Non-communicable diseases in Ghana spark caution, policy shifts

A nurse vaccinates a baby at a clinic in Accra, Ghana, as part of efforts to improve maternal and child survival rates.

Deja, Ghana – Local farmer Precious Amoreno almost died before she could give birth to her second child and had to travel almost 500km to receive hospital care because her local clinic was not equipped to deal with her high blood pressure – one of the most common. Non-communicable diseases (NCDs).

A nurse at her primary health care facility in Avram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she traveled, can tell something is wrong but lacks the tools for proper diagnosis and treatment.

Amorno said in an interview with Health Policy Monitoring.

“There was no blood pressure machine or medication in the facility,” she remembers, so the nurse referred her to Doncorcrum Presbyterian Hospital, about 500 kilometers away.

Donkorkrom, the only hospital in the Afram Plains North area, serves an area of ​​more than 5,000 square kilometres.

“Because of the distance between the elbows, I arrived at the hospital late and had to have a caesarean because I couldn’t push my baby” from the hospital, Amoreno recalls, sitting on a wooden bench in front of her house after returning. “I was tired and had complications.”

Non-communicable diseases such as cardiovascular and respiratory diseases, cancer, hypertension and diabetes are the leading causes of death globally. They are responsible for some of the highest rates of premature deaths in low- and middle-income countries, including sub-Saharan Africa.

But health services in low- and middle-income countries Not adapted yet to the growing burden of non-communicable diseases (NCDs) and continue to prioritize communicable diseases, according to Report Last year by the NCD Alliance.

In Africa, about 37% of premature deaths were due to non-communicable diseases in 2019, up from 24% in 2000, according to the WHO Regional Office for Africa.

But funding and resources to control non-communicable diseases in most African countries, including Ghana, remains a challenge because most of them depend on donor-driven funds, rather than local budget allocations.

2022 Report tracks the spread of universal health care In the region, government spending on health as a proportion of total health spending is lowest in African countries.

Only seven of the 47 African countries that are members of the WHO – Algeria, Botswana, Cabo Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets, relying heavily on donors and citizens to pay for their services.

“Total health financing as a proportion of GDP and the proportion of health financed by the government must be increased to enable countries to reduce personal spending and be able to steer the UHC agenda,” the report says.

Universal health coverage in Ghana, non-communicable diseases not yet integrated

Ghana Universal Health Coverage Roadmap 2020-2030 It aims to strengthen the country’s primary care system with a focus on integrated services, but the state does not have sufficient resources to implement it, and government assistance to citizens to obtain health care has declined sharply.

Ghanaian President Nana Akufo-Addo hosted a summit in April of African leaders to focus on combating non-communicable diseases, and is following it up with another session this week on the sidelines of the high-level meeting of the United Nations General Assembly in New York City.

Despite the attention paid to the issue, few Ghanaians have access to routine checks for non-communicable diseases such as hypertension and glucose at the primary care level, according to officials in the Ghana Health Service, which is part of the country’s health ministry.

Data from the Health Service’s Non-communicable Disease Program shows that one in five people was diagnosed with a non-communicable disease last year, with the situation becoming more pronounced in rural areas.

Primary care challenges in Ghana not only affect patients but also caregivers.

One of the nurses, Belinda Komato, who works in the northern and southern Avram Plains regions, said local care facilities had only enough resources to provide care. Antenatal, malaria and family planning needs, have to refer cases to Donkorkrom or another one hospital. She said there’s also nothing readily available Ambulance services for emergencies.

“We can’t even give birth naturally, because there is no equipment, midwife or electricity,” Komato said, adding that she hoped the government would step in and improve the overall standard of care. Regular vehicles take hours to get to the next facility for patients to get care. Sometimes we lose patients or their children because of the delay.”

Expanding the concept of primary care in Ghana to include non-communicable diseases

Initially, the government’s concept of primary care focused on maternal and newborn care with little regard for non-communicable diseases because they are seen as typical and easily overlooked conditions, said Dr Efua Komier, Ghana Health Services Program Director for Non-communicable Diseases.

She said that even primary care did not have adequate resources, and some places lacked blood pressure machines, glucose meters and other resources to deal with diabetes. She said some nurses are well equipped to educate people about non-communicable diseases. An initial survey by the Health Service found that only a few primary care facilities screen for non-communicable diseases.

But that is changing, says Comier.

“The COVID-19 outbreak has taught us a lesson for attention to non-communicable diseases, because we have seen most people with underlying health conditions die during the outbreak,” She said. “Non-communicable diseases have had low coverage because not much attention has been paid to them over the years.”

Ghana is not the only African country facing a challenge due to the lack of sufficient resources to combat non-communicable diseases.

Other countries such as Kenya, Malawi, Tanzania, Uganda and Zambia have worked to find solutions, turning to global health financing Cost-effective mechanisms to prevent non-communicable diseases and focused care services Mother and child care.

These financing mechanisms can ensure a more integrated approach to the millions of people around the world living with non-communicable diseases and other chronic health conditions, but health systems must adapt to provide a long-term perspective rather than responding to short-term conditions.

Restructuring Ghana’s health insurance provisions to include non-communicable diseases

WHO consultant and researcher, Dr. Coco Oonor Williams, suggested that restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve national care for non-communicable diseases. He described it as “unfortunate” that more information about non-communicable diseases is not widely available to the public.

“We need to restructure NHIS to cover education, awareness creation, NCD prevention along with remedial measures,” said Honorable Williams.

“People should know what lifestyles cause non-communicable diseases and they should be able to go to the hospital for tests under NHIS coverage, not just when they are sick,” he said. “People should be able to get checkups and checks under NHIS cover.”

Image credits: Kate Holt/USAID.

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