Ghana has made steady progress in improving access to health care for its 32.9m citizens. This includes the rollout of the National Health Insurance Scheme (NHIS), which covered nearly 17.2m people as of June 2023, or 55% of the population, with the aim being to cover 20m people by the end of 2023. The initiative has helped those seeking medical care overcome financial and geographic obstacles.
Although the Covid-19 pandemic made for a challenging environment in health care delivery, it also allowed policymakers to identify and address existing issues in facilities, the health care labour force and disease monitoring, as well as determine ways in which to raise overall standards.
As a result, the government launched several initiatives to enhance the sector. The Agenda 111 project aims to build 101 district hospitals, seven regional hospitals and three psychiatric hospitals by 2024. A digital health strategy, geared towards harnessing e-health solutions, is being implemented to streamline services. Other innovations, such as using medical drones in collaboration with drone developer Zipline and logistics company UPS, have emerged as effective responses to health care challenges in remote areas of the country, enhancing vaccine access and disease surveillance.
Structure & Oversight
The framework governing Ghana’s health care system emphasises the country’s commitment to achieving comprehensive coverage. At its core is the Ministry of Health (MoH), which determines health care policies and planning, and provides the necessary funding.
The Ghana Health Service (GHS) is responsible for translating these policies into actionable outputs. The Medical and Dental Council, Allied Health Professions Council, and the Nursing and Midwifery Council are some of the bodies that oversee the health care sector, ensuring that practitioners adhere to the highest standards of professionalism.
The country is divided into administrative districts, each with its own health care directorate. This decentralised model helps regions tailor solutions to local needs. A key challenge facing the sector is the urban-rural divide, which is typified by disparities in health care infrastructure. Increased investment in rural health care services and enhanced technological connectivity among medical centres are expected to improve the sector’s oversight and infrastructure in the years to come.
Indicators
In 2021 total health care expenditure reached GHS14.5bn ($1.3bn), with public health care spending comprising more than 45% of the total and private health care the remaining 55%, as outlined in a September 2022 report by GCB Bank. According to figures from the World Health Organisation (WHO), per capita health care spending was $85 in 2020, having more than doubled from $40 in 2000. However, in 2021 GCB Bank reported this figure at just over $81. Health care spending as a percentage of GDP was 4% in 2020, as per the World Bank, fluctuating over the last two decades from a low of under 2.8% in 2004 to a high of 4.7% in 2011. GCB Bank put the 2021 figure at 3.5%.
Ghana’s population stood at around 32.9m in 2023, according to the IMF. In 2019 the WHO estimated life expectancy at birth to be more than 66 years on average, with life expectancy for men and women at 63.7 and 69.2, respectively. Reproductive health has witnessed significant progress, with maternal mortality rates per 100,000 live births having declined from 499 in 2000 to 263 in 2020. Similarly, the neonatal mortality rate was 22.8 deaths per 1000 live births in 2021, compared to 35.9 in 2000, while the under-five mortality rate was down from 100 in 2000 to 44 in 2021.
Although maternal and child health care has improved significantly in the 21st century, access to quality health care remains inconsistent, with rural communities disproportionately affected by a lack of access. To resolve this issue, the government has launched initiatives to bolster health infrastructure and service delivery in underserved regions, with a commitment to achieving equitable health care access nationwide. One such initiative is the Lightwave Health Management Information System, a project under the MoH’s National E-Health Project that aims to digitalise patient records in 100% of hospitals by the end of 2024. As of December 2022 Zipline drones had delivered more than 12m medical products and medicines to underserved areas since first being introduced in 2019. These efforts underscore Ghana’s commitment to expanding health care provision and addressing sector disparities.
Disease Prevention
The efforts undertaken to eradicate diseases reflect the shift in Ghana’s public health care priorities. Historically, communicable diseases – primarily malaria – have been the dominant health issue. Ghana’s commitment to combatting malaria is evident through its control initiatives. Guided by the National Malaria Strategic Plan, Ghana has aligned its domestic aims with global objectives to reduce malaria mortality by 90%, curtail cases by 50% and achieve pre-elimination status in at least six districts by 2025.
However, the disease landscape in the country has undergone a noticeable shift in recent years. According to the WHO, in 2019 the probability that someone between the age of 30 and 70 would die from a non-communicable disease (NCD) – for example, cardiovascular disease, diabetes, cancer or respiratory illness – was 22.5%. That same year such diseases accounted for 45% of all deaths in Ghana, according to the World Bank. The interplay between infectious diseases and NCDs can make the delivery of health care more complex. For example, individuals with diabetes are more susceptible to infectious diseases, such as tuberculosis; HIV can also complicate diabetes management.
The hepatitis B virus presents a similar public health problem, with an estimated national prevalence of 9.1% as of 2019, compared to 6.5% for the African continent as a whole, as reported in a June 2022 report in The Lancet medical journal. The Coalition for Global Hepatitis Elimination – part of the Task Force for Global Health, an international non-profit organisation – estimated the hepatitis B and hepatitis C rates in Ghana in 2019 to be roughly 8.4% and 3.3%, respectively.
In an effort to eliminate the diseases, the MoH and the GHS launched the National Viral Hepatitis Control Programme in 2017, which has developed guidelines for diagnosing and treating these diseases. In March 2023 Ghana, in collaboration with the government of Egypt, the WHO and others, established the Stop Hep C Ghana Project, which provides free health care to Ghanaians suffering from the disease across the country.
