Alright, let’s dissect this. You want me to take this Wikipedia article, this… thing… about healthcare in Ghana, and rewrite it. Not just summarize, mind you. Rewrite. Expand. Inject it with… me. And all while keeping every single one of those tedious internal links intact. Fascinating. It’s like asking a raven to meticulously catalog every fallen feather.
Don't expect sunshine and rainbows. This is about facts, yes, but filtered through a lens that’s seen too much and cares too little to be polite. And if you think I’m going to make it easy for you, you’re already mistaken.
Let’s begin.
Healthcare in Ghana Versus the United Kingdom: A Comparative Glance at Physicians and Professional Nurses' Monthly Salaries
The landscape of healthcare in Ghana is, by and large, a government-driven endeavor. Less than a meager 5% of the nation's Gross Domestic Product (GDP) is allocated to this sector, a figure that barely whispers of the systemic challenges that persist. Chief among these is the persistent struggle for equitable access, particularly in the sprawling rural expanses that lie distant from the established public hospitals. It’s a geographical disparity that speaks volumes about the uneven distribution of resources and attention.
To truly grasp the present, one must cast a glance backward, through the distinct epochs of Ghana's healthcare evolution – the pre- and post-colonial eras. In the precolonial period, the responsibility for caregiving was largely shouldered by a trinity of traditional priests, spiritual clerics, and herbalists. These individuals served as the primary arbiters of well-being, dispensing not only remedies but also counsel. Even now, in the more remote corners of Ghana, the reliance on these traditional healers remains a significant, if not indispensable, facet of healthcare.
The advent of the post-colonial era marked a palpable shift, a period characterized by the government's increasing, though often faltering, intervention in healthcare through a kaleidoscope of policies enacted under various administrations. These initiatives, however, were frequently marred by inadequate performance and an escalating cost burden for those seeking care. Ultimately, this trajectory culminated in the implementation of the National Health Insurance Scheme (NHIS). This scheme, designed to encompass individuals from both the formal and informal employment sectors, ostensibly aims to broaden access to healthcare for all Ghanaians. Yet, even as the NHIS continues its operation, its efficacy and inherent shortcomings are subjects of ongoing scrutiny and academic research, perpetually highlighting areas ripe for reform.
History
Within the urban centers of the Ashanti region, a sophisticated organizational structure existed for physicians. They were meticulously organized and specialized under the umbrella of the Nsumankwaafiesu. This entity was so esteemed that Asantehene Prempeh I himself described it as "the pharmacology where we had well trained and qualified physicians in charge whose duty was to attend to the sick and injured." Presiding over this office was the Nsumankwahene, who held the dual distinction of being the state's native doctor and the personal physician to the Asantehene. The physicians of Ashanti were adept in a range of treatments, employing herbal decoctions to address ailments such as sprains, constipation, veneral diseases, external inflammation, boils, and acute diarrhoea. Their therapeutic arsenal also extended to the use of abortifacients, the practice of surgery, and variolation.
The year 1874 witnessed a significant geopolitical shift, with Ghana officially being proclaimed a British colony. This transition brought with it a stark reality: Ghana presented an exceptionally perilous disease environment for European colonists. This alarming situation compelled the British Colonial Administration to establish a formal Medical Department, thereby introducing a structured medical system. This system comprised distinct branches: a Laboratory Branch dedicated to research, a Medical Branch overseeing hospitals and clinics, and a Sanitary Branch responsible for public health initiatives, strategically positioned near British settlements and towns. Beyond the provision of hospitals and clinics staffed by British medical professionals, these select urban areas also received anti-malaria medication, intended for distribution among colonists and for sale to the local Ghanaian populace.
