Healthcare in Ghana

In the precolonial period traditional village priests, clerics, and herbalists were the primary care givers, offering advice and treatment to the sick.[1] Premodern traditional beliefs stressed the combination of spiritual and physical healing with priests and clerics identifying the supernatural causes of disease and its remedies and herbalists offering medicinal herbs. The intersection of spirituality and medicine can be seen in priests using practices such as divination to determine the cause of illness and suggesting curative sacrifices before prescribing medicinal herbs obtained from herbalists.[1]

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

History

In 1874 Ghana was officially proclaimed a British colony. Ghana proved to be an extremely dangerous disease environment for European colonists driving the British Colonial Administration to establish a Medical Department 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 centered near British posts and towns.[2] In addition to hospitals and clinics staffed with British medical professionals, these select towns were also provided anti-malaria medication to be distributed to colonists and to sell to local Ghanaians.[2]

The World Health Organization and the United Nations Children's Fund were active in providing money and support to provide additional western medical care in Ghana.[2][3] They provided, "financial and technical assistance for the elimination of diseases and the improvement of health standards."[1] Traditional health practices were not recognized by these initiatives or the British Medical Department in urban areas and were shunned by Christian missionaries in rural areas. However, traditional priests, clerics, and herbalists still remained important health providers especially in rural areas where health centers were scarce.[3] After independence in 1957 Kwame Nkrumah pushed health and education policies that aimed to make these services more available and accessible; however, these policies were still mainly targeted at urban populations with 76% of doctors practicing in urban areas while only 23% of the population lived there.[2] Health programs were financed entirely through general taxation but with free public healthcare and large government spending, Ghana found itself struggling economically. After Nkrumah left office in 1966, subsequent governments decided to continue to keep out of pocket fees low in addition to cutting government healthcare spending with the 1969 Hospital Fees Decree and the 1970 Hospitals Fees Act in the hopes of recovering fees and bolstering the economy.[4] Even with the cut in government spending, economic conditions continued to worsen as did healthcare services. By the 1980s, many social services, including healthcare, were inadequate and could not provide sufficient care and drugs despite the fact that healthcare was virtually free.[4]

On December 31, 1981, Jerry Rawlings overthrew the Limann government and became the Head of state of Ghana. With the World Bank and International Monetary Fund pressing the government to cut public spending through structural adjustment programs, the new regime passed the Hospital Fees Regulation in 1985 which resulted in greater out of pocket fees with the aim to be able to finance the drugs and resources the healthcare system needed.[5][4] This became the “cash and carry” system which required Ghanaians to pay out of pocket fees at each point of service. According to a number of empirical studies, this excluded many individuals from public healthcare who could not afford to pay these fees resulting in many Ghanaians belonging to the lower and middle classes to be dissatisfied with the cash-and-carry system; however, despite public disapproval in regards to healthcare, these structural adjustment programs are credited with saving Ghana's economy.[5]

In 1997, a Health Fund was launched to provide a pool of funding for the sector.[4] Still, however, the biggest barrier to Ghanaians receiving proper healthcare was the high out of pocket fees. Despite exemptions expansions and infrastructure that increased access to healthcare, out of pocket fees remained a huge barrier.[4] In the election of 2000, John Kufuor as part of the New Patriotic Party (NPP) won over the NDC candidate and in 2003 he launched the National Health Insurance Scheme as under the National Health Insurance Act, providing universal healthcare to all Ghanaians.[4]

Healthcare in the 21st century
Ghana health care providers monthly salary and income chart
Komfo Anokye Teaching Hospital, Kumasi

In Ghana, most health care is provided by the government and is largely administered by the Ministry of Health and Ghana Health Services. The healthcare system has five levels of providers: health posts, health centers and clinics, district hospitals, regional hospitals and tertiary hospitals. Health posts are the first level of primary care for rural areas.

These programs are funded by the government of Ghana, financial credits, Internally Generated Fund (IGF), and Donors-pooled Health Fund.[6] 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.

Rural areas

Health care is very variable through Ghana. Urban centres are well served, and contain most hospitals, clinics, and pharmacies in the country. 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.[7] Zipline began the Ghana Drone Delivery Service in April 2019 to deliver vaccines, blood, plasma, and drugs to remote areas. The plan is that health workers will receive deliveries via a parachute drop within about 30 minutes of placing their orders by text message. The drones have a round-trip range of 160km and can reach about 12 million people. [8]

Expenditure

In 2010, 5.2% of Ghana's GDP was spent on health,[9] and all Ghanaian citizens had access to primary health care. Ghanaian citizens make up 97.5% of Ghana's population.[10] Ghana's universal health care system has been described as the most successful healthcare system on the African continent by the renowned business magnate and tycoon Bill Gates.[10]

National Health Insurance
NHIS
National Health Insurance Scheme
Agency overview
Formed2003
Jurisdiction Republic of Ghana
Parent agencyParliament of Ghana
WebsiteOfficial Website

Ghana has a universal health care system, National Health Insurance Scheme (NHIS),[11] 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 prior to the establishment of the NHIS 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.[12] 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.[13]

Maternal and Child Health Care

Maternal Health Care

The current population of Ghana is estimated to be 30.42 million (around 50.9% is the male population, while the female population is around 49.1%)[14] 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.[15]

In 2015, the maternal mortality rate per 100,000 births for Ghana was 319[16] compared to 409.2 in 2008 and 549 in the year 1990.

