Affiliated Organization : United Kingdom Home Office
Publication Type : Country Policy and Information Note
Date of publication : June 2019
‘Health care expenditure is approximately USD100 per capita annually, or about 6.2 percent of GDP, both below the regional average…There are only 1.1 doctors and 9.8 nurses and midwives for every 10,000 inhabitants of Ghana, both of these are below even the low regional average, and represent a real strain on the delivery of health care. Wide inequities exist in the delivery of health care in Ghana, as only 24 percent of births from the lowest income quintile are attended by a skilled health professional, leading to much higher infant mortality rates.
‘Government spending makes up about half of total health expenditure in Ghana, with about one third of government spending in the form of a recently introduced social security system. Private health expenditure makes up most of the remainder, with most of this coming from out of pocket spending; private health insurance makes up only about 6 percent of total private health care spending. External funding from NGOs and other sources makes up about 10 percent of total health care expenditure.’
The training of physicians is also low relative to the country’s needs. These low levels of training are attributed mainly to preservice training being concentrated in just a few cities. Responding to this, the national government, since 2014, has been implementing efforts to set up tertiary teaching hospitals as a training ground for physicians in more regions and districts. Assessments on the quality of care, productivity, and competencies of health workers also illuminate poor reception by clients…
‘Health care expenditure is approximately USD100 per capita annually, or about 6.2 percent of GDP, both below the regional average…There are only 1.1 doctors and 9.8 nurses and midwives for every 10,000 inhabitants of Ghana
‘To assist with the preservation of health workers, the Ghanaian government has offered several incentives geared towards enhancing their productivity and attitudes, including subsidized and free housing, additional allowances, and professional development opportunities. Despite this, shortages still ensue outside of large cities and health workers still fail to perform up to standard, particularly in rural areas, among the poor, and in the Northern Region of the country. Given that health workers are integral agents in the provision of healthcare, the barriers that inhibit their work and functionality have critical implications for patient access.’
The Ghana Health Service report, The Health Sector in Ghana – Facts and Figures 2017, stated that in 2016 there were 1003 clinics, 404 hospitals, 855 health centres, and 3 psychiatric hospitals. In 2016, there were 3,365 doctors, 14,791 community health nurses, 7,662 midwives, 619 pharmacists, and 13,231 registered general nurses. The ratio of doctors per population in 2016 was 1:8481 .
‘Ghana operates a decentralized administrative structure with the country divided into ten regions with the Greater Accra region being the national capital of Ghana. The decentralized structure follows a four-tier system; national, regional, district, and sub-district levels. Health care is also decentralized along the administrative structure with the community level serving at the first point of the primary health care system. There are also clinics and health centres at the sub-district which are often manned by nurses and headed by Physician Assistants. At the district and regional levels are hospitals which are headed by medical officers and provide the secondary level of health care. The tertiary level is provided by the teaching hospitals which are located in the Northern, Ashanti, Greater Accra, and Central regions of Ghana. HIV-related services are also structured along the formal health system.’
Also, between 2009 and 2014, nearly seventy-one percent of live births were attended by skilled health personnel as compared to the average of over forty-eight percent of births that were attended by skilled health personnel in the continent at-large. The health indicators seen in the country over the last five years also attest to the efficacy of Ghana’s health system. According to the 2013 United Nations Development Programme (UNDP) Health Index, Ghana ranks 138th out of 187 countries with an index of just over zero point six and lags behind only six other African countries. Ghana’s status as a relatively healthier country is further corroborated by key health indicators provided by the World Health Organization (WHO). According to its 2016 health profile, life expectancy at birth for males is sixty-two years old and sixty-four years old for females, surpassing the average life expectancy on the continent (fifty-eight years old and sixty-two years old, respectively). The neonatal and child (under-five) mortality rate is also ranked at over twenty-four and over forty-nine per every 1,000 live births respectively, faring well when juxtaposed to the continent’s average (thirty-four and 100 deaths respectively).
