing and adherence."

The eminent panel also highlighted the enormous potentials to be achieved in maternal and child health, embracing research that recommends scaling up the Ghana Essential Health Intervention Program (GEHIP) implemented in Northern Ghana. 

All mothers and children deserve the best possible care and support. The success of community health services, known as GEHIP, shows that we can achieve an amazing amount of social good with a moderate investment. That is why Ghana should prioritize the health of mothers and infants across the country,” Prof. Amporfu said.

The eminent economists found that nutritional interventions are also essential for young children and recommended policy-makers prioritize the promotion of complementary feeding—breastfeeding combined with micronutrients and calcium―during pregnancy. These can yield benefits worth between 18 and 36 cedis for every cedi invested, according to researchers from the University for Development Studies.

There is a compelling moral and economic case to focus on nutrition and micronutrients for infants and children. A tiny amount spent today will have enormous impacts on the rest of a child’s life," said Prof. Kydland.

The panel also recommended better health access in rural areas through ambulance maintenance, which would yield benefits 21 times greater than their cost.

Not only can access to emergency health services be a life-saver for any of us. Economic research shows that it can be a very effective social investment. We need to make sure no Ghanaian is left behind, irrespective of where they live,” said Prof. Fosu.

Besides these health interventions, the eminent economists also highlighted the great potentials of digitization. They ranked an intervention that focuses on digital revenue collection in Ghana’s municipalities through the implementation of software called District Local Revenue (dLRev) as the country’s top priority. This, they said, would ensure a faster data collection process, improved efficiency, and increased revenue for the municipalities.

It is vital for local governments to generate their own income. Digitizing property and business fees can make tax collection much more efficient, and this will help municipalities to provide the best possible services to citizens,” said Prof. Botchwey.

A land titling reform program was also regarded highly by the eminent panel, as it would bring benefits such as increased property value of titled land, improved access to credit, higher certainty for investments, and smoother land transactions. Every cedi spent on the reform would yield a benefit of around 90 cedis.

Building a comprehensive and automated national-based land map can help Ghana unlock enormous economic opportunities. The research shows that stronger ownership means more economic growth and higher development for Ghana,” argued Prof. Fosu.

The Eminent Panel was facilitated by Dr. Bjorn Lomborg, President of Copenhagen Consensus and named by TIME magazine as one of the world’s 100 most influential people. 

Dr. Lomborg said that he looked forward to continuing close cooperation with the NDPC as well as all ministries involved in the Ghana Priorities process.

We are very interested in continuing to work with Ghana to help make sure that this research translates into action on value-for-money policies which will help to boost the country’s social development and economic potential.”

Multiple high-ranking policy-makers praised the policy prioritization efforts of the research academics. Finance Minister Ken Ofori-Atta said:

Ghana Priorities is a truly valuable and useful project. Estimating costs and benefits across a wide range of policies to uncover the best value-for-money is a great help for setting priorities. I’m excited that the NDPC will make this an annual event that will assist in guiding policy-making and be part of shaping an even better future for Ghana.”

Prof. George Gyan-Baffour, Minister for Planning, pointed out:

I’m very excited about Ghana Priorities. Coordinating dozens of the best economists nationally and internationally, the project has estimated costs and benefits for a vast range of the most relevant policies for Ghana. This information helps policymaking set more effective priorities, emphasizing where each cedi can do the most good. It is wonderful news that the NDPC will make this approach central in its work over the coming years. This can place value-for-money firmly at the center of the Ghanaian policy discussion, helping promote development even further.”

Dr. Kodjo Mensah-Abrampa, NDPC Director-General, added:

No government has unlimited funds, and prioritization based on the principle of cost-benefit analysis can help to identify policies that make every cedi go further. It is vital that our national policy discussion is informed by evidence such as the research provided by Ghana Priorities. We need to continue this evaluation of cost-effective policies in the future.”

Dr. Lomborg concluded that

in Africa, Ghana is a trailblazer for setting national priorities based on cost-benefit analysis. We hope that many other nations will follow this pioneering project.”