Ghana

The countries of the African Region face major public health challenges, which require an efficient management of health information to ensure a complete and accurate response along with a strict monitoring to promote the health of the populations. To that end, and accordingly to the regional recommendations of the declarations of Ouagadougou and Algiers in 2008, the WHO Africa Regional Office (WHO/AFRO) has implemented an African Health Observatory and real-time Strategic Information System (AHO&rSIS), which is operational since 2011.

One of the major roles of the African Health Observatory, besides helping countries of the WHO/AFRO region implementing functional national health observatories, is to compile health-related data and information (including demographic data- civil status, etc…) in one unique center, and to develop evidence ready to be used for each strategic decision in health.

Objectives

It permits monitoring the situation and health trends [including assessing the gains of the Millennium Development Goals (MDGs and monitoring of the Sustainable Development Goals SDGs)], supporting and facilitating the prediction of events and early-warning systems; sustaining the monitoring and evaluation of health reforms and priority health programs; enabling the generation and sharing of evidence for policy and decision-making; and establishing and maintaining networks and communities of practice for the translation and application of evidence and knowledge sharing. The products generated and/or stored by the observatory are at the disposal of users through a Web platform structured in three main parts: (1) «data and statistics», (2) «evidence», and (3) «publications and information products». 

Area of Support

1. Coordinate inputs to the African Health Observatory  and National Health Observatory including data gathering, development of the country integrated analytical health profile and networking with African Health Observatory Focal Points;
2. Provide support to the National Health Information System through adaptation and development of data quality norms and standards, training of national staff on data quality issues, establishing and sustaining effective working relationships with national, sub-national partners and relevant stakeholders;
3. Contribute to the validation of health related data to ensure compliance with data quality requirements before uploads in the real-time Strategic Information System (rSiS);
4. Contribute to capacity building of country staff and partners through training in the use of data for decision making through the rSiS and AHO Platforms;
5. Contribute to data quality audits in the country; Provide regular feedback to the ministry of health research institutions, national and sub-national partners generating and sharing data for decision making.
6. Manage the contribution of the country to national, WHO country office, Regional and Global information products.

Collaborating partners and institutions

1. Ministry of Health
2. Ghana Health Service
3. Other UN Agencies such as UNICEF, World Bank
4. INDEPTH Network

Donors

Department for International Development - DFID
 

For more information please contact

Mr. Ben Benasco Sackey, email: sackeyb [at] who.int 

Ghana’s Guinea Worm Eradication Programme (GWEP) was launched in the Northern region by Former President Jerry John Rawlings in 1987 following WHA resolutions
The first National Case Search was conducted in 1989 it revealed a total of 179,556 cases countrywide with all regions endemic and most cases in the Brong Ahafo, Northern and Volta regions.

With the support of key Partners (USAID, WHO, UNICEF, Global 2000 later The Cater Center (TCC) -Bank for Credit and Commerce International (BCCI) and later JICA) it took 23 years of intervention mainly as follows for interruption of indigenous transmission in May 2010.

• Surveillance, Health Education
• Use of Monofilament cloth and later Pipe filters
• Vector Control (monthly application of temephos)
• Case containment and management including worm extraction.

During a 3 year mandatory pre certification phase the focus was on Surveillance and heightened awareness drive and cash reward of GHS 200 offered for any hanging worm seen and verified. The International Certification Team (ICT) mission visited Ghana in July 2014 to evaluate the assertion of disease absence. The 6 teams visited all regions, 48 Districts, 83 Health facilities, 119 communities and interviewed 1320 respondents. 

Following the ICT’s mission report to International certification Committee of Dracunculiasis Eradication (ICCDE11) and their recommendation to the Director General of WHO, Ghana was certified free of the disease on 15 January 2015.

As a post certificated country Ghana is required to still focus on disease awareness and continue with rumour detection and investigations as part of the final process of eradication until the last 4 endemic countries (Mali, Chad, Ethiopia and South Sudan) interrupt indigenous transmission of the disease.   
 

