Strategy for the Management, Prevention and Control of Chronic Non-Communicable Diseases in Ghana

Objectives

Ghana’s 2012–2016 non-communicable disease (NCD) strategy treats NCDs as a national development challenge and aims to reduce avoidable morbidity, premature mortality, disability and socioeconomic harm from chronic diseases. Its vision is a healthy nation living longer with optimal physical and mental health, while its mission is to promote health, create enabling environments, strengthen health systems and resources, build partnerships and empower communities.[1][2]

• Reduce the incidence of chronic NCDs, exposure to unhealthy lifestyles, disease-related morbidity and the effects of NCDs on quality of life.[2][3]
• Address priority conditions including cardiovascular diseases, cancers, diabetes mellitus, chronic respiratory disease, sickle cell disease and injuries, while recognising links with communicable diseases such as tuberculosis.[4][5][6]
• Strengthen governance and coordination, health promotion, primary prevention, early detection, clinical management, rehabilitation, palliative care, surveillance, research, social support and financing.[1][7][8]
• Reduce modifiable risks from tobacco use, harmful alcohol consumption, unhealthy diets, excess salt and trans fats, physical inactivity, overweight and obesity, and unsafe driving.[9][3][10]
• Promote equitable access to affordable essential medicines, appropriate technologies, specialised services and integrated primary-care NCD services, particularly where screening and specialist care are concentrated in urban and higher-level facilities.[1][2][11]
• Apply evidence-informed, cost-effective, culturally appropriate, gender-sensitive and equity-focused interventions across the life course, with community participation and affordable technologies.[7][3]

The framework includes measurable prevention and service ambitions. It seeks to reduce average salt consumption from about 9 grams to 5 grams or less per day by 2025, reduce salt content in foods by 40% within five to seven years, and limit industrial trans fats to below 2% of fats and oils used in food manufacture and cooking.[12]It also sets tobacco, alcohol, physical-activity, diet, vaccination, screening and service-coverage targets, including increased hepatitis B vaccination and expanded cancer-screening sites.[13][14][15][16]

Implementation

Implementation is designed as a whole-of-government and multisectoral response led by the Ministry of Health and Ghana Health Service, with the Non-Communicable Disease Control Programme responsible for day-to-day planning, coordination and management. The approach combines population prevention with integrated, decentralised care, health-system strengthening and action on determinants beyond the health sector.[17][18][19]

• Coordinate national action through a multisectoral steering committee involving ministries, departments and agencies, private-sector actors, non-governmental organisations, civil society, researchers, training institutions and the media.[18]
• Assign the Ministry of Health a short- to medium-term coordinating role and require periodic reporting to the National Development and Planning Commission, while regional and district focal persons support implementation at subnational levels.[18]
• Strengthen or establish coordinating structures, appoint focal persons, hold coordination meetings, disseminate the policy and strategic framework, and seek to elevate the NCD Control Programme within the Ghana Health Service.[8][20]
• Integrate prevention and management into primary care and other existing services, including family planning, HIV testing, tuberculosis services, workplace programmes and school health education.[21][6][22]
• Deliver health promotion through mass media, social marketing, community and workplace initiatives, school curricula, counselling and culturally appropriate information materials.[23][24]
• Use regulation, legislation, food labelling, advertising restrictions, product standards, pricing measures and fiscal advocacy to reduce tobacco, alcohol and unhealthy-food risks.[10][23]

Service delivery is to expand screening, diagnosis, referral, treatment, rehabilitation and palliative care. Planned actions include wellness centres; routine measurement of blood pressure and screening for diabetes, cholesterol, obesity and selected cancers; specialist NCD clinics and outreach; strengthened district-hospital care; workforce training; clinical guidelines and job aids; essential medicines and diagnostics; and multidisciplinary rehabilitation and pain management.[6][11][16][25]

Health-system strengthening covers financing, governance, workforce, health information, medicines and technologies, and service delivery.[19]Priority information actions include improving the Centre for Health Information Management, incorporating NCD morbidity data into the District Health Information Management System, improving data quality, establishing disease registries and integrating NCD reporting into the Integrated Disease Surveillance and Response system.[19][25]Research is intended to inform policy and implementation across epidemiology, risk factors, health financing, food quality, traditional medicines, intervention effectiveness and integration with other programmes.[19]

Monitoring is to begin with process and output indicators because changes in morbidity may require several years to become visible.[8]The plan provides annual activity milestones and responsible agencies for many actions, including focal-person coverage, coordination meetings, public education, tobacco-control measures, screening, workforce training and specialist-service expansion.[20][14][22][16]Surveillance includes periodic risk-factor surveys, youth surveys, capacity assessments and cancer-registration reviews.[19][25]A formal independent evaluation of the national response is envisaged every five years, although the excerpts do not provide a fully consolidated indicator dictionary, reporting timetable or evaluation methodology.[8]

Resource mobilisation is a strategic priority. Proposed options include earmarked NCD funds, private-sector support for screening, expanded National Health Insurance Scheme coverage, taxes on tobacco and unhealthy foods, levies on profitable companies, diaspora bonds, voluntary mobile-phone contributions and digital taxes.[8]The supplied material does not specify a total NCD budget, detailed allocations, quantified funding gap or implementation costing framework.[1][8]

Monitoring & Evaluation

The framework combines routine health-information strengthening, risk-factor and service surveillance, activity-level performance monitoring, periodic capacity assessments and independent evaluation. It identifies historically incomplete facility reporting, limited inclusion of non-communicable diseases (NCDs) in the Integrated Disease Surveillance and Response system, and the absence of systematic risk-factor surveillance as major weaknesses requiring attention.[2]

