Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.
Historically, the healthcare system has gone through several major periods, pre and post-colonial. In the precolonial period traditional priests, clerics, and herbalists were the primary care givers, offering advice. [1] The use of traditional healers persists mostly in rural regions of Ghana.
The post-colonial period marks the beginning of government intervention on behalf of healthcare through a variety of policies on different government regimes. These policies culminate to the implementation of the National Health Insurance Scheme (NHIS). The NHIS is currently serves people in both the formal and informal employment sectors and seeks to increase access to healthcare for all Ghanaians. [2]
In urban Ashanti, all physicians were organized and specialized under the Nsumankwaafiesu which was described by Asantehene Prempeh I as "the pharmacology where we had well trained and qualified physicians in charge whose duty was to attend to the sick and injured." The head of this office was the Nsumankwahene who served as the native doctor of the state and doctor of the Asantehene. [3] Ashanti physicians applied herbal decoctions to cure sprains, constipation, veneral diseases, external inflammation, boils and acute diarrhoea. [4] Abortants, surgery and variolation were also employed among Ashanti physicians. [3]
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. [5] 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. [5]
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. [5] [6] 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. [6] 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. [5] Health programs were financed entirely through general taxation, so anyone could receive medical care in any government hospital at no cost. [7] Public Health workers would conduct inspections in workplaces to evaluate cleanliness to ensure that all citizens were living and working in environments that promoted preventative care. [7] But with free public healthcare and large government spending, Ghana found itself struggling economically. Declining world prices of its cash crops put more strain on the Ghanaian economy. [7] 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. [8] Even with the cut in government spending, economic conditions continued to worsen as did healthcare services. In 1980s, many social services, including healthcare, were inadequate and could not provide sufficient care and drugs despite the fact that healthcare was virtually free. [8]
By 1981, health services had dramatically declined to the extent that hospitals lacked basic supplies, while healthcare workers left the country in hordes. [7] In some public hospitals, patients had to provide their food, medicine, and bedding and could be detained until they paid their hospital bill. Others were forced to self-medicate due to the high prescription costs. 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. [9] [8] It was supposed to help the government make up 15% of healthcare servicing costs that it had lost in earlier years. [7] 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 and the structural adjustment programs lead the Ghanaian expenditure on healthcare to decrease from 10% in 1983 to 1.3% by 1997. [7] [8] Despite public disapproval in regards to healthcare, these policies are credited with saving Ghana's economy. [9]
In 1997, a Health Fund was launched to provide a pool of funding for the sector. [8] 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. [8] 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. [8]
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. [10] 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 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 4% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure. [11] 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 160 km and can reach about 12 million people. [12]
In 2010, 4.7% of Ghana's GDP was spent on health, [13] and all Ghanaian citizens had access to primary health care. Ghanaian citizens make up 97.5% of Ghana's population. [14] 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. [14]
National Health Insurance Scheme | |
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Agency overview | |
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Formed | 2003 |
Jurisdiction | ![]() |
Parent agency | Parliament of Ghana |
Website | Official Website |
Ghana has a universal health care system, National Health Insurance Scheme (NHIS), [15] 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. [16] 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:
The current NHIS operates under the one-time premium policy, where people make one payment for a lifetime of healthcare. The one-time premium policy was used as a way to increase access to healthcare services to those “outside formal sector employment”, allowing taxi drivers, street vendors, etc. to benefit from the NHIS. [17] The one-time payment plan has been unable to fully fund health services for all citizens. These services may have to funded by tax revenue. [17] In addition, the actual act of collecting premiums from the informal employment sector can be costly and there has been allegations of fraud on the part of the official collectors. [17] Those in the informal sector, who do not have the means to pay the one-time premium are essentially locked out of the NHIS benefits if they cannot get access to premium exemptions. Due to the unevenly spread benefits, the poor benefit less from the system. [18]
Although enrolment is mandatory, in practice it is voluntary, with population coverage at 36% in 2018 and 51% in 2021. [19] A 2017 survey revealed that health insurance paid out only 16.7% of the medical expenses of the ill or injured across the country. [20] Healthcare facilities prefer patients who pay for treatment in cash rather than paying by national health insurance. [19] The program does not appear to reduce out-of-pocket payments for subscribers. [19]
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%) [21] 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. [22]
Maternal deaths accounted for 14% of all deaths, 10% from direct maternal causes and 4% from indirect maternal causes. [23] Nearly all women (98%) aged 15-49 who had live births or stillbirths in the five years before the survey in 2017 received antenatal care (ANC) from a skilled provider (doctor, nurse/midwife, or community health officer/nurse). Among these women, 86% attended their first ANC visit for a checkup, and 14% went due to complications. [23]