For more information please contact:

Edward Gyepi-Garbrah gyepigarbrahe [at] who.int

Ghana’s National Health Policy identifies that a safe and healthy environment including the quality of air, water and soil has major implications for the health of Ghanaians. The WHO programme supports the Ministry of Health, Ghana Health Service, Ministry of Water Resources works and Housing and the Ministry of Local Government and Rural Development in the development and implementation of programmes aimed at reducing environmental and occupational risks and preventing their health impact.

WHO Ghana objectives:

• Strengthen capacity in assessment of environmental health risks and management of health impacts
• Support the development of policies, guidelines and strategies for water, sanitation and climate change
• Strengthen health staff capacity in environment and occupational health
• Support the review and adaptation of multilateral agreements and conventions on environment and sustainable development

Specific areas of support:

• Capacity building in environmental health impact assessments and  occupational health risks management
• Development and implementation of programmes for water, sanitation and health (WSH) with a focus on Water Safety Planning,  Household Water Treatment and Safe Storage, Water, Sanitation and Hygiene in Health Care Facilities, using the risk based approach
• Development of Guidelines on the Health Sector Adaptation to Climate Change and Health
• Adaptation and Implementation of the Libreville Declaration for Environment and Health, Minamata Convention on Mercury and other conventions on the environment and sustainable development

Key indicators:

• 89% of population has access to water (WHO/UNICEF Joint Monitoring Programme (JMP) 2015 )
• 15%of population use improved sanitation facilities (JMP 2015)

For more information please contact

Mrs  Akosua Kwakye
Email: kwakyea [at] who.int

National Policy

• Support for routine immunisation
• Accelerated control of vaccine preventable disease
• Surveillance for vaccine preventable diseases
• Support for cold chain & vaccine management
• Injection safety & waste management practices

The National EPI Policy in Ghana is that each child should receive one dose of BCG at birth, three doses of DPT-HepB+Hib, (at 6, 10 and 14 weeks), four doses of OPV (at birth, 6, 10 and 14 weeks) one dose of measles (at 9 months) and one dose of yellow fever (at 9 months).Every woman of childbearing age (12-44 years) should receive 5 doses of tetanus toxoid.

The Immunization System

The system consists of the Immunization Service, Vaccine Management, Logistics (including cold chain support), Surveillance of Vaccine Preventable Infections, and Advocacy and Social Mobilization.

Components of EPI

There are three components of the EPI system. These are (i) Routine Immunization which is delivered through the Reaching Every District (RED) approach in all districts (ii) Accelerated Disease Control (ACD) which comprises the campaigns, also known as Supplemental Immunization Activities (SIAs) and child health days (CHDs) and (iii) Vaccine Preventable Disease (VPD) Surveillance, targeting polio, measles, neonatal tetanus (NT) and yellow fever.

Main EPI delivery strategies

The following are the strategies through which EPI services are delivered in Ghana:

• Static - Routine immunization services daily at health facilities/hospitals
• Outreach – Outreach services are to remote communities, based on district/sub-district plans, catchment locations etc.
• Mini-mass (mop up) – These are occasional activities in selected districts to capture defaulters and also reach out to children missed in routine services
• Campaigns – These are mostly national activities which are conducted to reach large population (target group) in a given period as a supplementary activity to the routine immunization to increase immunity
• Persons mostly involved – Community Health Nurses (CHNs)/ Disease Control Officers (DCOs) who are supported by some midwives

WHO support for EPI in Ghana

WHO provides both financial and technical support to all three components of EPI Ghana.

