Health in Ghana

Komfo Anokye Teaching Hospital, Kumasi

Health in Ghana includes the prevention, care and treatment of disease and other maladies. As parts of the Ghanaian economy are not fully industrialized, issues arise that are common to growing healthcare systems.

History

Ghana versus United Kingdom; physicians and professional nurses monthly salary comparison chart

In the 16th century, traditionally, village healers and clerics were the primary care givers, offering herbal remedies. Though herbalist have traditionally offered the most ready treatment of illness, premodern traditional beliefs stressed the combination of spiritual and physical healing. Western medicine was introduced by Christian missionaries to the Gold Coast in the 19th century. This region was most involved in the development of a new health care system. A pre-medical department was formed initially, and in 1878, the Towns, Police, and Public Health Ordinance was enforced under its direction, initiating the construction and demolishing of infrastructure, draining of the streets, and issuing of fines to those that failed to comply with the heads of the colony. In 1893, a Public Works Department was introduced to implement a working sanitation system for the colony. Finally, in the 1880s, a Medical Department was formed, bringing about an introduction to a formal medical system, consisting of a Laboratory Branch for research, a Medical Branch of hospitals and clinics, and the Sanitary Branch for public health. After the war, the central government made a concentrated effort to expand western style medical facilities and after World War II both the World Health Organization and the United Nations Children's Fund have been active in providing money and support to provide additional western medical care in Ghana.^[1]

Healthcare

Ghana health care providers monthly salary and income chart

In Ghana, most health care is provided by the government and largely administered by the Ministry of Health and Ghana Health Services. The healthcare system has five levels of providers: health posts which are first level primary care for rural areas, health centers and clinics, district hospitals, regional hospitals and tertiary hospitals. These programs are funded by the government of Ghana, financial credits, Internally Generated Fund (IGF), and Donors-pooled Health Fund.^[2] Hospitals and clinics run by Christian Health Association of Ghana also provide healthcare services. There are 200 hospitals in Ghana. Some for-profit clinics exist, but they provide less than 2% of health care services.

Health care is very variable through the country. Urban centres are well served, and contain most hospitals, clinics, and pharmacies in the country. However, rural areas often have no modern health care. Patients in these areas either rely on traditional African medicine, or travel great distances for health care. In 2005, Ghana spent 6.2% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure.^[3]

In 2013, life expectancy at birth is 66 years with males at 65 years and females at 67 years,^[4] and infant mortality is at 39 per 1000 live births.^[5] The total fertility rate is 2.12 children per woman among the 15 million Ghanaian nationals. There was about 15 physicians and 93 nurses per 100,000 persons in 2010.^[6] 5.2% of the country's GDP was spent on health in 2010,^[7] and all Ghanaian citizens have access to primary health care 97.5% of the Ghana population.^[8] Ghana's universal health care system has been described as the most successful healthcare system on the Africa continent by the renowned business magnate and tycoon Bill Gates.^[8]

National Health Insurance

NHIS
National Health Insurance Scheme
Agency overview
Formed	2003
Jurisdiction	Republic of Ghana
Parent agency	Parliament of Ghana
Website	Official Website

Ghana has a universal health care system, National Health Insurance Scheme (NHIS),^[9] and until the establishment of the National Health Insurance Scheme, many people died because they did not have money to pay for their health care needs when they were taken ill. The system of health which operated was known as the "Cash and Carry" system. Under this system, the health need of an individual was only attended to after initial payment for the service was made.^[10] Even in cases when patients had been brought into the hospital on emergencies it was required that money was paid at every point of service delivery. When the country returned to democratic rule in 1992, its health care sector started seeing improvements in terms of:

• Service delivery
• Human resource improvement
• Public education about health condition

even with these initiatives in place many still could not access health care services because of the cash and carry system.

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former president John Kufour who when seeking the mandate of the people in the 2000 elections, promised to abolish the “cash and carry system” of health delivery.^[11] Upon becoming president, former president Kufour pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment. In 2003, the scheme was passed into law. Under the law, there was the establishment of National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of its citizens. Since its inception, the country's health facilities have seen constant rise in patient numbers and a considerable reduction in deaths.