• Develop indicators for the national NCD response, initially emphasising process and output measures because morbidity changes may take several years to become observable.[8]
• Track annual implementation milestones and responsible-agency outputs for governance, public awareness, tobacco control, alcohol control, physical activity, screening, vaccination, clinical care and surveillance activities from 2012 to 2016.[20][13][14][26][15][22][16][25]
• Monitor governance through regional and district focal-person coverage, coordination and steering-committee meetings, distribution of the strategic framework, programme-manager appointments, engagement with non-governmental organisations, and alcohol-policy dissemination.[20]
• Measure awareness through population knowledge, media programmes and articles, awareness events, distribution of information, education and communication materials, school coverage, media-training meetings and education of market-women associations.[13]
• Use explicit coverage targets, including full regional focal-person coverage by 2015, full district coverage by 2016, four coordination meetings in 2016, complete framework distribution by 2015, and health education reaching half of primary and junior secondary schools by 2016.[20][13]
• Monitor tobacco control through legislative progress, smoke-free institutions and public places, advertising restrictions, package warnings, tobacco purchases by minors, cessation-guideline distribution and tobacco-action-plan review meetings.[14]
• Track alcohol-control campaigns, policy meetings, monitoring reports, breath-testing among drivers admitted to accident and emergency facilities, and health-worker training in cessation methods.[26]
• Measure prevention and early-detection delivery through vaccination coverage, educational activity, dietary-guideline coverage, functional equipment, screening uptake, laboratory and prescriber training, and facility readiness.[15][22]
• Achieve specified service targets by 2016, including annual blood-pressure measurement for 75% of eligible adult outpatients per facility, training for 80% of laboratory personnel, fasting blood-glucose and cholesterol screening in 80% of primary-care facilities, updated NCD management training for 50% of prescribers, and functional weighing scales and blood-pressure monitors in all facilities.[22]
• Expand cancer and specialist-service monitoring through annual targets for cervical, breast, prostate and colorectal screening sites, equipped hospitals, trained providers, clinical-guideline availability, secondary prevention, specialist clinics and outreach sessions.[16][25]
• Integrate NCDs into the Integrated Disease Surveillance and Response system, increasing routinely reported NCDs from a 2009 baseline of none to five by 2016 and reaching district reporting coverage of 100% by 2015.[25]
• Conduct national or subnational chronic risk-factor surveys every three to five years, youth surveys, and periodic assessments of regional and district capacity to prevent and manage NCDs.[19][20][25]
• Strengthen data quality by incorporating NCD morbidity into the District Health Information Management System, training health-information officers, improving disease-severity classification and data-quality controls, including teaching-hospital data, and establishing selected-hospital registries.[19]
• Monitor risk factors through routine and survey data on blood pressure, blood glucose, cholesterol, triglycerides, overweight and obesity, diet, alcohol, physical activity and tobacco use.[27][5][19]
• Assess cancer registration through review meetings and institutional registries, with a target to increase registries from two in 2011 to three by 2015 and 2016.[25]
• Undertake a formal independent evaluation of the national response every five years and implement recommendations promptly; an earlier plan also called for formal independent progress evaluation after 2013.[8][7]
• Report periodically from the Ministry of Health to the National Development and Planning Commission on multisectoral steering-committee programmes and achievements.[18]

Dietary and lifestyle targets provide additional measurable benchmarks: reduce mean daily salt intake to 5 grams or less by 2025, reduce salt in foods by 40% over five to seven years, limit industrial trans fatty acids to below 2% of fats and oils used in food manufacture and cooking, promote at least five daily portions of fruit and vegetables, and encourage regular moderate-intensity physical activity.[10][12]The source does not provide a consolidated indicator dictionary, data-source protocol, universal reporting timetable, detailed surveillance governance architecture or comprehensive evaluation methodology.[7][3][11]

Costing & Financing

Financing is treated as a strategic requirement for NCD prevention, screening, treatment, rehabilitation, palliative care, surveillance and wider health-system strengthening, but the supplied material does not provide a consolidated national NCD budget, activity-level costing framework, quantified funding gap or financing forecast.[1][6][11][8]

• Mobilise increased resources and allocate earmarked funds specifically to NCD prevention and control.[1][8]
• Recognise inadequate funding, low political priority, competing priorities and limited development-partner interest as constraints on NCD prevention, management and care.[7][2]
• Build on development support for strategy development from the Government of Ghana, the West Africa Health Organization and the World Health Organization.[1]
• Prioritise financial resources commensurate with the NCD burden and increase budgetary allocations for primary prevention and case management.[28]
• Explore innovative financing through levies on profitable companies, diaspora bonds, voluntary mobile-phone solidarity contributions, digital taxes, tobacco excise taxes and excise taxes on unhealthy food.[8]
• Use fiscal measures to support healthier choices, including reduced taxes on healthier foods, and consider directing portions of alcohol and cigarette taxes or levies to NCD, tobacco and alcohol control.[10][23]
• Expand National Health Insurance Scheme benefits to cover NCD screening among healthy people, cancer screening and relevant treatment, while mobilising private-sector resources for screening campaigns.[6][8]
• Favour cost-effective interventions, affordable technologies, medicines and delivery systems suited to a resource-constrained setting.[3]

The broader economic context highlights substantial direct health-service costs and indirect productivity losses from illness, disability and premature death, with poorer households particularly vulnerable.[4]Global evidence cited estimates the 2001 cost of suboptimal blood pressure at US dollars 370 billion, around 10% of worldwide healthcare expenditure; it also associates every 10% increase in NCD mortality with a 0.5% annual reduction in economic growth.[4]Ghana-specific contextual figures include per-capita health expenditure of about US dollars 45 in 2009 and per-capita gross domestic product of US dollars 1,190.[4]