Really Amanda? Really?

In the middle of night, in a moment of indignation, I wrote a blog post on a report issued by Oxfam and a group of NGO partners on the health system in Ghana. I have since been duly chastised by Duncan Green and others.It’s pretty clear that my overheated rhetoric distracted from an important debate about health care in Ghana and more broadly about the role of evidence for policy change in the health sector.  I also erred in not taking proper note of the Ghanaian NGOs that contributed to the report. Though the media portrayed the report as being from Oxfam, I am now clear that this report was co-sponsored and should not be seen only as “the Oxfam report.”I deeply apologize to Oxfam and its partners and to our readers for the tone of my post. I should have dialed way back on the snark. Mea culpa.That said, I am sticking to my guns on substance.My point is that three studies have analyzed the Ghanaian health insurance scheme using impact evaluation methods: Mensah et al., Chankova  et al. and Nguyen et al.. These studies found that the Ghanaian insurance scheme increases utilization of key health care and provides financial protection against impoverishing out-of-pocket spending, especially for the poor. They also found that a large proportion of the poorest remain uninsured. Two of these studies are not cited by the report and the citation of Chankova et al. is limited to the study’s negative findings.While neglecting to take into account important evidence of the insurance scheme’s strengths, the report nonetheless offers sweeping recommendations: elimination of the insurance scheme and its replacement with Ministry of Health-run budgets provided to health facilities. This recommendation received wide coverage, including in the Guardian. In my view, the recommendation is based upon incomplete evidence, would be costly to implement and may result in less access to health care for poor people in Ghana.I fully support the elimination of economic barriers to health care for the poor, a key emphasis of the report. Our disagreement is on the nature of the available evidence about the government insurance scheme and the best way to improve access for the poor in the future.