HEALTH SECTOR REFORM IN GHANA

**1. According to the 1995 definition by Berman, the term "sustained" in Health Sector Reform
means it is: **
- A) A temporary and quickly executed effort
- B) Not enduring
- C) Ongoing without being a one-shot effort
- D) Externally imposed
- **Answer: C**

**2. What was emphasized in Ghana's health service development in the early 1950s?**
- A) Combatting poor nutrition
- B) Clinical care through a network of health facilities
- C) Addressing high population growth rates
- D) Establishing primary health care
- **Answer: B**

**3. The strategy concerning the drivers of slow health improvements in Ghana included
addressing:**
- A) Appropriate prioritization of services
- B) Poverty and poor nutrition
- C) Inadequate infrastructure improvement
- D) Decentralization of management
- **Answer: B**

**4. What is the primary cause of poor performance of the health care system noted in the text?**
- A) Overabundance of resources
- B) Inadequate financing and inappropriate use
- C) Strong monitoring and supervision
- D) Complete coverage of services
- **Answer: B**

**5. The five-year Medium-Term Health Strategy developed after Vision 2020 prioritized all the
following EXCEPT:**
- A) Increasing healthy lives
- B) Maximizing the use of science and technology
- C) Maintaining an 8% growth rate
- D) Controlling community diseases
- **Answer: D**

**6. What was one of the key achievements of the Medium-Term Health Strategy (MTHS) for 1997-
2001?**
- A) Enhanced focus on Malaria prevention
- B) Significant improvements in immunization coverage
- C) Elimination of disparities in health performance
- D) Adequate financing from government and donors
- **Answer: B**

**7. Which is NOT a focus of the 3rd Health Programme of Work 2007-2011?**
- A) Addressing risk factors to health
- B) Promotion of reproductive health services
- C) Promoting the application of High Impact Rapid Delivery interventions
- D) Enhancing only tertiary healthcare systems
- **Answer: D**
**8. The 2018-2021 health objectives included all the following EXCEPT:**
- A) Ensuring accessible healthcare (Universal Health Coverage)
- B) Intensifying control of communicable disease
- C) Promoting use of traditional medicine practices
- D) Enhancing efficiency in governance and management
- **Answer: C**

**9. What significant aim does the 2022-2025 Health Sector Medium Term Development Plan focus
on?**
- A) Reduction of new technology in health systems
- B) Increased access to quality essential healthcare services by 2030
- C) Ensuring a stable economic growth rate through healthcare improvement
- D) Expansion of urban-specific healthcare systems
- **Answer: B**

**10. A major reviewed performance issue from 2018-2021 was:**

- A) Suboptimal quality of care at all health system levels
- B) Overwhelming collaboration among MDAs
- C) Excessive national data on health
- D) Adequate infrastructure and logistics
- **Answer: A**

**11. In the 2022-2025 health sector objectives, which is NOT listed as a goal?**
- A) Universal access to efficient healthcare services
- B) Increase prevention and control of non-communicable diseases
- C) Ensure financial protections against poverty due to illness
- D) Boost responsive clinical and public health emergency services
- **Answer: C**
Sure, here's an extended set of 60 multiple-choice questions derived diligently from the text provided,
covering all parts of the document:

**1. What does "sustained" mean in the context of Health Sector Reform?**
- A) Temporary
- B) Long-lasting
- C) Quick
- D) Sporadic
- **Answer: B**

**2. According to Berman (1995), the term "purposeful" in Health Sector Reform implies:**
- A) Unplanned actions
- B) Results from a rational and planned process
- C) Accidental results
- D) Quick fixes
- **Answer: B**

**3. The term "fundamental" in Health Sector Reform means:**

- A) Minor changes
- B) Ignoring strategic dimensions
- C) Addressing significant, strategic dimensions of health systems
- D) Short-term impacts
- **Answer: C**

**4. The development of health care in Ghana during the early 1950s emphasized:**
- A) Clinical care
- B) Educational programs
 - C) Environmental health
- D) Physical fitness
- **Answer: A**

