Strategy for the Management, Prevention and Control of Chronic Non-Communicable Diseases in Ghana 2012-2016

Objectives

Ghana’s 2012–2016 National Policy and Strategic Plan for chronic non-communicable diseases (NCDs) seeks to reduce avoidable morbidity, premature mortality and disability, while improving quality of life and supporting longer, healthier lives.[1]It frames NCD prevention and control as a development priority because NCDs deepen poverty and inequality, impose direct health-service and productivity costs, and threaten national development objectives.[2][3]

• Reduce the incidence of chronic NCDs, limit exposure to unhealthy lifestyles, reduce NCD-related morbidity and improve the quality of life of people living with NCDs.[1]
• Prioritise cardiovascular diseases, cancers, diabetes mellitus, chronic obstructive respiratory diseases and sickle cell disease, while addressing related conditions and injuries within the broader NCD burden.[4][5]
• Reduce modifiable risk factors, particularly tobacco use, harmful alcohol consumption, unhealthy diets, physical inactivity, overweight and obesity.[6][7][8]
• Promote healthy nutrition, physical activity, safer driving, tobacco and alcohol control, relevant immunisation, healthy settings, behavioural change communication and community empowerment.[4][9][10]
• Improve early detection, affordable clinical care, palliative care, rehabilitation, primary health care integration and access to essential medicines, technologies and diagnostic services.[2][11][12]
• Strengthen health systems, surveillance, research, monitoring and evaluation, coordination, accountability and resource mobilisation for the national NCD response.[2][9][6]

The strategic framework favours evidence-informed, cost-effective, culturally relevant, gender-sensitive and equity-oriented interventions, using a life-course approach, community participation, integrated services and technologies appropriate to Ghana’s resource setting.[9]It combines population-level prevention with targeted screening, clinical management, secondary prevention, rehabilitation and palliative care.[13][11][12]

• Reduce average daily salt consumption from approximately 9 grams to 5 grams or less by 2025, reduce food-industry salt content by 40% over five to seven years, and limit industrially produced trans fatty acids to less than 2% of fats and oils used in food manufacture and cooking.[14]
• Promote at least five daily servings of fruit and vegetables, healthier school meals and moderate-intensity physical activity, such as brisk walking for at least 30 minutes on most days.[15][14][16]
• Reduce tobacco use among men from 9.6% in 2008 to 7.0% by 2013, frequent alcohol consumption from 18.4% to 16% among men and from 7.4% to 6% among women, and selected measures of inactivity, unhealthy diet and obesity.[7][8]
• Increase childhood hepatitis B vaccination coverage to 100% by 2016, expand vaccination for adults at risk and prepare for human papillomavirus vaccination for young girls.[17]
• Expand screening for hypertension, diabetes, cholesterol disorders and priority cancers, including cervical, breast, prostate and colorectal cancer.[11][17][18]

Implementation

Implementation is designed as a whole-of-government, multisectoral response led by the health sector, recognising that major NCD determinants lie beyond health services.[19]The Ministry of Health (MOH), Ghana Health Service (GHS) and Non-Communicable Disease Control Programme (NCDCP) are central institutions, working with other ministries, agencies, civil society, non-governmental organisations, professional bodies, academia, development partners, the private sector and the media.[2][4][10]

• Establish a National Multisectoral Steering Committee on NCDs, bringing together ministries, departments and agencies, private-sector organisations, non-governmental organisations, research and training institutions, civil society and the media.[10]
• Review national plans, assess progress, advocate for sector-specific operational plans and promote appointment of NCD liaison officers through the Steering Committee.[10]
• Coordinate Steering Committee meetings and activities through the MOH, with periodic reporting to the National Development and Planning Commission.[10]
• Assign day-to-day planning, coordination and management to the NCDCP, supported by regional and district NCD focal persons and intersectoral programme planning.[10][20]
• Strengthen the position of the NCDCP within GHS, develop disease-specific programmes and integrate tobacco control, nutrition, health promotion and the Regenerative Health and Nutrition Programme into relevant GHS structures.[10][15]

Service delivery combines prevention in communities and institutions with strengthened primary, district, regional and specialist care.[21][11][12]The plan calls for wellness centres and screening in communities, workplaces, schools, faith-based settings and health facilities, supported by referral pathways, specialised clinics, outreach, multidisciplinary teams, treatment guidelines and World Health Organization Package of Essential Noncommunicable Disease interventions.[11][12]

• Strengthen regulation, legislation, fiscal measures, product labelling, advertising restrictions and health promotion to reduce exposure to tobacco, alcohol, unhealthy foods, unsafe herbal medicines and other unwholesome products.[15][16][13]
• Engage the food industry to reformulate products, reduce salt and trans fats, and improve consumer access to healthier foods.[15][14]
• Train health workers in prevention counselling, cessation support, screening, treatment adherence, self-management, dietary care, foot care, referral and use of clinical algorithms.[16][13][11][12]
• Expand diagnostic capacity, essential medicines, affordable technologies, laboratory and imaging services, rehabilitation, reconstructive surgery, prostheses, hearing and visual aids, physiotherapy and oral morphine for pain management.[12][22]
• Integrate bidirectional diabetes and tuberculosis screening and link screening with family planning, HIV testing and counselling, schools, workplaces and Employee Wellbeing Programmes.[11][23]

