National Policy: Non-Communicable Diseases

Objectives

Ghana’s non-communicable disease (NCD) policy seeks to attain a healthy population that supports national development by reducing avoidable NCD morbidity and mortality, and by reducing the NCD burden to a level that no longer presents a major public-health or socioeconomic-development obstacle.[1]It aligns NCD prevention and control with government priorities, the Sustainable Development Goals and the World Health Organization Global Action Plan for NCD Prevention and Control.[2]

• Reduce exposure to behavioural, environmental and metabolic risk factors, including physical inactivity, tobacco use, harmful alcohol use, unhealthy diets, air pollution, hypertension, raised blood glucose, high serum lipids, overweight and obesity, and substance abuse.[3]
• Deliver a life-course response spanning infancy to older age, with primary prevention, health promotion, screening, early detection, clinical care, rehabilitation and palliative care.[4]
• Prioritise cardiovascular diseases, cancers, chronic respiratory diseases and diabetes mellitus, while addressing injuries, sickle-cell disease, mental health, oral health and eye health as conditions of special concern.[3][5]
• Strengthen early detection, management and quality care to reduce NCD-associated morbidity and mortality, including routine and opportunistic screening, newborn sickle-cell screening, counselling, therapy, rehabilitation and palliative care.[6][7]
• Advance universal health coverage through access to quality NCD services and financial risk protection under the National Health Insurance Scheme and other funding mechanisms.[8]
• Apply evidence-informed, cost-effective and culturally relevant interventions through primary health care, integrated service delivery, community participation, gender sensitivity, attention to social determinants of health, affordable technology and multisectoral action.[1]
• Promote health education, social and behaviour change communication, supportive environments, community action and media-based communication to enable healthier choices.[4]
• Strengthen sustainable financing, research, surveillance, workforce capacity, essential medicines, diagnostic devices and other health-system resources for NCD prevention and control.[4][9]

Implementation

Implementation uses a whole-of-government and Health-in-All-Policies model led collectively by the Ministry of Health, integrating NCD prevention and care across health-system levels, particularly primary care, while engaging public institutions, communities, civil society, development partners and private-sector organisations.[10][1]The NCD Prevention and Control Programme within the Ghana Health Service leads programme implementation, while the Ministry of Health’s NCD Unit supports cross-sector collaboration and secretariat functions.[5][10]

• Strengthen governance through the National Multisectoral NCD Steering Committee, which advises the Minister of Health, provides strategic direction, develops policies and action plans, supports enabling legislation, mobilises resources, builds partnerships and monitors progress.[10]
• Coordinate countrywide delivery through the Ghana Health Service NCD Division, support technical committees, and establish or strengthen the Division’s staffing and operational capacity.[11][9]
• Require ministries, departments, agencies and Metropolitan, Municipal and District Assemblies to incorporate NCD prevention and control activities into annual plans and budgets, with supervision and monitoring coordinated by the Ministry of Health and Inter-Ministerial Coordinating Committee.[12][10]
• Engage sectors including trade, urban planning, transport, agriculture, education, finance and social services, alongside security agencies, education authorities, regulatory bodies, traditional authorities, patient groups, professional bodies, academia, faith-based organisations and the private sector.[10][5][13]
• Develop and implement national guidelines for screening, NCD management, treatment, palliative care, medical devices, newborn sickle-cell screening and health and wellness clinics; establish wellness clinics; and strengthen Community-based Health Planning and Services capacity for screening and referral.[14][6]
• Integrate services and funding arrangements across programmes and levels of care to improve efficiency, address shared risk factors and reduce delivery costs.[15][1]
• Expand prevention through physical-activity promotion in settings where people live, work and play; tobacco-control enforcement; alcohol-harm reduction; food and nutrition regulation; hepatitis B vaccination for at-risk groups; and vaccination against high-risk human papillomavirus types 16 and 18.[4][16]
• Improve access to essential medicines, appropriate diagnostic devices, rehabilitation equipment, narcotic analgesics and specialised services, using treatment guidelines, essential-medicines lists, Ministry of Health framework contracts, regulatory enforcement and possible removal of taxes and levies on essential NCD medicines and devices.[14][11]
• Build workforce capacity through training, task shifting and task strengthening across regions, districts, hospitals, health centres and community-based services.[11][9]
• Strengthen data and accountability through routine data systems, sentinel surveillance, periodic NCD risk-factor surveillance, cancer registries, research networks, the STEPS Survey, inclusion of NCD indicators in national surveys, and periodic baseline, mid-term and end-line evaluations.[11][9][17]
• Use a sector-specific monitoring and evaluation plan coordinated by the National NCD Steering Committee, with indicators covering communication, service availability, screening, workforce training, surveillance, legislation, budget disbursement, resource mobilisation and incorporation of NCD activities into ministerial budgets.[15][18]
• Mobilise resources through domestic, bilateral and multilateral mechanisms, innovative financing, earmarked funds, donor mapping, resource-mobilisation conferences and potential investment of targeted tobacco, alcohol and sugar-sweetened beverage tax revenue in NCD programmes.[11][15][19]

Monitoring & Evaluation

The policy establishes a broad monitoring, evaluation, surveillance and accountability architecture for non-communicable disease (NCD) prevention and control, led by the Ministry of Health and coordinated through the National Multisectoral NCD Steering Committee. It combines cross-government supervision, routine data strengthening, periodic risk-factor surveillance, research, service-delivery monitoring and scheduled policy evaluation.[13][10][11][15][17]