Disease

Ghanaian biochemist presenting a Gene Bank in Ghana

According to the World Health Organization the most common diseases in Ghana include those endemic to sub-Saharan African countries, particularly: cholera, typhoid, pulmonary tuberculosis, anthrax, pertussis, tetanus, chicken pox, yellow fever, measles, infectious hepatitis, trachoma, malaria, and schistosomiasis. Though not as common, other regularly treated diseases include dracunculiasis, dysentery, river blindness or onchocerciasis, several kinds of pneumonia, dehydration, venereal diseases, and poliomyelitis.^[12]

In 1994, the WHO reported malaria and measles were the most common causes of premature death. In children under 5, 70 percent of deaths were caused by an infection compounded by malnutrition.^[12] A 2011 report by the Ghana Health Service said that malaria was the primary cause of morbidity and about 32.5 percent of people admitted to Ghanaian medical facilities were admitted because of malaria.^[13]

HIV/AIDS

Like other countries worldwide, HIV/AIDS is present in Ghana. In 2010 there were an estimated 230,000 people infected with the virus. The prevalence rate was at 1.3 percent in 2012. HIV prevalence is highest in the Eastern Region and lowest in the northern regions of the country. In response to the epidemic, the government established the Ghana AIDS Commission,.which coordinates efforts amongst international organizations and other parties to support education about and treatment of HIV/AIDS throughout Ghana.

Women's Health

Ghanaian female surgeon performing a surgery

The health of women in Ghana is critical for national development. Women’s health issues in the country are largely centered on nutrition, reproductive health and family planning.^[14] Reproduction is the source of many health problems for women in Ghana. The Ghana Living Standards Survey Report of the Fifth Round revealed that about 96.4% of women reported that they, or their partners, were using modern forms of contraception.^[15] This statistic has significant importance in reducing the spread of HIV/AIDS, which currently affects 120,000 women in Ghana (of the 230,000 people living with the disease in the country).^[16] Interventions for improving the health of women in Ghana, such as the Ghana Reproductive Health Strategic Plan 2007-2011, focus on maternal morbidity and mortality, contraceptive use and family planning services, and total empowerment of women.^[17]

Maternal and Child Health Care

In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery.^[18] It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Ghana is 350. This is compared with 409.2 in 2008 and 549 in 1990. The under 5 mortality rate, per 1,000 births is 72 and the neonatal mortality as a percentage of under 5's mortality is 39. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Ghana the number of midwives per 1,000 live births is 5 and the lifetime risk of death for pregnant women 1 in 66. ^[18]

Breast cancer

Ghanaian female surgeon preparing to perform a surgery

In Ghana, breast cancer is the leading malignancy.^[19] In 2007, breast cancer accounted for 15.4% of all malignancies, and this number increases annually.^[19] Roughly 70% of women who are diagnosed with breast cancer in Ghana are in the advanced stages of the disease.^[20] In addition, a recent study has shown that women in Ghana are more likely to be diagnosed with high-grade tumors that are negative for expression of the estrogen receptor, progesterone receptor, and the HER2/neu marker.^[21] These triple negative breast tumors are more aggressive and result in higher breast cancer mortality rates.^[21]

Explanations for the delayed presentation among women in Ghana have been traced to the cost of, and access to, and routine screening mammography.^[20][22] Furthermore, women with breast cancer in Ghana describe a feeling of hopelessness and helplessness, largely due to their belief in fatalism, which contributes to denial as a means of coping.^[22] Mayo et al. (2003) conclude, however, that lack of awareness may be a more critical variable than fatalism in explaining health care decisions among women in Ghana.

Over the past decade, international delegations and nongovernmental organizations have started responding to the growing problem of breast cancer in Ghana. In particular, the Breast Health Global Initiative and the Susan G. Komen for the Cure established a Ghana Breast Cancer Alliance to help increase early detection and reduce the breast cancer mortality rate in the country. Through public education, awareness, training, and particularly promotion of early detection practices, international aid groups can help improve the situation in Ghana.^[23]

Water Supply and Sanitation

The water supply and sanitation sector in Ghana still faces a number of problems, partly due to a neglect of the sector until the 1990s. Tariffs were kept at a low level which was far from reflecting the real cost of the service. Economic efficiency still remains below the regional average, resulting in a lack of financial resources to maintain and extend the infrastructure.^[24] Since 1994, the sector has been gradually modernized through the creation of an autonomous regulatory agency, introduction of private sector participation, and decentralization of the rural supply to 138 districts, where user participation is encouraged. The reforms aim at increasing cost recovery and a modernization of the urban utility Ghana Water Company Ltd. (GWCL), as well as of rural water supply systems.^[25]

Another problem which partly arose from the recent reforms is the existence of a multitude of institutions with overlapping responsibilities. The National Water Policy (NWP), launched at the beginning of 2008, seeks to introduce a comprehensive sector policy.^[26]

See also

• Village by Village
• Volunteer Partnerships for West Africa
• Accra Declaration

References

External links

• The State of the World's Midwifery - Ghana Country Profile