Monitoring focuses on process and output indicators because population-level changes in morbidity may take years to emerge.[6]The plan includes annual activity milestones from 2012 to 2016, indicators for focal-person coverage, coordination meetings, strategic-framework distribution, public awareness, screening, service readiness, training, surveillance and cancer registration.[20][24][17][25]It also calls for routine NCD reporting through the Integrated Disease Surveillance and Response system, risk-factor surveys, disease registries, health-system capacity assessments and independent five-yearly evaluations.[22][6][25]

Resource mobilisation includes increasing budgetary allocations, earmarking NCD funds, expanding National Health Insurance Scheme coverage for screening and cancer services, mobilising private-sector support and considering tobacco, alcohol, unhealthy-food, digital and corporate levies, diaspora bonds and voluntary mobile-phone solidarity contributions.[6]The target share of the recurrent annual health budget allocated to NCDs is 10% in 2013, 13% in 2015 and 15% in 2016.[26]The plan does not specify total monetary budgets, detailed expenditure allocations or quantified funding gaps.[6][26]

Monitoring & Evaluation

Monitoring and evaluation combine national coordination, routine health information, surveillance, implementation indicators and independent review. The framework prioritises monitoring of non-communicable diseases (NCDs), outcomes, risk factors and the national response, with a plan of action for 2010-2013 and annual implementation milestones through 2016.[2][6][20]

• Develop indicators for the national NCD response, focusing initially on process and output measures because changes in morbidity may take years to become apparent.[6]
• Track implementation through indicators covering NCD focal-person coverage, coordination and Steering Committee meetings, strategic-framework distribution, programme-manager appointments, policy coverage, capacity surveys, public knowledge, media outputs, information-material distribution and school education.[20][24]
• Monitor risk-factor outcomes against baselines and targets, including tobacco and alcohol use, physical inactivity, unhealthy diet, overweight and obesity, salt consumption, fruit and vegetable intake, vaccination coverage and screening uptake.[7][8][17]
• Use programme reports, surveys, monitoring visits, meeting reports, study reports, activity records and service-readiness measures, including coverage of functional blood-pressure monitors, glucometers and test strips.[17][23]
• Strengthen surveillance by incorporating NCD morbidity into the District Health Information Management System and the Integrated Disease Surveillance and Response system, conducting periodic risk-factor and youth surveys, expanding cancer registries, and routinely monitoring morbidity, cause-specific mortality and health-system capacity.[22][25]
• Improve data quality through stronger Centre for Health Information Management capacity, facility registers that capture risk factors such as overweight and obesity, trained health-information officers, data-quality checks and stakeholder review.[11][22]
• Assess health-institution capacity periodically to identify gaps in equipment, medicines, logistics and capability to detect and manage NCDs.[12]
• Review national plans and assess progress through the National Multisectoral Steering Committee on NCDs, which is to report periodically to the National Development and Planning Commission.[10]
• Conduct formal independent evaluations of the national response every five years, implement recommendations promptly, and use civil society organisations to advocate for commitment and monitor progress towards agreed objectives.[6]

Named enforcement and monitoring responsibilities include the Food and Drugs Board for tobacco-control requirements, law-enforcement agencies for drink-driving measures, and the Ministries of Education, Youth and Sports, and Health for monitoring physical education programmes.[16][13]The document does not specify a single consolidated reporting timetable, complete indicator register, evaluation methodology or comprehensive accountability framework beyond the arrangements described.[4][9]

Costing & Financing

Financing policy seeks to increase and prioritise resources for NCD prevention, case management and health-system strengthening, recognising that existing funding is low relative to the disease burden.[21][1]The plan promotes cost-effective, culturally appropriate interventions and affordable technologies, medicines and delivery systems suited to Ghana's resource setting.[2][9]

• Increase recurrent health-budget allocations for NCDs, with targets of 10% in 2013, 13% in 2015 and 15% in 2016.[26]
• Create earmarked NCD funds and explore financing through levies on profitable companies, diaspora bonds, voluntary mobile-phone solidarity contributions, digital taxes, tobacco excise taxes and excise taxes on unhealthy foods.[6]
• Advocate for National Health Insurance Scheme coverage of NCD screening, common-cancer screening, medical examinations and treatment.[11][6][26]
• Mobilise private-sector resources for screening campaigns and consider directing a proportion of alcohol and cigarette tax revenue towards tobacco, alcohol and wider NCD control.[15][16][6]
• Use fiscal measures, including reduced taxes on healthier foods, to support healthier choices.[15]

Funding constraints include competing health priorities, limited political interest and little or no development-partner funding for NCDs.[1]Development of the national policy and strategic plan received support from the Government of Ghana, the West Africa Health Organization and the World Health Organization.[2]

Economic context highlights the direct health-service costs and indirect productivity losses associated with NCDs, their links to poverty and inequality, and the potential macroeconomic consequences of increased NCD mortality.[5][3]The source reports global 2001 costs of suboptimal blood pressure of US dollars 370 billion and Ghana's 2009 per-capita health expenditure of about US dollars 45.[3]It does not specify a total NCD implementation budget, activity-level allocations, unit costs, quantified funding gap, expenditure ceiling or costing methodology.[2][6][26]