DIGYA, Ghana – Local farmer Precious Amewornu nearly died just before she could give birth to her second child and had to travel nearly 500 kilometers to seek treatment at the hospital as her local clinic was not equipped to do so. dealing with her high blood pressure – one of the most common. non-communicable diseases (NCDs).
A nurse at her primary health care facility in Afram Plains, the fishing and farming community along the Atlantic coast just west of Togo where she left, could tell something was wrong, but lacked the tools necessary for proper diagnosis and treatment.
“The nurse told me that my blood pressure was high as she watched me and placed her hand on my forehead and neck,” Amewornu said in an interview with Monitoring of health policies.
But there was “no blood pressure monitor or medicine in the facility”, she recalls, so the nurse referred her to Donkorkrom Presbyterian Hospital, nearly 500 kilometers away.
Donkorkrom, the only hospital in the northern district of Afram Plains, provides services over an area of more than 5,000 square kilometers.
“Due to the distance between the two facilities, I arrived late at the hospital and had to have a caesarean section because I couldn’t push my baby,” Amewornu recalled as she sat on a wooden bench in front of her house after her return. of the hospital. “I was tired and had complications.”
Non-communicable diseases such as cardiovascular and respiratory diseases, cancers, high blood pressure and diabetes are the leading causes of death worldwide. They are responsible for some of the highest rates of premature mortality in low- and middle-income countries, including sub-Saharan Africa.
But health services in low- and middle-income countries still need to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritize infectious diseases, according to a report released last year by the NCD Alliance. .
In Africa, some 37% of premature deaths were due to NCDs in 2019, up from 24% in 2000, according to the World Health Organization (WHO) Africa Regional Office.
But funding and resources to control NCDs in most African countries, including Ghana, remains a challenge as most of them depend on donor funds, rather than local budget allocations.
A 2022 monitoring report on the deployment of universal health care in the region shows that public expenditure on health as a proportion of total health expenditure is lowest in African countries.
Only seven of the 47 WHO Member States in Africa – Algeria, Botswana, Cape Verde, Eswatini, Gabon, Seychelles and South Africa – fund more than 50% of their health budgets. health, relying heavily on donors and citizens to pay for their own services.
“Overall health financing as a proportion of GDP and the proportion of government-funded health must increase to enable countries to reduce out-of-pocket spending and be able to drive their UHC agenda,” the report says. .
Ghana’s universal health coverage, NCDs yet to be mainstreamed
from Ghana CSU Roadmap 2020-2030 aims to strengthen the country’s primary care system with an emphasis on integrated services, but the country does not have enough resources to carry it out and government assistance to citizens to access health care has greatly decreased.
Ghanaian President Nana Akufo-Addo hosted a summit in April for African leaders to focus on tackling non-communicable diseases, and he is following that up with another session this week on the sidelines of the UN High Level Meeting. United Nations General Assembly in New York.
Despite the attention given to the issue, few Ghanaians still have access to routine screenings for non-communicable diseases such as high blood pressure and blood sugar at the primary care level, according to officials from the Ghana Health Service, which does part of the country’s Ministry of Health.
Data from the health department’s NCD program shows that one in five people was diagnosed with one of the NCDs last year, and the situation is even more pronounced in rural areas.
Primary care challenges in Ghana affect not only patients but also caregivers.
A nurse, Belinda Kumatu, who works in the northern and southern districts of Afram Plains, said local health facilities only had enough resources to provide care for the prenatal needs, malaria and family planning, and are obliged to refer cases to Donkorkrom or another hospital. She said there is also not readily available ambulance services for emergency situations.
“We can’t even do a normal birth because there is no equipment, midwife or electricity,” Kumatu said, adding that she hopes the government will step in and improve the standard. general care. “Ordinary vehicles take hours to get to the next facility for patients to access care. We sometimes lose patients or their babies due to delay.
The Ghanaian concept of primary care extended to NCDs
Initially, the government’s primary care concept focused on maternal and newborn care with little attention to NCDs because they are seen as lifestyle conditions and are easily overlooked, said Dr Efua Commeh, Head of the Ghana Health Services NCD program.
But even primary care doesn’t have enough resources, she said, and some places lack blood pressure monitors, glucometers and other resources to manage diabetes. And some nurses are also well equipped to educate people about NCDs, she said. A preliminary survey by the health department revealed that only a few primary care facilities perform NCD screenings.
But that is changing, according to Commeh.
“The COVID-19 outbreak has taught us the lesson to pay attention to NCDs, as we have seen most people with underlying health conditions die during the outbreak,” she says. “NCDs have received low coverage because little attention has been given to them over the years.”
Ghana is not the only African country facing lack of resources to tackle NCDs.
Other countries like Kenya, Malawi, Tanzania, Uganda and Zambia have all worked to find solutions, turning to global health financing mechanisms for cost-effective NCD prevention and care services focused on maternal and child care.
Such funding mechanisms could ensure a more integrated approach for the millions of people around the world living with NCDs and other chronic diseases, but health systems must adapt to provide a longer-term perspective rather than respond to short-term conditions.
Restructuring Ghana’s Health Insurance Provisions to Include NCDs
A WHO consultant and researcher, Dr Koku Awoonor-Williams, has suggested that restructuring Ghana’s National Health Insurance Scheme (NHIS) would be the surest way to improve its national NCD care. He called it “unfortunate” that more information about NCDs is not widely available to the public.
“We need to restructure the NHIS to cover education, awareness and prevention of NCDs in addition to curative measures,” said Awoonor-Williams.
“People should know the lifestyles that cause NCDs and they should be able to go to hospital for checks as part of NHIS cover, not just when they are sick,” he said . “People should be able to go to screenings and checks under NHIS cover.”
Image credits: Kate Holt/USAID.
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