Healthcare in Ghana

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]

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]

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),[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]

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 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: 34^th[18]

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]

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]

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]