"Like many other countries in Africa, Ghana spent much of the 1980s and 1990s paying off debt and enacting austerity measures designed to shore up its economy. The country’s health sector noticeably suffered under the economic cutbacks, resulting in staff shortages and poor maintenance of health facilities. In order to curb the deterioration of health services and to boost the quality of health care delivery, Ghana eventually implemented a pay-per-service health care model, commonly referred to as the “cash-and-carry” system."