**5. What was the focus of Ghana’s Primary Health Care Programme in the late 1970s?**
- A) Clinical care only
- B) Surgical advancements
- C) Underlying factors of health such as education and environmental health
- D) Pharmaceutical distribution
- **Answer: C**

**6. The "Strengthening of District health Systems Initiative" aimed to improve:**

- A) Health care delivery management
- B) Clinical training
- C) Advanced medical research
- D) Hospital construction
- **Answer: A**

**7. What issue did the reorganization of Ghana's healthcare system address in the late 1990s?**
- A) Technological advancement
- B) Organizational inefficiencies
- C) Export of medical professionals
- D) Health education
- **Answer: B**

**8. Which improvement has been unevenly distributed across Ghana according to the text?**
- A) Use of technology in diagnosis
- B) Improvement in the health status of Ghanaians
- C) Educational programs
- D) Economic development
- **Answer: B**

**9. Which of these factors contributed to slow improvement in Ghanaians’ health status?**
- A) Advanced technology
- B) Low literacy rates among women
- C) Adequate health infrastructure
- D) Efficient health system
- **Answer: B**

**10. What was a primary cause of the poor performance of the healthcare system?**
- A) Adequate financing
- B) Strong monitoring
- C) Centralized and vertical organizational set up
- D) Decentralized management
- **Answer: C**

**11. One of the health-related goals of Vision 2020 was to:**

- A) Ensure no changes in population growth
- B) Reduce population growth from 3% to 2%
- C) Increase population growth to 4%
- D) Ignore population metrics
- **Answer: B**

**12. Which intervention did not result from taking a cue from Ghana’s Vision 2020 document?**
- A) Developing a long-term economic growth plan
 - B) Setting a five-year program for reform in the health sector
- C) Organizing healthcare at the regional level
- D) Removing economic and financial barriers to healthcare access
- **Answer: C**

**13. Which is NOT listed as an objective under the five pillars of health reforms in Ghana?**
- A) Financing through increasing government allocation
- B) Investing in medical tourism
- C) Improving quality of health care
- D) Increasing access to health care
- **Answer: B**

**14. A key achievement of the MTHS 1997-2001 was:**

- A) Guinea worm eradication
- B) Stabilized HIV/AIDS rates
- C) Improved immunization coverage
- D) Flawless disease monitoring
- **Answer: C**

**15. The 2nd Health Programme of Work (2002-2006) emphasized health services that were:**
- A) Gender sensitive
- B) Overly affordable
- C) Less focused on preventive measures
- D) Geared towards technological upgrades only
- **Answer: A**

**16. The third Programme of Work (2007-2011) in Ghana focused on promoting:**

- A) International healthcare standards
- B) Wealth creation through healthy lifestyles
- C) Dependent health practices
- D) Private-only sector health investment
- **Answer: B**

**17. One major focus of the 2nd Programme of Work (2002-2006) was:**
- A) Partnerships for bridging health inequalities
- B) Delivering intensive surgical operations
- C) Improving only urban healthcare delivery
- D) Reducing private sector involvement
- **Answer: A**

**18. High Impact Rapid Delivery (HIRD) interventions, introduced in Ghana’s health sector, were
specifically aimed to improve:**
- A) Overall economic conditions
- B) Maternal and child health
- C) Adult male health statistics
- D) Health tourism metrics
- **Answer: B**

**19. Health Sector objectives for 2012-2017 included all of the following EXCEPT:**
- A) Middle-income status attainment with specific per capita income
- B) Elimination of all communicable diseases
- C) Enhancing national capacity for health-related MDGs
- D) Improve governance and management of the health system
- **Answer: B**
**20. The goals for 2018-2021 in the health sector did NOT include:**
- A) Intensification of prevention and control of non-communicable diseases
- B) Complete eradication of non-communicable diseases
- C) Reduction of new HIV/AIDS and other STIs among vulnerable groups
- D) Ensure sustainable and equitable healthcare services
- **Answer: B**