1. For Routine immunization, the support is usually for the following activities: district micro planning, Training, Data management, Cold chain and logistics, Vaccine management Injection safety and waste management, Monitoring and supervision, Social mobilization and community involvement.
2. Support for Accelerated Disease Control covers NIDs for polio eradication; SIAs for measles control, Maternal and Neonatal Tetanus (MNT) elimination; yellow fever prevention and control and all other integrated campaigns.
3. WHO support for VPD surveillance has mostly been for the Polio laboratory at Noguchi Memorial Institute for Medical Research, the Public Health Reference lab for measles and yellow fever at Korle-Bu, Polio Experts and National Certification Committees, Districts Health teams for community-based VPD surveillance activities etc. Diseases covered are Acute Flaccid Paralysis (AFP) for polio, measles, yellow fever and neo-natal tetanus.

Focal Point - Mr Stanley Kwasi Diamenu

The objectives are to:

• Support attainment of IHR (2005) minimum core capacities for all-hazard alert and response including strengthening priority disease surveillance in the context of IDSR framework.
• Support country capacity building in resilience and preparedness to mount rapid, predictable, and effective response to major epidemics and other public health emergencies.

Areas of Support

WHO’s strategic agenda on preparedness, surveillance and response has as one of its main focus areas strengthening national networks and systems capacity to anticipate, prevent, respond and control epidemics and other complex health emergencies as well as manage risks to health and other public health events. 
This is done in synergy with provision of technical support and advocacy for building core capacity for the 2005 International Health Regulations while strengthening health systems. Consequently the goal in capacity building in coordination, surveillance, laboratory, social mobilization and logistic managements is geared towards preparedness and response to public health events and epidemic prone and emerging diseases including Ebola Virus Disease, meningitis, Lassa fever, yellow fever, cholera and influenza.

Collaborating partners and institutions:

• Ministry of Health/Ghana Health Service
• UN Agencies
• Government of Canada
• Government of Norway
• Government of Japan
• African Development Bank
• European Union
• Centers for Disease Prevention and Control

___________________________________________________

Related document:

	Ebola Preparedness and Response in Ghana [pdf]
	Ghana Mental health strategy (Report to the Norwegian Ministry of Foreign Affairs) [pdf]

For more information please contact:

Dr Sally-Ann Ohene, Disease Prevention and Control Officer

Email: ohenes [at] who.int

WHO’s RMNCAH programme provides technical support to the Ministry of Health for planning, implementation, monitoring and evaluation of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health programmes in the country. The program also works on promoting healthy and active ageing thus, promoting health through the life course. It collaborates with partners within the UN system, bi-lateral and multilateral agencies and Professional bodies (Obstetrician/Gynaecologists, Paediatricians and Midwives) for a coordinated approach to RMNCAH activities.

Ghana’s maternal mortality ratio is currently 319 per 100,000 live births and the Neonatal mortality rate is 29 per 1000 live births. At the current rate, neonatal mortality make up 71% of infant mortality and 48% of under-five mortality. Inadequate access to quality skilled delivery, emergency obstetric and newborn care and family planning has been identified as some contributing factors and so these are the intervention areas the programme is focusing on. WHO’s RMNCAH program is working to improve access to, coverage and quality of health services for women, newborns, children and adolescents along the continuum of care.

The main focus areas are thus:
•    Sexual and Reproductive Health
•    Maternal and Newborn  health
•    Child and Adolescent health
•    Ageing and health
•    Gender, equity and human rights

WHO supports the Ghana MDG Acceleration Framework (MAF) and its unfinished agenda. This is Ghana’s Action Plan to redouble efforts to overcome bottlenecks in implementing evidence-based, feasible and cost-effective interventions that have proven to work in reducing maternal mortality. In this era of the Sustainable Development Goals (SDG), the program will continue to support the achievement of the health related goals by supporting country adoption and adaptation of various WHO guidelines and strategies for implementation. 
No woman should loss her life while giving life and every baby born should survive, thrive and go through the life course to reach their full potential and age with dignity

WHO RMNCAH resources can be accessed at: https://www.who.int/maternal_child_adolescent/en/ 

Key RMNCAH Indicators

UN Maternal Mortality Estimation Inter-agency Group (2015); Ghana Demographic and Health Survey (2014)