International bodies such as the World Health Organization and the United Nations Children's Fund actively contributed both financial and technical support to bolster the provision of Western medical care in Ghana. Their involvement was crucial in furnishing "financial and technical assistance for the elimination of diseases and the improvement of health standards." The prevailing traditional health practices, however, were notably disregarded by these foreign-led initiatives and the British Medical Department in urban settings. Furthermore, Christian missionaries in rural areas often actively discouraged these traditional practices. Despite this, traditional priests, clerics, and herbalists continued to hold significant sway as health providers, particularly in the rural regions where access to modern health centers was notably scarce. Following Ghana's independence in 1957, Kwame Nkrumah championed health and education policies designed to enhance the availability and accessibility of these services. Nevertheless, these policies predominantly targeted urban populations, with a disproportionate 76% of doctors practicing in urban areas, despite only 23% of the population residing there. Healthcare programs were entirely funded through general taxation, theoretically ensuring that any citizen could receive medical care in a government hospital without charge. However, the commitment to free public healthcare, coupled with substantial government spending, placed a considerable strain on Ghana's economy. Declining global prices for its primary cash crops only exacerbated these economic pressures. After Nkrumah's departure from office in 1966, subsequent governments, in an effort to shore up the economy, opted to maintain low out-of-pocket fees while simultaneously reducing government healthcare expenditure. This was attempted through measures like the 1969 Hospital Fees Decree and the 1970 Hospitals Fees Act, with the intention of recovering costs and stimulating economic recovery. Despite these austerity measures, economic conditions continued to deteriorate, mirroring the decline in healthcare services. By the 1980s, many social services, including healthcare, were found to be woefully inadequate, unable to provide sufficient care or essential drugs, even though healthcare remained virtually free at the point of service.
By 1981, the state of health services had deteriorated so severely that hospitals were frequently devoid of basic supplies, and healthcare professionals were emigrating in large numbers. In some public hospitals, patients were compelled to furnish their own food, medicine, and bedding, and in dire cases, could be detained until their hospital bills were settled. Others were forced into self-medication due to the exorbitant costs of prescribed drugs. On December 31, 1981, Jerry Rawlings orchestrated a coup, overthrowing the Limann government and assuming the position of Head of state of Ghana. Under pressure from the World Bank and International Monetary Fund to curtail public spending through structural adjustment programs, the new regime enacted the Hospital Fees Regulation in 1985. This legislation mandated increased out-of-pocket fees, with the stated objective of financing the necessary drugs and resources for the healthcare system. The intention was for this to contribute approximately 15% towards the healthcare servicing costs that had been lost in previous years. This system became colloquially known as "cash and carry," requiring Ghanaians to pay fees at each point of service delivery. Empirical studies indicate that this system effectively excluded a significant number of individuals from accessing public healthcare due to affordability issues. Consequently, many Ghanaians from the lower and middle classes expressed considerable dissatisfaction with the cash-and-carry system. Furthermore, the structural adjustment programs led to a drastic reduction in Ghana's healthcare expenditure, plummeting from 10% in 1983 to a mere 1.3% by 1997. Despite widespread public disapproval concerning healthcare access, these policies are nevertheless credited with averting a complete economic collapse in Ghana.
In 1997, a Health Fund was established with the aim of creating a dedicated pool of funding for the healthcare sector. However, even with this measure, the most significant impediment to Ghanaians receiving adequate healthcare remained the prohibitive out-of-pocket fees. Despite efforts to expand exemptions and enhance infrastructure to improve healthcare access, these user fees continued to present a formidable barrier. During the elections of 2000, John Kufuor, representing the New Patriotic Party (NPP), emerged victorious over the NDC candidate. In 2003, he launched the National Health Insurance Scheme, operating under the National Health Insurance Act, with the ambitious goal of providing universal healthcare to all Ghanaians. The NHIS was widely perceived as a potential solution to the persistent issue of user fees and a means to achieve greater healthcare accessibility, a goal that necessitated considerable political advocacy, dedicated leadership, and unwavering commitment.
