Behind the Budget Numbers: What GH¢225bn In, GH¢234bn Out Means for a Ghanaian on Dialysis

The front page of this week's Graphic Business lays Ghana's 2025 finances out in tidy green and red bubbles: GH¢224.88 billion collected, GH¢233.78 billion spent, an GH¢8.90 billion shortfall. Taxes funded 86% of everything the state took in. Debt interest alone consumed GH¢22 of every GH¢100 earned.

Capital expenditure the money that builds and equips things got just 9% of total spending. Social benefits, tucked near the bottom of the outgoing column, received a mere GH¢2.61 billion out of GH¢233.78 billion.

For most readers, those are abstractions decimal points in a fiscal report. For a Ghanaian on dialysis, they are the difference between making it to next week's session or not.

Where the Money Doesn't Reach
Chronic kidney failure requires two to three dialysis sessions a week, indefinitely, for life unless a transplant becomes possible, and Ghana still has no functioning renal transplant programme.

A single private session costs upward of GH¢1,000. For a family without insurance cover, that is roughly GH¢3,000 a week, before drugs, transport, or lost income from time spent in a hospital chair rather than at work.

The government's answer has, on paper, evolved considerably.

Free dialysis was folded into the National Health Insurance Scheme benefit package, and the Ghana Medical Trust Fund popularly known as Mahama Cares was launched in April 2025 specifically to cover chronic conditions like kidney failure that NHIS alone could not sustain.

Parliament has since approved a GH¢2.9 billion budget for the Fund, and the President himself pledged six months of his salary to seed it, later joined by ministerial salary deductions and private donations.

But the Renal Patients Association of Ghana has been blunt about what patients actually experience. As of earlier this year, its leadership said only two facilities in Accra Korle-Bu Teaching Hospital and the Islamic Hospital were actually running the free dialysis programme, leaving both institutions overwhelmed with queues.

By May, the association's president was saying plainly that no single patient had yet benefited directly from Mahama Cares, and calling for more transparency on who the fund was actually reaching.

Their central demand is not primarily for individual grants but for machines and centres: more dialysis units at Komfo Anokye, Cape Coast, and beyond, so that patients across the country are not funnelled into two overstretched facilities in the capital.

The Fiscal Logic Behind the Shortage
This is where the front page's macro numbers and a dialysis patient's weekly reality meet. Ghana collected 86% of its 2025 revenue through taxation, yet debt servicing alone swallowed roughly a fifth of every cedi earned money that never reaches a hospital ward.

Capital expenditure, the budget line that would pay for new dialysis machines and renal centres outside Accra, was squeezed to just 9% of total spending, against an GH¢8.90 billion overall shortfall the government had to absorb some other way.

Social benefits the category dialysis subsidies, disability support, and similar transfers fall under came in at just over one percent of total expenditure. It is not that Ghana's budget planners are indifferent to kidney patients; ministers from Kwabena Mintah Akandoh downward have repeatedly and publicly committed to expanding coverage.

It is that a fiscal structure where interest payments outrank capital investment by more than two to one leaves comparatively little room to build the very infrastructure machines, trained renal nurses, new dialysis units upcountry that would let a policy commitment translate into a shorter queue at Korle-Bu.

A Familiar Ghanaian Pattern
There is a bitter irony that will be familiar to long-time observers of Ghana's public finances: the country has, at different points, come close to a crisis at Korle-Bu's renal unit severe enough that patients died after the hospital's indebtedness forced a temporary closure.

Each time, public outcry forces a policy response a benefit package expansion, a new trust fund, a presidential salary pledge. Each time, the underlying fiscal arithmetic heavy debt service, thin capital spending, taxes stretched across competing priorities reasserts itself before the policy can fully take root.

For the dialysis patient, none of this is academic. It is the difference between a subsidised session at a well-equipped public unit and a GH¢1,000 bill at a private clinic three times a week. Graphic Business's front-page bubbles describe where Ghana's money came from and where it went in 2025. For thousands of Ghanaians tethered to a dialysis machine, that same chart describes, almost line for line, why help is still arriving more slowly than their illness does.

Mustapha Bature Sallama
Medical/ Science Communicator,
Private Investigator, Criminal Investigation and Intelligence Analysis,

International Conflict Management and Peacebuilding. ( USIP)

[email protected]
+233555275880

Sources
Graphic Business, "GH¢225bn in, GH¢234bn out," front page, Sept. 14–20, 2026 edition https://www.graphic.com.gh/business

Rainbow Radio Online, "No Single Patient Has Benefited from Mahama Cares Initiative – Renal Association," May 13, 2026 https://rainbowradioonline.com/2026/05/13/no-single-patient-has-benefited-from-mahama-cares-initiative-renal-association/

Rainbow Radio Online, "Only two facilities in Accra offering free dialysis – Renal Patients Association," Feb. 13, 2026 https://rainbowradioonline.com/2026/02/13/only-two-facilities-in-accra-offering-free-dialysis-renal-patients-association/

Rainbow Radio Online, "Renal Patients Association Raises Concerns Over 'Mahama Cares' Accessibility," Feb. 13, 2026 https://rainbowradioonline.com/2026/02/13/renal-patients-association-raises-concerns-over-mahama-cares-accessibility/

Rainbow Radio Online, "Mahama Cares Fund Receives GHS 6.1 Million Boost Following Ministerial Salary Deductions," May 7, 2026 https://rainbowradioonline.com/2026/05/07/mahama-cares-fund-receives-ghs-6-1-million-boost-following-ministerial-salary-deductions/

Citinewsroom, "Dialysis cost now covered under NHIS – Akandoh," May 31, 2025 https://www.citinewsroom.com/2025/05/dialysis-cost-now-covered-under-nhis-akandoh/

Graphic Online, "Parliament approves GH¢6.87bn for NHIA - Dialysis for needy, promoting health check covered" https://www.graphic.com.gh/news/general-news/ghana-news-parliament-approves-ghc6-87bn-for-nhia-dialysis-for-needy-promoting-health-check-covered.html

NHIA, "NHIS Free Dialysis Program Remains in Effect Until Ghana Medical Care Trust Fund Becomes Fully Operational" https://www.nhis.gov.gh/News/nhis-free-dialysis-program-remains-in-effect-until-ghanamedical-care-trust-fund-becomes-fully-operational-5689

Ghana News Agency, "Government moves to roll dialysis onto National Health Insurance Scheme," Nov. 19, 2023 https://gna.org.gh/2023/11/government-moves-to-roll-dialysis-onto-national-health-insurance-scheme/

PMC/NCBI, "Fifty years of hemodialysis in Ghana current status, utilization and cost of dialysis services" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612280/