**21. A key challenge identified for the Ghana health sector from 2018-2021 was:**
- A) Increasing urban population only
- B) Adequate health infrastructure
- C) Suboptimal quality of care at all levels
- D) Overwhelming support from international donors
- **Answer: C**

**22. Goals of the 2022-2025 Health Sector Medium Term Development Plan include all EXCEPT:**
- A) Ensuring universal access to efficiently managed health services
- B) Decline in pharmaceutical innovations
- C) Reduction of maternal and child mortality and disabilities
- D) Enhanced access to emergency services
- **Answer: B**

**23. By 2030, the Ghana health sector aims to achieve:**

- A) Minor improvements in service quality
- B) Decreased funding for health services
- C) Increased access to quality essential healthcare and services for all
- D) Stabilization of health service prices
- **Answer: C**

**24. Which of the following was not a focus area for the Ghana Health Service post-Vision 2020?**
- A) Maximizing healthy and productive lives
- B) Fair distribution of developmental benefits
- C) Establishing nationwide gym facilities
- D) Attainment of an 8% national economic growth rate
- **Answer: C**

**25. Which is NOT a factor contributing to the slow improvement in the health status of Ghanaians?
**
- A) Advanced telemedicine services
- B) Poor nutritional options for vulnerable groups
- C) High population growth rate
- D) Limited access to safe water and sanitation
- **Answer: A**

**26. The Medium-Term Health Strategy’s (MTHS) end of term review indicated all EXCEPT which
issue?**
- A) Continual improvement in malaria management
- B) Limited attention to diseases like Malaria and HIV/AIDS
- C) Misaligned targets that impacted benchmarking efforts
- D) Geographic disparities in health performance
- **Answer: A**

**27. The 3rd Programme of Work was anchored on which theme?**

- A) Creating wealth through health
- B) Reducing the disease burden through technology
- C) Health for all economic growth
 - D) Health-driven education programs
- **Answer: A**

**28. What was the major focus of the 2nd Programme of Work (2002-2006)?**
- A) Rehabilitation of outdated health facilities
- B) Reducing disparities and delivering gender-sensitive services
- C) Building partnerships with only high-income countries
- D) Promoting intensive urban health initiatives only
- **Answer: B**

**29. The objectives for the Health Sector 2018-2021 included addressing:**
- A) Only rural healthcare disparities
- B) Governance and management efficiency
- C) Lack of resources for communicable diseases
- D) Reducing outpatient services
- **Answer: B**

**30. What was a significant issue revealed in the review of the 2018-2021 health sector
performance?**
- A) Overemphasis on behavioral and environmental health interventions
- B) Lack of national databases for health data
- C) Perfect alignment of international health policies
- D) Excessive focus on urban health development only
- **Answer: B**

**31. What was the major outcome of the Health Sector 5-year Programme of Work 2002-2006
regarding lifestyle factors?**
- A) Improvement in smoking, alcohol, and obesity rates
- B) Behavioral factors worsened
- C) High engagement in exercise and consumption of fruits and vegetables
- D) Unchanged rates of non-communicable diseases
- **Answer: B**

**32. The under-five mortality rate in the latter years of the document had:**
- A) Risen significantly
- B) Stabilized
- C) Decreased to near zero
- D) Not been tracked
- **Answer: B**

**33. What theme underpins the 3rd five-year Programme of Work, 2007-2011?**
- A) Inclusive growth through health
- B) Creating wealth through health
- C) Supportive health systems
- D) Health and environmental synchrony
- **Answer: B**

**34. Which issue was not addressed in the 2nd Programme of Work theme, “Partnerships for
Health”?**
- A) Bridging the inequalities gap
- B) Health policy misalignment
- C) Delivering pro-poor services
- D) Gender sensitivity and financial risk protection
- **Answer: B**
**35. High Impact Rapid Delivery (HIRD) was rolled out nationwide by the end of:**
- A) 2005
- B) 2006
- C) 2007
- D) 2008
- **Answer: C**