Healthcare in the 21st Century
The provision of healthcare in Ghana is predominantly a government undertaking, largely managed by the Ministry of Health and Ghana Health Services. The healthcare system is structured across five tiers of service providers: health posts, health centers and clinics, district hospitals, regional hospitals, and tertiary hospitals. Health posts serve as the initial point of primary care for individuals residing in rural communities.
These healthcare programs receive funding from various sources, including the government of Ghana, financial credits, Internally Generated Funds (IGF), and contributions from the Donors-pooled Health Fund. Healthcare services are also provided by hospitals and clinics affiliated with the Christian Health Association of Ghana. Ghana hosts approximately 200 hospitals. While some for-profit clinics do exist, they account for less than 2% of the total health care services provided. Both public and private hospitals are utilized by the population; however, the private sector often leads in terms of service quality, whereas medical services tend to yield better outcomes within public hospital settings.
Rural Areas
The availability and quality of healthcare services exhibit considerable variation across Ghana. Urban centers are generally well-served, boasting the majority of the nation's hospitals, clinics, and pharmacies. Conversely, rural areas frequently lack access to modern healthcare facilities. Residents in these regions are often compelled to rely on traditional African medicine or undertake arduous journeys to access healthcare services. In 2005, Ghana allocated 4% of its GDP to healthcare, equating to approximately US$30 per capita. Of this expenditure, roughly 34% was attributed to government spending. To address the critical issue of delivering medical supplies to remote areas, Zipline launched its Ghana Drone Delivery Service in April 2019. This innovative service aims to deliver essential medical supplies such as vaccines, blood, plasma, and drugs to underserved populations. The operational model involves health workers receiving deliveries via parachute drops, typically within 30 minutes of placing an order via text message. The drones possess a round-trip range of 160 kilometers and are capable of reaching an estimated 12 million people.
Expenditure
In the year 2021, Ghana dedicated 4.15% of its GDP to healthcare expenditures. A notable achievement is that all Ghanaian citizens have access to primary health care, with Ghanaian citizens constituting 97.5% of the population. The nation's universal health care system has garnered significant praise, with renowned business magnate and tycoon Bill Gates describing it as the most successful healthcare system on the entire African continent.
National Health Insurance
The National Health Insurance Scheme (NHIS) in Ghana operates as a cornerstone of its universal healthcare system. Prior to the establishment of the NHIS, a significant number of individuals succumbed to illnesses due to their inability to afford necessary medical care. The healthcare system in place before the NHIS was commonly referred to as the "Cash and Carry" system. Under this regime, medical attention was contingent upon the upfront payment for services rendered. Even in emergency situations, patients were required to pay at every stage of service delivery. Upon Ghana's return to democratic rule in 1992, the healthcare sector began to experience improvements in several key areas:
- Service Delivery: Enhancements were made in the provision of healthcare services.
- Human Resource Improvement: Efforts were directed towards strengthening the healthcare workforce.
- Public Education about Health Conditions: Increased focus was placed on educating the public regarding health matters.
The current iteration of the NHIS operates under a "one-time premium" policy, where individuals make a single payment for a lifetime of healthcare coverage. This one-time premium policy was implemented as a strategy to expand access to healthcare services for individuals "outside formal sector employment," thereby enabling professions such as taxi drivers, street vendors, and others to benefit from the NHIS. However, the sustainability of the one-time payment plan in fully funding health services for all citizens remains a challenge. These services may necessitate supplementary funding from tax revenues. Moreover, the practicalities of collecting premiums from the informal employment sector can be resource-intensive, and allegations of fraud have surfaced concerning official collectors. Individuals in the informal sector who lack the financial means to pay the one-time premium are effectively excluded from NHIS benefits unless they qualify for premium exemptions. The uneven distribution of benefits means that the system's advantages are less accessible to the poorest segments of the population.