For more information please contact:

Dr Roseline Dansowaa Do, Program Officer
Email: doer [at] who.int 

The objective is it to support the development of policies plans and strategies for implementation of interventions to prevent and control non-communicable diseases including mental health disorders

Areas of Support

WHO technical support for NCD includes the development and implementation of national plans for the control of NCDs (cardiovascular diseases, diabetes, cancers and respiratory disorders) and control  of NCD risk factors  including implementation of the WHO Framework Convention on Tobacco Control and alcohol regulation. Some specific areas benefitting from catalytic support include a pilot of the WHO Package of NCDs interventions (WHO PEN), cervical cancer prevention and control activities. Building on the support provided for the development Mental Health Act 846 of 2012, attention is being paid to improving community based mental health services. Other areas of work include violence prevention and eye health.

Collaborating partners and institutions:

• Ghana Health Service (Public Health Directorate, NCD Control Program, Institutional Care Division)
• Ministry of Health Regenerative Health
• Mental Health Authority
• Ghana Road Safety Commission
• Bill and Melinda Gates Foundation
• Basic Needs 

For more information please contact:

Dr Sally-Ann Ohene, Disease Prevention and Control Officer

Email: ohenes [at] who.int

The objective is to provide technical and policy support for the implementation and monitoring of priority (NTDs) interventions in line with the WHO roadmap for control and elimination of NTDs.

Areas of Support

Two categories of NTDs are reported in Ghana. These are (i) the Preventive Chemotherapy (PCT) diseases which include Lymphatic Filariasis, Onchocerciasis, Trachoma, Schistosomiasis and Soil Transmitted Helminthiasis   and (ii) the Case Management diseases which consists of Buruli ulcer, Yaws, Leprosy and Human African Trypanosomiasis. WHO support for NTD in Ghana is mainly in the area of research and monitoring surveys, surveillance and mapping, development of plans, delivery of drugs for Mass Drug Administration. 

Collaborating partners and institutions:

• Ghana Health Service NTD Control Program
• USAID
• Sight Savers
• ANESVAD
• American Leprosy Mission

For more information please contact:

Dr Sally-Ann Ohene, Disease Prevention and Control Officer

Email: ohenes [at] who.int

Brief description of Program

Joint UN Team on HIV/AIDS (JUTA) main objective for HIV Treatment and PMTCT  is to equip stakeholders with relevant tools for effective delivery of Prevention of Mother to Child Transmission of HIV (PMTCT) and Treatment services in the country.

Ghana has a five year National Strategic Plan (NSP) 2016 -2020 for HIV response and has further developed a five-year 90-90-90 Roadmap set out in collaboration with partners and stakeholders to locate, test, treat and retain PLHIV in ART care, to ensure effective viral load suppression.  Funding and Technical support are  from Global Fund, USAID, Joint UN Team on HIV (JUTA) and other partners. This roadmap also identifies priority health sector actions required to achieve the 90-90-90 targets addressing bottlenecks and ensuring commodity security for the control of HIV.

Program strategy

Deliver HIV care and prevention interventions with a task-sharing approach to enhance access to quality healthcare improve efficiency and bridge service delivery gaps.
The theme of the 90-90-90 Roadmap is “LOCATE, TEST, TREAT AND RETAIN (L2TR) GHANA CAMPAIGN”

Approaches are:

• Fast tracking enrolment of clients on ART.
• Scaling-up HIV testing in differentiated care settings.
• Strengthening viral load monitoring of ART clients.
• Improve data reporting system and strategic information

Services are:

• HIV Testing Service
• Prevention of Mother to Child Transmission of HIV (PMTCT)
• HIV and AIDS Treatment, Care and Support
• TB and HIV Collaboration
• Blood Safety
• Sexually Transmitted Infections
• Post Exposure Prophylaxis (PEP)
• Targeted Behavior Change Interventions (BCI) for preventing new HIV Infections