In 2015, the maternal mortality rate per 100,000 births for Ghana was 319 [24] 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 ratein 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. [25]
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[ citation needed ]
Gross Reproduction Rate | 1.43 babies Per 1,000 births |
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Ratio at Birth - Male to Female | 102.62 males per 100 females in 2015 |
Maternal Age | Fertility Rate Per 1,000 Women |
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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 is the most common cancer among females in Ghana. [27] In 2020, there were 4400 cases of breast cancer and 2797 estimated cervical cancer cases. [28] Over 3,000 women are diagnosed with cervical cancer each year and more than half of the figure die in Ghana. [29] In 2018, it was estimated that over four thousand cases of breast cancer will be diagnosed and about 1800 women could die from cancer. [30]
In Ghana, breast cancer is the leading malignancy. [31] In 2007, breast cancer accounted for 15.4% of all malignancies, and this number increases annually. [31] Roughly 70% of women who are diagnosed with breast cancer in Ghana are in the advanced stages of the disease. [32] 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. [33] These triple negative breast tumors are more aggressive and result in higher breast cancer mortality rates. [33]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. [26]
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. [25]
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. [34] 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. [35] 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. [36] 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%. [37] In the Northern region where the capital is Tamale, the rate of exclusive breastfeeding is 63.3%. [38]
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. [36]
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
A comparison of the healthcare systems in Canada and the United States is often made by government, public health and public policy analysts. The two countries had similar healthcare systems before Canada changed its system in the 1960s and 1970s. The United States spends much more money on healthcare than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on healthcare in that year; Canada spent 10.0%. In 2006, 70% of healthcare spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on healthcare was 23% higher than Canadian government spending. U.S. government expenditure on healthcare was just under 83% of total Canadian spending.
The health care system in Japan provides different types of services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance program, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profits and be managed by physicians.
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 ; 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2019 was averaged at 81 years.
Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of Health and Welfare to which South Koreans of sufficient income must pay contributions in order to insure themselves and their dependants, and the Medical Aid Program, a social welfare program run by the central government and local governments to insure those unable to pay National Health Insurance contributions. In 2015, South Korea ranked first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea was rated as the second most efficient healthcare system by Bloomberg. Health insurance in South Korea is single-payer system. The introduction of health insurance resulted in a significant surge in the utilization of healthcare services. Healthcare providers are overburdened by government taking advantage of them.
Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.
In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.
Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.
The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI), is a worldwide programme of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), launched in 1992 in India following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990. The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breast-milk Substitutes.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
The National Health Insurance Scheme (NHIS) is the publicly funded healthcare systems established by the Government of Ghana in 2003. The program was a form of national health insurance established to provide equitable access and financial coverage for basic health care services to Ghanaian citizens. Ghana's universal healthcare system has been described as the most successful healthcare system on the African continent by business magnate Bill Gates. The system has been found to have made Ghana's rate of health insurance one of the highest in Africa, though funding problems may complicate its future.
Examples of health care systems of the world, sorted by continent, are as follows.
Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.
Healthcare in Rwanda was historically of poor quality, but in recent decades has seen great improvement. Rwanda operates a universal health care system, and is considered to have one of the highest-quality health systems in Africa.
Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.
The Trust Hospital, also known as The Trust Hospital Company Limited, is a Ghanaian healthcare facility that used to provide healthcare services to the staff of SSNIT and their dependants. It was later upgraded to a full-fledged hospital to extend their services to the general public. The Trust Hospital engages in a number of health screening activities including Breast Cancer Awareness campaigns for the general public through partnership with other private organizations.
Current estimates indicates that over 24,000 new cases of cancer are recorded each year at Ghana. In 2020, 15,802 Ghanaians died from cancer. A 2015 study in Kumasi recorded breast and cervical cancer raked high records among females. Prostate cancer recorded the highest among males. Breast, liver and cervical were leading in both sexes.
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