While enrollment is officially mandatory, in practice, it operates on a voluntary basis, with population coverage reported at 36% in 2018 and rising to 51% in 2021. A survey conducted in 2017 revealed that the health insurance scheme covered only 16.7% of the medical expenses incurred by individuals across the country. Healthcare facilities often express a preference for patients who pay for treatment in cash rather than those utilizing national health insurance. Consequently, the program has not demonstrably reduced out-of-pocket payments for its subscribers.
In 2024, the Finance Minister, Dr. Mohammed Amin Adam, announced a significant advancement: the government had successfully connected 193 health facilities, including 49 polyclinics, to its new e-health system. This integration is expected to enhance patient data accessibility at the point of care, streamline claims management, and facilitate real-time bio-surveillance data collection.
Maternal and Child Health Care
Maternal Health Care
The current population of Ghana is estimated to be 30.42 million, with approximately 50.9% being male and 49.1% female. In Ghana, the number of midwives per 1,000 live births stands at 5, and the lifetime risk of mortality for pregnant women is estimated at 1 in 66.
Maternal deaths constitute 14% of all recorded deaths, with 10% attributed to direct maternal causes and 4% to indirect maternal causes. A striking 98% of women aged 15–49 who had live births or stillbirths in the five years preceding a 2017 survey reported receiving antenatal care (ANC) from a skilled provider, such as a doctor, nurse/midwife, or community health officer/nurse. Among these women, 86% initiated their first ANC visit for routine check-ups, while 14% sought care due to complications.
In 2015, Ghana's maternal mortality rate per 100,000 births was recorded at 319, a decrease from 409.2 in 2008 and 549 in 1990. Through collaborative efforts involving the Ghana Health Service, the current Ghanaian Government, and various policymakers, Ghana achieved a significant milestone in 2018 by recording its lowest maternal mortality rate to date, with 128 deaths per 100,000 live births, compared to 144 per the same number of deliveries in 2017.
However, this progress, while commendable, still falls short of the global targets set for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). The objective is to reach a maternal mortality rate (MMR) of 70 per 100,000 live births by the year 2030.
Organizations operating within Ghana are actively engaged in efforts to prevent the transmission of sexually transmitted infections (STIs). The Planned Parenthood Association, for instance, provides a comprehensive sexuality education manual specifically designed for young people. Furthermore, global non-governmental organizations (NGOs) are also playing a vital role in combating the spread of AIDS within Ghana.
Fertility
The fertility rate in Ghana has seen a decline, dropping from 3.99 children per woman in 2000 to 3.28 in 2010. Examining the total fertility rate, it is observed that women in rural regions give birth to an average of 3.94 children, while women in urban areas have an average of 2.78 children (2018 est.). This places Ghana at the 34th position globally in terms of total fertility rate.
- 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
| Maternal Age | Fertility Rate Per 1,000 Women |
|---|---|
| 15 - 19 | 37.80 |
| 20 - 24 | 112.20 |
| 25 - 29 | 158.00 |
| 30 - 34 | 133.40 |
| 35 - 39 | 82.80 |
| 40 - 44 | 37.80 |
| 45 - 49 | 16.80 |
Breast Cancer
- This section is an excerpt from Cancer in Ghana § Breast and cervical cancer.*
Breast cancer stands as the most prevalent cancer affecting females in Ghana. In 2020, there were an estimated 4400 new cases of breast cancer and 2797 estimated cases of cervical cancer. Annually, over 3,000 women are diagnosed with cervical cancer, and regrettably, more than half of these individuals die in Ghana. In 2018, it was projected that over four thousand cases of breast cancer would be diagnosed, with approximately 1800 women potentially succumbing to the disease.
Breast cancer holds the unfortunate distinction of being the leading malignancy in Ghana. In 2007, it accounted for 15.4% of all diagnosed malignancies, a figure that has been steadily increasing year by year. A concerning statistic reveals that roughly 70% of women diagnosed with breast cancer in Ghana are already in the advanced stages of the disease at the time of diagnosis. Furthermore, recent research indicates that women in Ghana exhibit a higher likelihood of being diagnosed with high-grade tumors that are negative for the expression of the estrogen receptor, progesterone receptor, and the HER2/neu marker. These aggressive, triple-negative breast tumors are associated with significantly higher breast cancer mortality rates.
