Ghana: Ghana Health Profile

Ghana is located on West Africa's Gulf of Guinea. It has a total land area of 238,533 km and an estimated population of 23,478,000. It has a population growth rate of 2.6% and a total fertility rate of 4.0. About half the population live in the rural area.
Ghana is divided into ten administrative/political regions which are further divided into 170 District Assemblies. The District Assemblies develop, plan and mobilize resources for programmes and strategies for the development of the district. Ghana has a stable political situation, with Presidential and Legislative elections held every four years. Transition of power between political parties has taken place without incident in 2000 and 2008.

Leading health care development

Over the past decade health care in Ghana has improved dramatically, primarily as a result of a wide variety of government-led initiatives and programmes. Projects overseen by the Ministry of Health (MoH) in recent years have included upgrading the country’s public health infrastructure in an effort to streamline and improve medical services on offer; expanding the scope of the government’s disease control and immunisation programmes; and encouraging the ongoing development of the private sector.

These efforts have been paid for by a substantial boost in funding. According to a 2010 report from the World Health Organisation (WHO), which cites numbers from 2007, on a per capita basis government spending on health care nearly tripled over the first seven years of the past decade, rising from $19 in 2000 to $54 in 2007 (at average exchange rates). In 2007, according to the report, the government was responsible for 51.6% of all health care-related spending in Ghana, while the private sector contributed 48.4%.

This relatively even split in terms of spending is the result of close and ongoing cooperation between the MoH’s Private Sector Unit (PSU) and the nation’s numerous private health care providers. The PSU, which was formally launched as an independent division within the ministry in early 2011, offers a wide variety of services to private firms, including helping them source financing and draw up business plans, for example. In an effort to further develop the private sector, the unit is in the process of expanding the MoH’s public-private partnership programme.

While private sector providers will likely play an increasingly important role in the sector as a whole in the coming years, the government is expected to continue to provide core services for the majority of the population for some time to come. With this in mind, the MoH is currently working to improve many of its existing programmes and introduce a number of new public health initiatives.

At the centre of this effort is the ministry’s Disease Control Unit (DCU), which has a long-term mandate to eradicate infectious diseases in Ghana. The DCU oversees programmes aimed at controlling a wide variety of diseases, including malaria, HIV/AIDS, diphtheria, tuberculosis, hepatitis B, yellow fever and measles. In general, the unit has a three-pronged approach to combating these diseases, which includes education and awareness programmes, prevention initiatives and treatment programmes.

Communicable diseases are responsible for around 73% of deaths in Ghana. Malaria is one of the biggest public health challenges facing the government today. According to the WHO, in 2008 some 5.04m cases of malaria were reported in Ghana (which is equal to around 21% of the population), and the country’s malaria mortality rate was 109 per 100,000 people, which is higher (albeit only slightly) than the African average.

The government is working to improve this situation, primarily by boosting awareness and increasing education about malaria among the general population. In terms of prevention, the MoH has partnered with a number of non-governmental organisations and private sector players to encourage the use of mosquito nets, with a focus on the youth population, which is especially susceptible to the disease.

While much less prevalent than malaria, HIV/AIDS remains a very serious problem in Ghana. The disease is harder to treat and, in general, remains much less understood and accepted among the population. According to estimates by the Ghana AIDS Commission (GAC), there are currently around 260,000 HIV-positive people in the country.

The first case of HIV in Ghana was reported in 1986, according to the Joint UN Programme on AIDS. By 2003 prevalence had risen to 3.1% nationwide. The GAC, which was launched in 2000 and formalised by an act of parliament in 2002, has been quite effective in stanching the spread of the disease. Beginning in 2003, the incidence of HIV/AIDS in Ghana started to fall off, reaching 1.7% by 2007 and 1.5% as of late June 2011.

The GAC’s fight against the disease is carried out on multiple fronts. The organisation’s prevention efforts are aimed at high-risk populations, including sex workers, intravenous drug users and sexually active homosexual men. The GAC is also working to completely eliminate mother-child transmission – which results in 2500-3000 HIV-positive babies being born each year – by 2015.

