Scholarly Project Report - Ghana: A Health System's Response to Diabetes

Abstract

Purpose: This study aims to convey the current response of the Ghanaian health system to the growing diabetes burden. Methods: This study adopted a mixed methods approach. Using a Systemic Rapid Assessment Toolkit, semi-structured, key informant interviews were conducted in January 2016. Field observations and interactions with physicians as well as a primary literature review provided further insight. Quantitative data from these studies as well as from the Center of Health Information Management (CHIM) complimented the qualitative information in order to provide a holistic understanding of the situation. Results: Ghana formed a NCD control program two decades ago led by a multi-sectoral steering committee, relaying the understanding of the diverse actors and interventions needed to operationalize efforts. Since then, a failure to commit resources to the program has limited its effectiveness and resulted in a significant gap between policy rhetoric and action. Disproportionate investment in vertical programming has limited the system’s ability to respond adequately to the demands of NCD prevention. Ghana’s transition to a LMIC and declining external resources for health mean innovative financing instruments like microtaxes/levies will become increasingly important. Experience from the sub-continent shows that these mechanisms can generate significant and reliable streams of revenue enabling longer-term planning and improved service delivery. Ghana’s National Health Insurance Scheme is a potential boon for NCD control efforts that has been insufficiently utilized. Difficulties in expanding enrollment, lack of guidelines standardizing treatment, lack of comprehensive data on the extent of DM, and limited training of health workers continues to stymy the provision of efficacious, equitable care. A resurgent civil society organization, increasing political will, DHIMS II platform with increasing resources however, present opportunities for Ghana and lessons for the subcontinent. Conclusions: Our findings reveal many opportunities available to Ghana’s still nascent health system as it seeks to reform to meet the changing needs of its populace. In addition to awareness among policy makers of the enormity of the challenge, bold rhetoric and the outlined strategies require sufficient resource allocation to enable translation. Ghana provides a strong example of a lower middle-income country grappling with this shifting burden of disease; although the challenges and opportunities outlined above are context specific, the underlying lessons transcend borders and may provide lessons for similar countries across the continent.