National Policy: Non-Communicable Diseases

Objectives

Ghana’s revised national policy for non-communicable diseases (NCDs) provides a strategic framework to reduce avoidable NCD morbidity, mortality and socioeconomic harm, aligned with the Sustainable Development Goals, including the target to reduce premature NCD mortality by one-third through prevention and treatment while promoting mental health and wellbeing.[1][2]Its vision is a healthy population that supports national development through a reduced NCD burden; its mission is to prevent and control avoidable NCD-related illness and death through health promotion, stronger health systems and resources, partnerships, and community empowerment.[3]The goal is to reduce the NCD burden to the lowest possible level of public-health and socioeconomic significance.[3]

• Reduce exposure to behavioural, environmental and physiological risk factors, including physical inactivity, tobacco use, harmful alcohol use, unhealthy diets, air pollution, hypertension, raised blood lipids, overweight or obesity, raised blood glucose and substance abuse.[4][2]
• Strengthen primary prevention through health promotion, physical-activity promotion, alcohol and tobacco control, nutrition action, immunisation, public and school health education, and social and behaviour change communication.[5][6][7]
• Strengthen early detection and management through routine screening, clinical care, counselling, rehabilitation and palliative care, with the objective of reducing NCD morbidity, mortality and disability.[5][8][9]
• Prioritise cancers, injuries, sickle cell disease, mental health, oral health and eye health within the wider NCD response, while maintaining that these conditions are not necessarily more important than other NCDs.[10][11]
• Strengthen the health system through an adequately resourced NCD Division, research, surveillance, workforce development, emergency injury services, access to essential medicines and diagnostic devices, and periodic evaluation.[11][12][13]
• Secure sustainable funding and resources through cost-effective interventions, affordable technologies, health-insurance coverage, sectoral budgeting and financial-management integration, and domestic and external resource mobilisation.[3][12][13]

The framework is guided by evidence-informed decision-making, universal health coverage, primary health care, cultural relevance, gender sensitivity, community participation, integrated service delivery, multisectoral involvement, attention to social and legal determinants of health, and efficient use of existing infrastructure, institutions and human resources.[3][5]It is intended to support Ghana’s Universal Health Coverage Roadmap for 2020–2030, national health policy and other development and sector policies.[14]

Implementation

Implementation uses a whole-of-government and whole-of-society model led by the Ministry of Health and Ghana Health Service, combining multisectoral governance, integrated service delivery, legislation, regulation, community action, health-system strengthening and evidence use.[12][15]The NCD Prevention and Control Programme within the Ghana Health Service Disease Control Department leads programme activity, while the Ghana Health Service Division of Non-Communicable Diseases provides countrywide coordination and technical leadership.[14][15][13]

• Strengthen governance through the National Multisectoral NCD Steering Committee, which advises the Minister of Health, provides strategic direction, monitors progress, supports resource mobilisation and keeps NCDs on the national development agenda.[15]
• Coordinate cross-sector action through the Ministry of Health NCD Unit, which serves as Steering Committee secretariat, and through defined roles for agencies in activity-based plans.[16][15]
• Engage ministries and agencies responsible for trade, urban planning, transport, agriculture, education, finance, social services, security and Port Health, alongside Metropolitan, Municipal and District Assemblies, using a Health-in-All-Policies approach.[14][15]
• Partner with the private sector, civil society organisations, non-governmental organisations, professional bodies, academia, faith-based organisations, development partners, patient advocacy groups and traditional authorities.[15][17][18]
• Integrate NCD prevention, screening, treatment, rehabilitation and palliative care into primary care and other levels of the health system, using affordable evidence-based technologies, medicines and delivery systems.[3][5]
• Develop screening and management guidelines, establish health and wellness clinics, strengthen Community-based Health Planning and Services capacity, train health workers, and maintain supplies of essential medicines and appropriate medical devices.[8][9]
• Expand specialised services through cancer registries, sentinel sites, glaucoma and cervical-cancer screening centres, multidisciplinary mental-health teams, rehabilitation and palliative-care services, and emergency centres along major highways.[19][20][21]
• Support prevention through public education, supportive environments, community action, personal-skills development, media campaigns, school health education, vaccination, nutrition programming and safe opportunities for physical activity.[5][7][22]
• Apply and enforce legislation and regulation, including tobacco-control measures, food and drink labelling and marketing controls, alcohol pricing and taxation measures, and policies supporting healthier lifestyles.[6][16][23]

Workforce measures include staff production, retention and equitable distribution, relevant tools, task shifting and task strengthening.[13]Access to NCD medicines and devices is to be supported through Standard Treatment Guidelines, the Essential Medicines List, Ministry of Health framework contracts, regulatory enforcement by the Food and Drugs Authority and Ghana Standards Authority, and removal of taxes and levies on essential medicines and diagnostic devices.[13]The National Health Insurance Scheme is expected to strengthen financial risk protection, with proposed review or expansion of coverage for wellness services, cancer screening and treatment, childhood cancers, cervical cancer and prostate cancer.[24][16][25]

Monitoring arrangements include a sector-specific monitoring and evaluation plan coordinated by the National NCD Steering Committee, strengthened routine data systems, sentinel surveillance and periodic surveys of NCD risk factors.[13][25]Planned measures include the STEPS Survey, revised data-collection instruments, five cancer registries and sentinel sites, and inclusion of NCD indicators in the Ghana Demographic and Health Survey and Multiple Indicator Cluster Survey.[20]Baseline, mid-term and end-line evaluations are envisaged, alongside incorporation of NCD reviews into Annual Health Sector Review reports.[21]The supplied material does not specify complete indicator definitions, baselines, targets, reporting intervals, data-verification responsibilities or accountability sanctions.[25][19][20][21]