**36. Goals for the Health Sector in 2012-2017 include all except:**
- A) Attaining middle-income status
- B) Enhancing capacity for health-related Millennium Development Goals (MDGs)
- C) Promoting traditional medicinal practices widely
- D) Ensuring financial protection for the poor
- **Answer: C**

**37. A main goal for the 2022-2025 Health Sector Medium Term Development Plan is to:**
- A) Encourage private healthcare exclusivity
- B) Reduce avoidable maternal and child deaths
- C) Return to the centralized healthcare model
- D) Decrease investment in public health infrastructure
- **Answer: B**

**38. By the year 2030, the healthcare sector aims to achieve:**

- A) Limited access to everyday health services
- B) Increased access to quality essential healthcare for everyone
- C) Focusing healthcare services mainly in urban areas
- D) Reducing international assistance in health
- **Answer: B**

**39. The Berman definition of “Fundamental” in Health Sector Reform includes:**

- A) Short-term strategies only
- B) Narrow impact changes
- C) Addressing significant, strategic dimensions
- D) Avoiding deep structural changes
- **Answer: C**

**40. Essential components of improving healthcare delivery efficiency mentioned include all
EXCEPT:**
- A) Decentralization
- B) Improved financial management
- C) Reducing GHS mechanism
- D) Improving logistical management
- **Answer: C**

**41. What does the text suggest about the organizational setup impacting healthcare delivery?**
- A) It was decentralized and horizontal
- B) Prioritization of services was appropriate
- C) It was centralized and vertical
to D) Linkages between care providers were strong
- **Answer: C**

**42. What aspect of distribution posed a significant issue according to the text?**
- A) Disproportionate distribution of medical professionals
- B) Uneven access to innovative medical technology
- C) Unequal establishment of healthcare institutions
- D) High cost of medication nationwide
 - **Answer: A**

**43. The 2012-2017 health objectives specifically focus on enhancing:**

- A) Medical health services quality
- B) Dependency on foreign health standards
- C) Commercial aspects of healthcare services
- D) Private health facility ratings
- **Answer: A**

**44. In the health sector reforms for 2012-2017, what was a targeted area for improvement?**
- A) Increasing community-based health practices
- B) Lowering urban health standards
- C) Reducing communicable and non-communicable diseases
- D) Expanding exclusivity in healthcare access
- **Answer: C**

**45. As per the 2018-2021 objectives, what was one of the health service goals?**
- A) Ignoring emerging health threats
- B) Emphasizing treatment over prevention
- C) Reduce morbidity and mortality from diseases
- D) Concentrate solely on non-communicable diseases
- **Answer: C**

**46. The 2022-2025 plan targets what key aspect of health care improvement?**
- A) Decreasing emergency response times
- B) Providing universal, equitable, and accessible healthcare services
- C) Limiting healthcare to specific population groups
- D) Reducing international collaboration
- **Answer: B**

**47. Review of the 2018-2021 health sector performance indicated what problem related to
collaboration?**
- A) Over-collaboration leading to confusion
- B) Weak collaboration among ministries and agencies
- C) Forced collaborations that reduced efficiency
- D) Opaque agreements that hindered progress
- **Answer: B**

**48. A criticism noted in the health sector review of 2002-2006 pertained to what aspect?**
- A) Overemphasis on traditional health systems
- B) Excessive budget allocation
- C) Over-focus on delivery of medical technology
- D) Complete elimination of preventive interventions
- **HelplineD:** C

**49. What does the document say about the status of behavioral factors by the end of the 2nd
Programme of Work (2002-2006)?**
- A) They had improved
- B) They worsened, thus requiring more attention
- C) They were not mentioned in health programs
- D) They had stabilized
- **Answer: B**