• Establish supervision and monitoring mechanisms across ministries, departments and agencies, led by the Ministry of Health with support from the Inter-Ministerial Coordinating Committee.[13][10]
• Use the National Multisectoral NCD Steering Committee to coordinate the sector-specific monitoring and evaluation plan, monitor progress, guide implementation coherence and maintain accountability for prevention and control actions.[10][15]
• Require ministries, departments, agencies and Metropolitan, Municipal and District Assemblies to incorporate NCD activities into annual plans and budgets, with compliance subject to monitoring.[12]
• Strengthen routine NCD data systems and establish sentinel surveillance for continuous data collection, analysis, interpretation and action-oriented monitoring.[11]
• Conduct periodic surveillance of NCD risk factors and disease trends, supported by operational research, local evidence and relevant international research.[1][11]
• Implement specific surveillance activities, including the STEPS Survey, reviews and updating of data-collection instruments, district training on updated instruments, establishment of five cancer registries and sentinel sites, and inclusion of NCD indicators in the Ghana Demographic and Health Survey and Multiple Indicator Cluster Survey.[9]
• Strengthen cancer and eye-health surveillance, including integration of eye-health screening into management of other NCDs and monitoring of prevention and control delivery.[20]
• Track indicators for communication and advocacy activities, school health education, human papillomavirus vaccination and education, nutrition interventions, physical-activity infrastructure, and health-facility education plans.[15][21][22]
• Monitor screening and care through indicators covering guideline development and uptake, routine blood-pressure, blood-sugar and urine checks, newborn sickle-cell screening, wellness clinics, medicine and device availability, rehabilitation, palliative care, physiotherapy and trained personnel.[6][7]
• Assess health-system strengthening through establishment of the NCD Division, research-network activity, meetings, systematic reviews, workshops, a national research conference and surveillance outputs.[9]
• Institutionalise evaluation through baseline, mid-term and end-line assessments, NCD reviews within Annual Health Sector Review reports, and revision of relevant indicators and targets.[17]
• Use accountability measures including proposals to the Public Services Commission, facility and service coverage, staff-training coverage, surveillance outputs, steering-committee meetings, community scorecards and published nutrition-friendly school league tables.[6][9][17][19]
• Monitor financing implementation through indicators on achievement of resource-mobilisation funding targets, establishment of an NCD Fund, disbursement of budgeted funds, NCD budget lines across ministries, National Health Insurance Scheme benefit expansion, and integration of NCD actions into planning, budgeting, audit and control systems.[18]

Weak NCD data collection, limited population-based evidence and scarce nationally representative data are identified as important constraints to planning and implementation.[3][8][5]Although the policy framework includes indicator levels, definitions, targets and data sources, the supplied indicator tables do not populate these fields.[15][21][22][18]The supplied extracts do not provide a complete reporting timetable or a detailed evaluation methodology beyond the stated periodic-evaluation arrangements.[23][24][17]

Costing & Financing

Financing is a strategic objective and implementation requirement for NCD prevention and control. The policy recognises persistent underfunding of prevention, health promotion, risk reduction, treatment adherence and the NCD Prevention and Control Programme, while seeking sustainable domestic and external resources, expanded financial protection and more efficient use of available funds.[2][8][5][4][19]

• Increase funding for NCD prevention and management services and integrate NCD interventions into sector planning, budgeting, financial-management, internal-audit and control systems.[24][13][18]
• Mobilise resources through local revenue plans, collaboration between the Ministry of Finance and Ministry of Health, multilateral and bilateral partners, donor mapping, resource-mobilisation conferences and a resource-mobilisation plan.[12][19]
• Explore innovative funding under the Ghana Beyond Aid agenda, alongside domestic, bilateral, multilateral and existing health-financing mechanisms.[11]
• Advocate earmarked funds, increased budgetary allocations and establishment of an NCD Fund, with funding-target achievement and disbursement of budgeted resources subject to monitoring.[11][18]
• Expand National Health Insurance Scheme coverage and financial risk protection for NCD services, including wellness services and selected childhood, cervical and prostate cancers, and review coverage for screening and treatment of common cancers.[8][24][15][18]
• Invest proceeds from targeted taxation on tobacco products, alcoholic beverages and sugar-sweetened beverages in NCD prevention and control programmes, while exploring alcohol pricing and tax measures.[16][15]
• Remove taxes and levies on essential NCD medicines and diagnostic devices, improve their availability through treatment guidelines, essential medicines lists and Ministry of Health framework contracts, and enforce quality standards for medicines and devices.[11]
• Prioritise interventions according to cost-effectiveness and promote affordable technologies, medicines and service-delivery systems appropriate to Ghana’s resource-constrained setting.[1]
• Integrate NCD services and programme funding arrangements across levels of care to reduce costs and improve cross-programmatic efficiency.[15]

The policy identifies direct and indirect economic pressures from diagnostic tests, medicines, long-term treatment and geographical barriers to care, as well as productivity impacts, absenteeism, chronic medication costs and reduced staff capacity.[12][11]A reported 2009 study associated psychological distress with a 7% loss of gross domestic product.[23]Rehabilitation is also identified as an intervention that can reduce costs, although no monetary estimate is given.[14]The supplied extracts do not provide a total budget, expenditure allocations, quantified funding gap, costing methodology, financing forecast or detailed economic assumptions.[25][24][11][19]