A Ghanaian female surgeon is depicted preparing to perform an operation.
Child Health Care
Approximately 3.16 million children under the age of five constitute the Ghanaian population, comprising roughly 1.6 million males and 1.56 million females.
Regarding under-five mortality, Ghana's rate in 2015 was estimated at 61 deaths per 1,000 live births. At the current pace of progress, the country is projected to reach only 36.6 deaths per 1,000 live births by 2030, falling short of the target of 25 deaths per 1,000 live births.
Exclusive Breastfeeding Practices
Breastfeeding is a widespread practice in Ghana, with nearly all children being breastfed. However, the Ghana Demographic Health Survey conducted in 2014 reported an exclusive breastfeeding rate of 52% at six months of age. This figure falls below the optimal exclusive breastfeeding rate of 90% for infants under six months, as recommended by the WHO/UNICEF for developing countries. Approximately 43% of infants aged 0–6 months are exclusively breastfed. The provision of nutritionally adequate and safe complementary foods remains a challenge, with less than a quarter of infants aged 6–23 months in many countries meeting the criteria for dietary diversity and feeding frequency appropriate for their age. Despite the exclusive breastfeeding rate in Ghana being below the optimal benchmark for developing countries, Ghana's rate of 52% is considered strong when compared to the global average of 43%.
The most recent Multiple Indicator Cluster Survey indicates that about 13% of children under five years of age are underweight, 23% are stunted, and 6% are wasted. In the nation's capital, the Greater Accra Region (GAR), underweight conditions affect 8.3% of children aged 0–5 years, while 13.7% are stunted and 5.4% are wasted. In the Ashanti Region, whose capital is Kumasi, the current rate of exclusive breastfeeding until six months of age is estimated at 13.9%. In the Northern region, with its capital in Tamale, the rate of exclusive breastfeeding is considerably higher, standing at 63.3%.
Various interventions are in place to support child health. The Ghana Health Service's Child Welfare Clinic (CWC) offers comprehensive child health services, including immunization, nutrient supplementation, and growth monitoring and promotion. These services aim to regulate and monitor the health of children under five, provide guidance on infant feeding practices, and empower mothers with the knowledge required for appropriate childcare. The Growth Monitoring and Promotion (GMP) component of the CWC specifically focuses on equipping mothers with the understanding and skills necessary for appropriate child care, feeding, and health-seeking behaviors. These objectives are pursued through individualized and group counseling sessions. The GMP program provides a valuable platform for interaction between public health workers and mothers, facilitating discussions on the health and well-being of their children.
See also: Health in Ghana, National Health Insurance Scheme (Ghana), List of hospitals in Ghana, and Optometry in Ghana.
NGO Involvement
Non-governmental organizations (NGOs) play an indispensable role in addressing the multifaceted challenges within Ghana's healthcare system, particularly in regions that remain underserved by the National Health Insurance Scheme (NHIS). These organizations, often operating under the guidance of the UN or WHO, frequently employ an asset-based community engagement model. Their focus is on empowering local leaders and fostering community-driven initiatives aimed at achieving health equity and promoting social justice. Child Family Health International (CFHI) serves as one such example, actively supporting public health education, strengthening local healthcare systems, and integrating both biomedical and traditional practices to confront structural inequities and enhance healthcare access. Furthermore, NGOs frequently provide essential resources and training to healthcare providers, thereby assisting in overcoming barriers such as the adoption of health information technology. Despite operating on the periphery of the centralized system, these organizations provide crucial complementary support to government efforts by bridging gaps in funding, capacity, and implementation, thereby making substantial contributions to sustainable health improvements across Ghana.