**50. During the health sector programs, a key observed trend in the underweight rates for children
under five was:**
 - A) Unchanging rates
- B) A slight increase
- C) A decline
- D) Sporadic fluctuations
- **Answer: C**

**51. What was the focus of the National Health Policy which guided the 3rd Programme of Work?**
- A) Focusing strictly on hospital care
- B) Promoting healthy lifestyles and reproductive and nutrition services
- C) Reducing funding for health education
- D) Ignoring lifestyle-related health risks
- **Answer: B**

**52. Measures to address disparities in the 2nd five-year Programme included all EXCEPT:**
- A) Promoting gender-sensitive health services
- B) Ensuring financial risk protection
- C) Exclusive focus on urban populations
- D) Developing strategies for delivering pro-poor services
- **Answer: C**

**53. What was the priority of healthcare reform in Ghana for the year 2012-2017 regarding
economic status?**
- A) Maintaining high economic growth from health infrastructure
- B) Attaining a minimum of $1000 USD per capita by a set year
- C) Reducing economic input into healthcare
- D) Ignoring economic indicators entirely
- **Answer: B**

**54. The Health Sector objective from 2018-2021 aiming for 'Universal Health Coverage' focused
mainly on:**
- A) Sustainable, affordable, equitable, and accessible services
- B) Excluding rural areas from primary healthcare services
- C) Privatization of all healthcare facilities
- D) Reducing healthcare quality for efficiency
- **Answer: A**

**55. Which consequence was noted due to inadequate health sector financing from 1997-2001?**
- A) Increase in private sector investments
- B) Financial stability in health systems
- C) Expansion of health facilities
- D) Continued disparities and performance issues
- **Answer: D**

**56. The term 'HIRD' in Ghana’s health sector represents:**

- A) High International Rapid Deployment
- B) High Impact Rapid Delivery
- C) High Intensity Role Distribution
- D) Health Internal Resilience Development
- **Answer: B**

**57. For healthcare finance strategies post-2020, which method was NOT noted in the medium-term
plans?**
- A) Decreasing donor funding significantly
- B) Better management of internally generated funds
- C) Increasing government allocations
 - D) Pooling of donor funds
- **Answer: A**

**58. Key barriers to healthcare access identified before the reforms included all EXCEPT:**
- A) Economic and financial barriers
- B) Geographic or physical access issues
- C) Lack of public interest in healthcare services
- D) Socio-cultural barriers
- **Answer: C**

**59. By 2030, the health objectives in Ghana aim to significantly reduce what?**
- A) Maternal, adolescent, and child deaths and disabilities
- B) Private healthcare investments
- C) Use of traditional medicine
- D) Economic growth from healthcare
- **Answer: A**

**60. What does MTHS assume regarding population health outcomes and health interventions? **
- A) No correlation exists
- B) More interventions correlate with worse outcomes
- C) A direct link between health outcomes and selected health interventions
- D) Outcomes are unrelated to interventions
- **Answer: C**

**61. Which organizational issue was highlighted as negatively impacting health service
performance?**
- A) Overly competitive recruitment practices
- B) Centralized and vertical structures
- C) Excessively autonomous local health units
- D) Overemphasis on community-based care
- **Answer: B**

**62. What initiative tackled health management issues in district-level systems?**

- A) Strengthening of District Health Systems Initiative
- B) Central Health Services Program
- C) Rural Health Networking Project
- D) Urban Health Improvement Endeavor
- **Answer: A**

**63. Which was not a cause of poor health system performance identified in the text?**
- A) Appropriate prioritization of services
- B) Weak monitoring and supervision
- C) Inadequate and poor distribution of human resources
- D) Inadequate financing
- **Answer: A**

**64. What key area did not improve as expected by the end of the MTHS 1997-2001?**
- A) Immunization coverage
- B) Management of communicable diseases
- C) Reduction in maternal and child mortality
- D) Health system infrastructure
- **Answer: B**

**65. By the 3rd Programme of Work, how had childhood underweight status changed?**
- A) It showed no significant change.
 - B) There was a notable decline.
- C) It had increased alarmingly.
- D) Data was inconclusive.
- **Answer: B**