The organisation is also working to expand the availability of treatment. Currently around 20% of the HIV-positive population accesses treatment, primarily in the form of antiretrovirals. The GAC is working to boost this number to 80% in the coming years, largely by expanding the national network of HIV testing and counselling sites.

Both the government and numerous other private aid organisations have rolled out education programmes throughout the country that seek to impart reliable information about HIV/AIDS. Boosting the level of understanding about the disease is expected to result in better detection and treatment. Continued funding and focus on the sector in general will also see improved provisions across the board.
 

The Government’s development agenda is to transform Ghana into a middle income country with GDP per capita of at least 1000 USD by 2015. The strategies for achieving this growth is to improve human capital, strengthen the role of the private sector in the development of the economy, and to provide good governance.

HEALTH & DEVELOPMENT

The health sector in 1996, adopted Sector Wide Approach (SWAp) in its sector reforms; with government, partners, civil societies and the private sector all playing a part. As a result of this reform, the Ministry of Health (MoH) retained responsibility for policy formulation, monitoring and evaluation, resource mobilization and regulation of the health services delivery. The Ghana Health Service (GHS) was created to assume responsibility for service delivery and implementation of the health policies and programmes designed by the MoH. A common
management arrangement has been developed in which partners and stakeholders participate in sector dialogues and develop sector plans. Joint planning, budgeting, supervision, monitoring and reporting framework is being used; making a joint ownership of most processes and products of the sector.

To make the health sector more responsive, all public-owned health institutions, divisions, facilities and agencies have the responsibility for their own planning, budgeting, implementation, monitoring and evaluation by being designated as Budget Management Centres. National, regional, district, sub-district and community levels are organized to implement the 5-year Plan of Work (5YPOW), which is developed by the Ministry and all key partners and stakeholders. The private and the NGO sectors including the Christian Health Association of Ghana provide over 40 % of health care in Ghana, especially in the rural areas. In 2005, Ghana introduced the National
Health Insurance Scheme (NHIS) to improve financial accessibility to healthcare. The NHIS is administered peripherally through District Wide Health Mutual Insurance Schemes (DWHIS).

The Scheme is tax-based and covers most services offered at the district hospital level. Despite a number of constraints, it has registered over 50% of Ghana’s population. In 2008 free maternal care was included in the range of service covered by the NHIS Ghana is going through an epidemiologic transition where the prevalence of non-communicable diseases is increasing. The major causes of child mortality include malaria, diarrhoea, respiratory infection, and neonatal conditions. HIV infection, hypertension, diabetes mellitus and road traffic accidents are major causes of mortality in adults. Low level of literacy, poor sanitation, under-nutrition, alcohol abuse, sedentary life styles and unhealthy diets constitute the broad determinants of ill-health contributing to high morbidity and mortality rates.

The health sector is implementing its third five year Programme of Work (2007-2011) which links health closely to poverty reduction through the Growth and Poverty Reduction Strategy (GPRS II) which recognises that improving the health of the poor is crucial to achieving accelerated and sustainable growth.

OPPORTUNITIES

• Easy access to international technical expertise(IST, AFRO and HQ)
• Clear monitoring mechanisms from AFRO and HQ.
• Partnering opportunities with other UN agencies to support the health sector.
• Availability of clear guidelines and tools for development and implementation of  CSS and for ensuring compliance with WHO regional and global priorities.
• Availability of multi-professional human resource base within the UN system
• Broad consultations during development of both CCS1 and CCS II.
• Team spirit within WHO country office.
• Collaboration of Government officials and partners on consultation.
• Easy access to information for evidence-base planning

CHALLENGES

• Inadequate marketing of the CCS & POA to stakeholders
• CCS not sufficiently being used as a planning tool.
• Weak monitoring and supervision of lower levels within the country.
•  Human resource constraints within the health sector and at the country office
• Inadequate funding to support implementation of the plans
• Regular reviews/monitoring of CCS implementation by all partners have not been formalized.
• Wrong perceptions that WHO is a funding institution
• Lack of ownership of the CCS by the Ministry of health
• Weakness of the health systems
• Dichotomy of the Ministry of Health and the Ghana Health Service