With collaborative efforts from the Ghana Health Service, the current Ghanaian Government, and the various policy makers, Ghana has for the first time recorded its lowest maternal mortality rate in 2018 with 128 deaths per 100,000 live births as against 144 per the same number of deliveries in 2017.

The progress, however, still falls short of global targets for reproductive, maternal, newborn, child and adolescent health (RMNCAH) targets to reach a maternal mortality rate (MMR) of 70 per 100,000 live births by 2030.[17]

Fertility

Fertility rate declined from 3.99 (2000) to 3.28 (2010). Looking at the total fertility rate, 3.94 children are born to every woman in the rural region and 2.78 children are born to every woman in the Urban region (2018 est.). Country comparison to the world: 34th[18]

Gross Reproduction Rate 1.43 babies Per 1,000 births
Ratio at Birth - Male to Female 102.62 males per 100 females in 2015
Maternal Age and Fertility[19]
Maternal Age Fertility Rate Per 1,000 Women
15 - 19 37.80 Per 1,000 Women
20 - 24 112.20 Per 1,000 Women
25 - 29 158.00 Per 1,000 Women
30 - 34 133.40 Per 1,000 Women
35 - 39 82.80 Per 1,000 Women
40 - 44 37.80 Per 1,000 Women
45 - 49 16.80 Per 1,000 Women

Breast cancer
Ghanaian female surgeon preparing to perform an operation

In Ghana, breast cancer is the leading malignancy.[20] In 2007, breast cancer accounted for 15.4% of all malignancies, and this number increases annually.[20] Roughly 70% of women who are diagnosed with breast cancer in Ghana are in the advanced stages of the disease.[21] 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.[22] These triple negative breast tumors are more aggressive and result in higher breast cancer mortality rates.[22]

Explanations for the delayed presentation among women in Ghana have been traced to the cost of, and access to, routine screening mammography.[21][23] 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.[23] Mayo et al. (2003) concludes, 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 Susan G. Komen for the Cure are helping to 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 have helped in improving the situation in Ghana.[24]

Child Health Care

About 3.16 million children under the age of 5 years make up the Ghanaian population; with 1.6 million being males and 1.56 million being females.[19]

For under-five mortality, Ghana in 2015 was estimated to have a rate of 61 deaths per 1000 live births and at the current pace, it could only reach 36.6 deaths per 1000 live births in 2030 against the target of 25 deaths per 1000 live births.[17]

Exclusive Breastfeeding Practices

In Ghana, breastfeeding is common with nearly all children being breastfed. However, the Ghana Demographic Health Survey in 2014 has reported an exclusive breastfeeding rate of 52% at 6 months, which is below the optimal Exclusive Breastfeeding rate of 90% in infants less than 6 months set by the WHO/UNICEF for developing countries.[25] About 43% of infants 0–6 months old are exclusively breastfed; Few children receive nutritionally adequate and safe complementary foods;in many countries less than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age.[26] Though the rate of exclusive breastfeeding in Ghana is below the optimal rate for developing countries, Ghana is doing well (52%) compared to the global rate (43%) of exclusive breastfeeding.

The latest Multiple Indicator Cluster Survey shows that about 13% of children below age 5 years are underweight, 23% are stunted, and 6% are wasted. In the country's capital, Greater Accra Region (GAR), underweight is found among 8.3% of children 0-5 years while 13.7% and 5.4% are stunted and wasted respectively.[27] In the Ashanti Region where the capital is Kumasi, The current rate of exclusive breastfeeding till 6 months of age is an estimated 13.9%.[28] In the Northern region where the capital is Tamale, the rate of exclusive breastfeeding is 63.3%.[29]

There are interventions such as The Ghana Health Service's Child Welfare Clinic (CWC) which is a comprehensive child health service that includes immunization, nutrient supplementation, and growth monitoring and promotion to regulate and monitor the under five health care, infant feeding practices, and empower mothers on the appropriate care required for their children in the country.