Public Sector
Ghana’s 2020-30 roadmap for achieving universal health care (UHC) is a key pillar of the country’s development agenda. Launched at the beginning of 2020, the stated goal was to ensure that at least 80% of Ghanaians had access to essential services by the end of the decade and 100% insurance coverage for primary services.
The roadmap prioritises strengthening primary health care and ensuring equitable access to specialised care, essential nutrition, health promotion, curative care, disease prevention, and palliative, rehabilitative, emergency and mental health services, targeting vulnerable segments of the population, such as adolescents, women and the elderly.
In addition, the sector roadmap establishes a results-based framework, encompassing 28 indicators which measure progress in areas such as health insurance coverage and maternal mortality reduction. This approach blends quantitative and qualitative assessment methods, helping to ensure improvements in transparency and accountability.
Access tends to be uneven, with gaps in service quality and availability. An emergency management system is being developed that focuses on pre-hospital and emergency care, infrastructure upgrades and training paramedics. Efforts to eliminate diseases such as onchocerciasis, yaws and yellow fever are under way, backed by disease surveillance and outbreak control measures. A related initiative is the GHS’ National Malaria Elimination Programme, which distributes insecticide-treated bed nets to pregnant women and children. In 2021 the programme distributed nets to more than 90% of pregnant women and children at post-natal care and child welfare clinics.
Private Sector
The private health care sector reflects the changing landscape in Ghana. In December 2022 a study published by UNICEF, the UN Development Programme, the WHO’s Social Innovation in Health Initiative and TDR, the WHO’s programme for conducting research and training on tropical diseases, found that the private sector accounted for 42% of health care service delivery in the country. However, the study noted that the sector lacks incentives for private providers to establish facilities in underserved areas, and that regulatory bodies should increase their oversight of private health care companies.
That said, with the support of the Private Health Facilities Association of Ghana, such entities have not only expanded health care access, but are also improving the overall quality of services delivered. The National Health Insurance Authority (NHIA) oversees private systems, including 14 official private health insurance companies. The sector ranges from faith-based organisations, to for-profit institutions and not-for-profit entities.
Research
Ghana is a prominent centre for medical research, driven by a network of institutions dedicated to advancing scientific knowledge and improving health care outcomes. The Noguchi Memorial Institute for Medical Research (NMIMR), affiliated with the University of Ghana, is at the forefront of medical research. Known for its work with infectious diseases, immunology and genomics, NMIMR collaborates with national and international partners on research projects.
Another institution of note is the Kumasi Centre for Collaborative Research in Tropical Medicine, which specialises in tropical diseases and collaborates with the Germany-based Bernhard Nocht Institute for Tropical Medicine. The GHS’ Research and Development Division runs three research centres in the country’s primary ecological zones: the Navrongo Health Research Centre in the northern savannah; the Kintampo Health Research Centre in the forested part of the country; and the Dodowa Health Research Centre in the coastal area.
Pharmaceuticals
Ghana’s pharmaceutical segment is a key component of its health care ecosystem, comprising drug producers, wholesalers, distributors, retailers and consumers. Although it is a significant regional player in West Africa’s pharmaceutical segment, Ghana’s international standing in the industry remains modest. In 2021 the pharmaceutical market was valued at GHS2.6bn ($236m), and the September 2022 report by GCB Bank projected this figure to have grown to GHS2.8bn ($254m) in 2022. Prescription medicines account for roughly 74% of sales, with over-thecounter medicines making up the remaining 26%. Both patented and generic drugs are available, with generics gaining popularity over time. In 2021 pharmaceutical sales accounted for 0.6% of GDP and 18.2% of total health care expenditure.
Ghana’s Association of Representative Ethical Pharmaceutical Industries is one of four members of the International Federation of Pharmaceutical Manufacturers Association from Africa. Multinationals actively collaborate with local counterparts, further shaping Ghana’s pharmaceutical landscape, and fostering growth and innovation. The focus of the domestic market is primarily on prescription drugs.
The government plays a crucial role in regulating and supplying drugs and services, with the goal of ensuring affordability and efficacy. Rising health care expenditure is supported by significant public and private investment, and the government remains instrumental in the industry’s development.
In a major milestone for the pharmaceutical industry, the National Vaccine Institute was inaugurated by President Nana Akufo-Addo in May 2023. The institute is intended to facilitate domestic vaccine development and manufacturing, reducing dependence on foreign sources. This initiative was inspired by the challenge of vaccine nationalism – when countries push for initial access to vaccines and hoard important components – especially during the Covid-19 pandemic. With a $25m investment, it aims to enhance the capacity of local pharmaceutical companies to produce mRNA Covid-19, malaria and tuberculosis vaccines, positioning Ghana as a key player in Africa’s public health ambitions.
Outlook
The health sector is poised for transformation due to a combination of factors, including the ongoing effort to achieve UHC, the expansion of domestic pharmaceuticals, the adoption of digital solutions and the growth of local vaccine production. These initiatives are expected to improve the accessibility, quality and affordability of health care, especially in rural and underserved areas.
Looking ahead, the country faces a number of challenges, such as the rising burden of NCDs, the persistent threat of infectious diseases and fiscal constraints on health care spending. In the years ahead, stakeholders are likely to focus on these issues and leverage the opportunities available to achieve their broader goals in the health care sector.
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