Program Indicators

• Percentage of young people aged 15-24 who are living with HIV
• New HIV infections among children
• AIDS-related mortality
• TB/HIV mortality
• Proportion of eligible persons (Adults and children) currently receiving ARV therapy
• People living with HIV that initiated ARV therapy, with an undetectable viral load at 12 months
• HIV-positive pregnant women who received ARVs
• Infants born to HIV-infected women who receive a virological test for HIV within two months of birth
• Proportion of pregnant women tested

Brief description of Program

WHO and partners are supporting the National TB Control Program (NTP) with technical assistance for the implementation of the medium term strategy 2014 -2018 to deliver integrated control strategies for TB, seeking to address the major challenge of low TB case finding and improving upon programmatic management of Multi-Drug Resistant TB (MDR-TB). This is to be done through access to newer diagnostics and treatment in health care facilities.

In collaboration with technical Partners and key country stakeholders WHO, USAID, Global Fund, Stop TB Partnership and other Partners,

Program strategy

Deploying approaches to reduce the burden of tuberculosis in Ghana until it is no longer a disease of public health importance through:

• Intensified screening, detection of cases and early enrolment of new cases.
• Improving treatment success for MDR-TB and introducing shorter term regimen for TB treatment
• Improving on Paediatric TB management.
• Reducing death among TB-HIV co-infected cases through TB/HIV collaborative activities.
• Improve programme management; coordination, monitoring, evaluation and operations research and partnerships for resource mobilization.

Program indicators

• Case notification rate
• TB prevalence rate
• TB incidence rate
• TB mortality rate
• TB/HIV mortality rate
• Multidrug resistance prevalence among new TB patients
• Treatment success rate in all forms of TB cases (disaggregated by age, sex and HIV status)
• Treatment success rate in  bacteriologically confirmed new cases (disaggregated by age, sex and HIV status)  
• Notification of MDR-TB cases  (Notified cases of bacteriologically confirmed, drug resistant TB (Rifumpicin-resistant TB and/or multidrug-resistant TB) as a proportion of the estimated number of multidrug-resistant TB cases among notified TB cases)
• Treatment success rate multidrug-resistant TB
• Number of cases with drug-resistant TB (Rifumpicin-resistant TB and/or multidrug-resistant TB) that began second-line treatment (disaggregated by bacteriologically confirmed and presumptive cases.

Brief description of Program

WHO supports the health sector with technical assistance to deliver integrated strategies for the control of Malaria.  The medium term National Malaria Strategic Plan (NMSP) 2014 -2020 is being implemented within the longer term national vision of reducing the incidence of communicable diseases and ensuring long, healthy and productive life of individuals.

The overall goal is to reduce malaria morbidity and mortality by 75% by 2020 using 2012 as baseline in line with the Sustainable Development Goals (SDGs).

Major partners in the control of malaria include the Global Fund, The President’s Malaria Initiative, USAID, UNICEF, DFID, the Private Sector Malaria Foundation and others.

Program Strategy

Deliver an integrated malaria control approach using multiple interventions for prevention and treatment, public – private sector collaboration and community involvement.

The main case management interventions are for Diagnosis and Treatment and these include:

• The use of Rapid Diagnostic Tests (RDTs) or Microscopy.
• The use of ACTs in a comprehensive national treatment policy

Prevention interventions include:

• Intermittent Preventive Treatment of malaria in Pregnant women(IPTp)
• Long Lasting Insecticide Treated Nets use (LLINs)
• Indoor Residual Spraying (IRS)
• Limited larviciding,
• Seasonal Malaria Chemoprevention (SMC)

Program Indicators:

• Parasite prevalence
• All-cause under-5 mortality rate
• Reported malaria cases (presumed & confirmed, disaggregated by age and sex)
• Confirmed malaria cases (microscopy or rapid diagnostic test) per 1,000 persons per year (disaggregated by age and sex)
• Suspected malaria cases that receive a parasitological test
• Malaria test positivity rate
• In-patient malaria deaths per 1,000 persons per year
• Confirmed malaria cases that received first-line antimalarial treatment according to national policy
• Proportion of population that slept under an insecticide-treated net the previous night (disaggregated by age, sex, pregnancy status, geographical location)
• Proportion of households with at least one insecticide-treated net for every two people and/or treated with indoor residual spraying within the last 12 months

The program supports the Ministry of Health and other key stakeholders in the pharmaceutical (including traditional medicine) sector to develop, implement and monitor national drug policies and improve access to essential medicines for priority diseases such as HIV/AIDS, TB and Malaria by monitoring the sector and assessing problem areas to define technical support to be provided.

Ensuring multi-sector collaboration and assisting the Ministry of Health in the co-ordination of partners involved in the pharmaceutical and Traditional Medicine sectors e.g. international agencies, NGOs and relevant networks to ensure an integrated and appropriate technical support to the country.

Help to identify skills and projects and actively contribute to strengthen academic institutions and human resources.

Program Summary

• Medicines Policy
• Access to Essential Medicines for priority diseases
• Quality and Safety of Medicines
• Rational Use of Medicines by health professionals and consumers

Broad strategy of program

To collaborate with major partners to strengthen national capacity to improve access to safe, good quality, affordable essential medicines including traditional medicines by implementing and evaluating national medicines policy, strengthening supply systems to improve access, the quality and safety of medicines and their rational use.

Program Indicators

• National Medicines Policy Implementation Plan
• Integrating TRIPS Agreement flexibilities into National Legislation to protect public health
• Transparent and Accountable Legislation for Medicines Regulatory work
• Implementation of Basic Medicines Regulatory Functions
• Implementation of Basic Quality Assurance Procedures
• Basic System for regulating Pharmaceutical Promotion
• Herbal Medicines Regulated
• Adverse Drug Reaction Monitoring
• Percentage of Key Medicines Available in Public Health Facilities
• Pricing Policy for maximum retail mark-up in both Public and Private Sectors
• Drugs and Therapeutic Committees (DTCs) in all Regional Hospitals
• National Consumer Education Campaigns
• Continuing education for Pharmacists Pharmacy Technicians and Assistants

The Nutrition Program supports the Ministry of Health, Ghana Health Service and other key players to develop and implement policies, strategies and guidelines aimed strengthening maternal, infant and young child nutrition programming and the reduction of malnutrition and in Ghana.

WHO Ghana objectives
1.    To strengthen capacity and skills for implementing of essential nutrition actions for maternal, infant and young child.
2.    To support the development and update of policies, strategies for prevention of malnutrition. 
3.    To support the establishment of systems for monitoring nutrition outcomes and implementation of the national nutrition action plan
4.    To establish networks, partnerships, linkages in nutrition and inter-sectoral coordination

Areas of support

Development of policies, strategies, guidelines
•    Support the development of infant and young child nutrition guidelines
•    Adaptation and development of Micronutrient Deficiency Prevention and Control Guidelines
•    Development of the protocol, guidelines and training manuals for the Management of Severe Acute Malnutrition in Inpatient Care
•    Support the in the development of nutrition and food safety policies

Capacity building
•    Support training on the Integrated Course in Infant Young Child Feeding Counselling
•    Support training on the Management of Severe Acute Malnutrition in Inpatient care
•    Support training on Essential Nutrition Actions for maternal infant and young child

Assessment/Monitoring 
•    Assessment of Infant and Young Child Feeding Practices, Programs and Policies
•    Monitoring of the Code for Marketing Breast milk Substitutes and the Ghana breastfeeding Regulations LI1667
•    Monitoring implementation and adherence to the protocol for the management of severe acute malnutrition in inpatient care

Key Indicators

Key Indicators (source Ghana Demographic and Health Survey, 2014)

For more information please contact
Mrs.  Akosua Kwakye
Email: kwakyea [at] who.int