**66. Vision 2020's health focus shifted towards:**

- A) Increasing the life expectancy to 80 years.
- B) Reducing population growth from 3% to 2%.
- C) Focusing solely on medical advancements.
- D) Eliminating all external health support.
- **Answer: B**

**67. The medium-term plan for 2012-2017 set a new financial target of:**
- A) $500 USD per capita income
- B) $1000 USD per capita income
- C) $1500 USD per capita income
- D) $2000 USD per capita income
- **Answer: B**

**68. What was a major critique in the review of health programmes from 2018-2021?**
- A) Too much focus on rural development
- B) Inadequate national data on non-communicable diseases (NCDs)
- C) Excessive budget allowances
- D) Overreliance on traditional health practitioners
- **Answer: B**

**69. During the first long-term strategy period, what was a primary goal for health reforms?**
- A) Decline in educational partnerships
- B) Promotion of non-scientific health interventions
- C) Maximizing healthy and productive lives of Ghanaians
- D) Reducing governmental involvement in healthcare
- **Answer: C**

**70. What was noted as an ongoing problem in the achievements from MTHS 1997-2001?**
- A) Entire elimination of targeted diseases
- B) Continuation issues such as Malaria, HIV/AIDS, TB, and Guinea worm
- C) Overachievement in set health targets
- D) Mismanagement of financial resources
- **Answer: B**

**71. In Ghana’s health developments by the late 1970s, what was emphasized?**
- A) Solely clinical care
- B) Educational and environmental health
- C) Privatization of health care
- D) Reduction in health research
- **Answer: B**

**72. What was a major challenge noted in the 2nd Programme of Work review regarding lifestyle
adjustments?**
- A) Lack of focus on diet and exercise
- B) Significant attention to mental health
- C) Overregulation of health habits
- D) Emphasis solely on medical solutions
- **Answer: A**
**73. What overarching theme drives the third Programme of Work in 2007-2011?**
- A) Wealth generation through improved health
- B) International accolades in health achievements
- C) Reducing dependence on global health standards
- D) Focusing health services on the elderly population
- **Answer: A**

**74. Post-2020 health strategies aimed to improve funding by:**

- A) Curtailing donor contributions
- B) Increasing government allocations
- C) Cutting costs on medical supplies
- D) Limiting staff development
- **Answer: B**

**75. What was a key health goal set by Vision 2020 formulated in the 1990s?**
- A) To increase average lifespan
- B) To reduce dependency on donor funding
- C) To limit health service growth
- D) Protection and promotion of environmental health
- **Answer: D**

**76. Causes for disparities in health outcomes between 1997 and 2001 included:**
- A) Even development across regions
- B) High-quality healthcare in all districts
- C) Geographical differences and uneven spread of benefits
- D) Uniform access to healthcare services
- **Answer: C**

**77. What does the 2007-2011 Programme of Work prioritize in high-risk populations?**
- A) Delaying healthcare reforms
- B) Rolling out High Impact Rapid Delivery (HIRDeliveries
- C) Concentrating on administrative functions
- D) Reducing financial allocations
- **Answer: B**

**78. The health sector in 2018 aimed to enhance efficiency in:**

- A) Providing universal health coverage
- B) Governance and management
- C) Reducing non-communicable disease rates to zero
- D) Implementing emergency-only services
- **Answer: B**

**79. What major financial trend was reported in the health sector reforms from the early 2000s?**
- A) Sufficient funding from both government and donors
- B) Decrease in overall health spending
- C) Reliance solely on internal funds
- D) Continuing issues with adequate financing
- **Answer: D**

**80. In addressing healthcare efficiencies, which aspect was targeted for improvement during
various programs?**
- A) Establishing more medical schools
- B) Implementing innovative financial management strategies
- C) Removing all external audits
- D) Creating a healthcare monopoly
- **Answer: B**