A Mobile ODT (private company that provides information about medical apparatus and equipment) report, A revolution in cervical cancer screening in Ghana, dated 26 July 2018, stated:
‘Dr Kofi Effah feels understandably proud of his clinic and his staff. He heads the Cervical Cancer Prevention and Training Center of the Catholic Hospital, Battor, which opened to address the dire need for cervical cancer screening in Ghana…
‘At the outpatient clinic, the staff treats individual patients, offering to screen, follow up of screen positives and treatment where necessary. They not only provide medical procedures but also vitally needed patient education…
‘Dr. Effah has ambitious plans. Through the training program, he hopes to create a network of cervical cancer screening around Ghana…
‘Started in 2017, the Battor training program trains small groups of health workers, typically 4-6 per cohort, in basic cervical cancer screening – detection and treatment of cervical precancer…
‘In the first year of the training program from September 2017 to mid-July 2018, 47 health workers have received training. Trainees include a range of healthcare workers, from general nurses and community health nurses to midwives and physician assistants.’
The World Health Organisation (WHO) 2016 Diabetes Country Profile on Ghana stated that insulin, metformin and sulphonylurea, drugs used to manage diabetes, are generally available in Ghana. However, retinal photocoagulation, renal replacement therapy by dialysis, renal replacement therapy by transplantation, blood glucose measurement, oral glucose tolerance test, HbA1c testing, foot vibration testing, and foot vascular status by Doppler testing are generally not available in Ghana. Urine strips for glucose and ketone measurements are generally available in Ghana.
A MedCOI response, dated 6 December 2018, stated that laboratory research of blood sugar (HbA1c), blood-glucose self-testing strips, and blood-glucose meters are all available in Ghana. Insulin (administered by injection), glibenclamide, metformin, gliclazide and glimepiride are all available in Ghana.
Another MedCOI response (dated 10 November 2017), stated that tolbutamide, used to control blood-sugar levels, is available in Ghana.
A MedCOI response, dated 5 July 2017, stated that psychiatric treatment of alcohol/drug addiction, including group psychotherapy, is available in Ghana. There are also specialised (detoxification) clinics available for the treatment of people with alcohol/drug addictions. Social workers are also available to help and assist people with alcohol/drug addictions. Acamprosate and disulfiram – used to treat drug addiction – are available in Ghana, but the following drugs are not available: methadone, naltrexone hydrochloride, buprenorphine, buprenorphine+naloxone (combination), and nalmefene.
‘Of the 172 health facilities surveyed, 165 (96%) were offering HIV testing Services (HTS) during the survey period. More than 90% of the surveyed facilities reported to offer Anti-Retroviral Treatment (ART)
A BMC Health Services Research report, Availability of HIV services along the continuum of HIV testing, care and treatment in Ghana, dated 26 September 2018, stated:
‘Ghana has been providing HIV and AIDS services since the identification of the first case in 1986 and added highly active antiretroviral therapy to its comprehensive care in 2003.
‘Of the 172 health facilities surveyed, 165 (96%) were offering HIV testing Services (HTS) during the survey period. More than 90% of the surveyed facilities reported to offer Anti-Retroviral Treatment (ART), patient counselling, TB screening and Prevention of Mother to Child Transmission (PMTCT) services. Viral load and Early Infant Diagnosis (EID) and laboratory testing services were reported at 10 (5.8%) and 23 (13.4%) respectively. HIV testing services (HTS), PMTCT, ART, patient counselling and opportunistic infections (OI) prophylaxis services were offered at all Tertiary and Regional hospitals surveyed. EID sample collection and testing services was reported at 2 out of 27 (7.4%) of the Health Centre and/or clinics in Ghana.’
‘Indoor residual spraying is one of several tools supporting the National Malaria Control Programme’s goal of reducing malaria illness and death by 75 percent in Ghana between 2012 and 2020.
‘In 2017, implementers of spraying efforts in Ghana were able to significantly expand their coverage area, supported by the Unitaid-funded NgenIRS project. The two implementers are AGAMal, funded by the Global Fund, and PMI AIRS, now known as PMI VectorLink. Nearly, 400,000 homes were sprayed last year in the Upper-west, Northern and Upper-east regions of the country.’
The Amnesty International Report 2017/18 stated:
‘Shackling of people with psychosocial disabilities remained common, particularly in private “prayer camps” across the country. The practice involved restraining a person using chains or ropes and locking them in a confined space such as a room, shed or cage…A coalition of civil society organizations called on the government to adopt and enforce a ban on shackling and to invest in appropriate community-based services to support people with mental health conditions.’
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