Financing combines advocacy for increased budget allocations and earmarked funds, integration of NCD interventions into planning, budgeting, audit and internal-control systems, a proposed NCD fund, donor mapping and resource-mobilisation conferences.[13][17][26]It also proposes investing revenues from targeted taxation of tobacco, alcoholic beverages and sugar-sweetened beverages in NCD programmes, alongside domestic, bilateral and multilateral funding mechanisms.[13][25]No quantified overall budget, allocation, funding gap or costed implementation plan is specified in the supplied material.[13][17][26]

Monitoring & Evaluation

Monitoring and evaluation are intended to be embedded in the non-communicable disease (NCD) response through strengthened surveillance, routine data systems, research, periodic evaluation and cross-government supervision. The policy assigns coordination and oversight roles to the Ministry of Health, Ghana Health Service and National Multisectoral NCD Steering Committee, but the supplied material does not consistently provide indicator definitions, baselines, targets, reporting intervals, data-verification responsibilities or sanctions for non-compliance.[12][15][13][25][19][20][21]

• Strengthen routine NCD data systems, establish sentinel surveillance and conduct periodic surveillance of NCD risk factors to inform action and the monitoring and evaluation framework.[13][25]
• Maintain and strengthen the inclusion of diabetes, hypertension and road-traffic injuries in the Integrated Disease Surveillance and Response system, addressing weaknesses in NCD data collection that have constrained planning, implementation and coordination.[24][14]
• Develop a sector-specific monitoring and evaluation plan aligned with policy objectives and coordinated by the National NCD Steering Committee.[25]
• Use indicators for risk-factor communication and prevention, including public education, social and behaviour change communication materials, media discussions, publications, social-media activity, health-facility education plans, NCD champions, advocacy campaigns and school health education.[25][7][22]
• Track service-delivery readiness and coverage through screening guidelines, wellness clinics, newborn sickle cell screening, blood-pressure, blood-sugar and urine checks, essential medicine and device availability, trained personnel, rehabilitation, palliative care and physiotherapy services.[9][19][20][21]
• Conduct the STEPS Survey, review and update data-collection instruments, train districts in their use, establish five cancer registries and sentinel sites, and include NCD indicators in the Ghana Demographic and Health Survey and Multiple Indicator Cluster Survey.[20]
• Undertake baseline, mid-term and end-line evaluations, incorporate reviews of NCD prevention and control into Annual Health Sector Review reports, and revise relevant indicators and targets.[21]
• Institutionalise periodic evaluation of NCD prevention and control activities, while strengthening surveillance for NCDs, cancer and eye health.[10][11][16]
• Supervise and monitor implementation across Ministries, Departments and Agencies through mechanisms established by the Ministry of Health and Inter-Ministerial Coordinating Committee; use the National Multisectoral NCD Steering Committee to monitor progress and advise the Minister of Health.[12][15]
• Review plans and budgets of Ministries, Departments and Agencies and Metropolitan, Municipal and District Assemblies for compliance with inclusion of NCD activities, as a proposed Ministry of Finance monitoring function.[27]

Costing & Financing

Financing is a stated policy objective and implementation area, responding to underfunding of NCD prevention, health promotion, risk reduction, treatment adherence and programme capacity. The approach combines domestic resource mobilisation, integration of NCDs into public planning and budgeting, health-insurance expansion, private-sector engagement and potential bilateral, multilateral and innovative financing. No overall budget, costed workplan, quantified funding gap, allocation, unit cost or economic forecast is supplied.[1][24][14][5][13][25][17][26]

• Increase funding for NCD prevention and management, secure resources for planned activities, and strengthen financing, research and development across the health system.[1][11][16][12]
• Integrate NCD interventions into sector planning, annual budgets, financial-management systems, internal audit and control arrangements across Ministries, Departments and Agencies and local assemblies.[27][16][12][26]
• Expand National Health Insurance Scheme coverage to support quality NCD care and financial risk protection, including proposed wellness services, childhood cancers, cervical cancer, prostate cancer, cancer screening and treatment of common cancers beyond cervical and breast cancer.[24][16][25][17][26]
• Mobilise domestic revenue and engage bilateral and multilateral partners, donor-mapping processes and resource-mobilisation conferences; explore innovative financing consistent with the Ghana Beyond Aid agenda and existing health-financing arrangements.[27][13][17][26]
• Advocate earmarked funding and increased budget allocations, including investment of returns from targeted taxation of tobacco products, alcoholic beverages and sugar-sweetened beverages in NCD programmes.[13][25]
• Establish a proposed NCD fund, pursue funding targets and disbursement of budgeted funds, and create NCD budget lines across Ministries.[17][26]
• Prioritise cost-effective interventions and affordable technologies, medicines and delivery systems in the context of resource scarcity.[3]
• Recognise direct and indirect economic burdens from diagnostic testing, medicines, chronic treatment and geographical barriers to service access.[13]
• Note that tobacco-control measures include an ad valorem tax reported at 175%, although no revenue estimate or allocation arrangement is provided.[6]
• Note a reported 2009 estimate that psychological distress caused a 7% loss of gross domestic product; the supplied material provides no wider NCD costing assumptions.[11]