The Growth Monitoring and Promotion (GMP) component of the CWC is focused on empowering mothers to know about and become competent to practice appropriate child care, feeding, and health seeking. These outcomes are pursued using individualized and group counseling. The GMP provides an opportunity for interaction between public health workers and mothers regarding the health and well-being of their children.[27]

See also: Health in Ghana, National Health Insurance Scheme (Ghana), List of hospitals in Ghana, and Optometry in Ghana

References
  1. "Ghana : a country study". The Library of Congress. Retrieved 2018-05-07.
  2. Twumasi, Patrick (1981-04-01). "Colonialism and international health: A study in social change in Ghana". Social Science & Medicine. Part B: Medical Anthropology. 15 (2): 147–151. doi:10.1016/0160-7987(81)90037-5. ISSN 0160-7987. PMID 7244686.
  3. La Verle Berry, ed. (1994). "HEALTH AND WELFARE". Ghana: A Country Study.
  4. Carbone, Giovanni (2011). "Democratic demands and social policies: The politics of health reform in Ghana". The Journal of Modern African Studies. 49 (3): 381–408. doi:10.1017/S0022278X11000255. JSTOR 23018898.
  5. Agyei-Mensah, Samuel; Aikins, Ama de-Graft (2010-09-01). "Epidemiological Transition and the Double Burden of Disease in Accra, Ghana". Journal of Urban Health. 87 (5): 879–897. doi:10.1007/s11524-010-9492-y. ISSN 1099-3460. PMC 2937133. PMID 20803094.
  6. Canagarajah, Sudharshan; Ye, Xiao (April 2001). Public Health and Education Spending in Ghana in 1992-98 (PDF). World Bank Publication. p. 21.
  7. "WHO Statistical Information System". World Health Organization. Retrieved 2008-09-23.
  8. "Drones to deliver medicines to 12m people in Ghana". Financial Times. 24 April 2019. Retrieved 9 June 2019.
  9. Field Listing :: Health expenditures Archived 2014-03-26 at the Wayback Machine.cia.gov. Retrieved 24 June 2013.
  10. "These are the countries where I'm the least known" – Bill Gates visits Ghana". TheJournal.ie. Retrieved 24 June 2013.
  11. "National Health Insurance Scheme (NHIS)". nhis.gov.gh. Retrieved 5 June 2013.
  12. "National Health Insurance Scheme" (PDF).
  13. Warren, D. M.; Tregoning, Mary Ann (1979). "Indigenous Healers and Primary Health Care in Ghana". Medical Anthropology Newsletter. 11 (1): 11–13. doi:10.1525/maq.1979.11.1.02a00110. JSTOR 648386.
  14. "Ghana Population". world population review. 2019-08-28. Retrieved 2019-09-14.
  15. United Nations Population Fund. The state of world's midwifery 2011 : delivering health, saving lives. [United Nations Population Fund]. OCLC 741259917.
  16. Field Listing :: Maternal mortality rate.cia.gov. Retrieved 7 May 2016.
  17. ANNOH, ABIGAIL (June 27, 2019). "Ghana records first lowest maternal mortality rate". Ghanaian Times. Retrieved 2019-09-16.
  18. "Demographics of Ghana", Wikipedia, 2019-08-25, retrieved 2019-09-16
  19. "Ghana Population - 2018". Geobase. Retrieved 2019-09-14.
  20. Clegg-Lamptey, J.N.A; Hodasi, W (2007). "A study of breast cancer in Korle Bu teaching hospital: assessing the impact of health education". Ghana Medical Journal. 41 (2): 72–77. PMC 2002569. PMID 17925846.
  21. Kirby, A (2005). "Early Detection of Breast Cancer in Ghana, West Africa". Journal of Investigative Medicine. 53: S80.5–S80. doi:10.2310/6650.2005.00005.15.
  22. Stark, A.; Kleer, Celina G.; Martin, Iman; Awuah, Baffour; Nsiah-Asare, Anthony; Takyi, Valerie; Braman, Maria; e. Quayson, Solomon; et al. (2010). "African Ancestry and Higher Prevalence of Triple-Negative Breast Cancer: Findings from an international study". Cancer. 116 (21): 4926–4932. doi:10.1002/cncr.25276. PMC 3138711. PMID 20629078.
  23. Mayo; Hunter, Anita; et al. (2003). "Fatalism Toward Breast Cancer Among the Women of Ghana". Health Care for Women International. 24 (7): 608–615. doi:10.1080/07399330390217752. PMID 14627208.
  24. "BHGI and Ghana combat breast cancer together".
  25. Asare, Bernard Yeboah-Asiamah; Preko, Joyce Veronica; Baafi, Diana; Dwumfour-Asare, Bismark (2018-03-06). "Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana". International Breastfeeding Journal. 13: 12. doi:10.1186/s13006-018-0156-y. ISSN 1746-4358. PMC 5840768. PMID 29541153.
  26. "Improving breastfeeding, complementary foods and feeding practices". UNICEF. Retrieved 2019-09-16.
  27. Gyampoh, Sandra; Otoo, Gloria Ethel; Aryeetey, Richmond Nii Okai (2014-05-29). "Child feeding knowledge and practices among women participating in growth monitoring and promotion in Accra, Ghana". BMC Pregnancy and Childbirth. 14: 180. doi:10.1186/1471-2393-14-180. ISSN 1471-2393. PMC 4047542. PMID 24886576.
  28. Ayawine, Alice; Ae-Ngibise, Kenneth Ayuurebobi (2015). "Determinants of exclusive breastfeeding: a study of two sub-districts in the Atwima Nwabiagya District of Ghana". Pan African Medical Journal. 22: 248. doi:10.11604/pamj.2015.22.248.6904. ISSN 1937-8688. PMC 4764318. PMID 26958111.
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