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

Objectives

Ghana’s National Policy for the Prevention and Control of Chronic Non-Communicable Diseases (NCDs) seeks to reduce the NCD burden to the lowest possible level, including avoidable morbidity and premature mortality, and to enable a healthy population to live longer with optimal physical and mental health. Its mission is to reduce avoidable NCD morbidity and mortality through health promotion, enabling environments, stronger health systems and resources, partnerships, and community empowerment.[1]The strategy covers 2012 to 2016 and adopts a whole-of-government, multisectoral framework, with health-sector leadership alongside action on determinants outside the health system.[2]

• Reduce the incidence of chronic NCDs, exposure to unhealthy lifestyles, NCD-related morbidity, and the associated loss of quality of life.[1][3]
• Address cardiovascular diseases, cancers, diabetes mellitus, chronic respiratory diseases, sickle cell disease, injuries, mental and neurological disorders, and other chronic conditions identified within the national NCD burden.[4][5]
• Promote healthier lifestyles and environments by reducing tobacco use, harmful alcohol use, unhealthy diets, physical inactivity, overweight and obesity, and unsafe driving.[6][3]
• Improve early detection, equitable access to quality clinical services, rehabilitation, palliative care, self-management, psychosocial support and secondary prevention.[7][8][9]
• Strengthen health information, surveillance, research, primary health care, institutional capacity, partnerships and financing for NCD prevention and control.[7][10][11]

The policy is guided by evidence-informed, cost-effective, culturally appropriate, gender-sensitive, equity-oriented and life-course approaches, with integration and community participation as central principles.[12][3]Primary prevention includes food regulation and nutrition promotion, salt and trans-fat reduction, physical activity, tobacco and alcohol control, and vaccination against hepatitis B, with possible human papillomavirus vaccination subject to relevant considerations.[13][14][15]The plan also specifies measurable risk-factor ambitions, including reducing tobacco use among men from 9.6% in 2008 to 7.0% by 2013, frequent alcohol consumption among men from 18.4% to 16% and among women from 7.4% to 6%, and average salt consumption by 10% by 2012.[16][17]

Service priorities encompass screening for hypertension, diabetes, cholesterol and cancers, reciprocal tuberculosis and diabetes screening, strengthened diagnostic capacity, specialist and outreach services, and access to essential medicines and palliative care.[8][9][18]The strategy therefore combines population-level prevention with earlier diagnosis and integrated care for people living with NCDs.[2][8]

Implementation

Implementation is designed as a coordinated national response led by the Ministry of Health and Ghana Health Service, working across government, development partners, non-governmental organisations, civil society, professional bodies, research and training institutions, the private sector, media and communities.[2][7][19]The Non-Communicable Disease Control Programme is responsible for day-to-day planning, coordination and management, while regional and district focal persons support decentralised implementation.[19][20]

• Establish a National Multisectoral Steering Committee on NCDs to review plans, assess progress, promote sector-specific operational plans and encourage liaison officers in relevant ministries.[19]
• Coordinate the Committee through the Ministry of Health in the short to medium term and provide periodic updates to the National Development and Planning Commission.[19]
• Strengthen the NCD Control Programme within the Ghana Health Service, integrate tobacco control, and strengthen regulatory bodies including the Food and Drugs Board and Traditional Medicines Council.[19][13]
• Integrate NCD prevention, screening and care into primary health care, schools, workplaces, communities, faith-based settings and health facilities.[7][21][8]
• Build health-system capacity across finance, governance, workforce, information, medicines and technologies, and service delivery.[9][10]

Operational delivery includes public education and behaviour-change communication; legislation, enforcement and fiscal measures on tobacco, alcohol, food standards, labelling and advertising; negotiation with food industry to reduce salt and industrial trans fats; and multisectoral physical-activity action involving transport, education, sport, local government, urban planning and civil society.[13][14][21]Health workers are to receive pre-service and in-service training in counselling, risk assessment, screening, diagnosis, treatment guidelines and NCD case management.[21][8][9]

Monitoring is intended to combine routine health information, facility registers, disease registries, national capacity assessments, cancer registration, risk-factor surveys and the expanded Integrated Disease Surveillance and Response system.[10][22]National risk-factor surveys are envisaged every five years, while annual implementation plans assign activities, targets and responsibilities for 2012 to 2016.[10][20]Indicators include coordination structures, awareness activities, service coverage, screening, tobacco and alcohol controls, physical-activity activities, surveillance reporting, and clinical-service capacity.[20][23][24][22]The plan calls for independent evaluation of the national response every five years, although the supplied material does not provide a complete reporting schedule or detailed evaluation methodology.[11]

Financing priorities are to increase and earmark resources for NCD prevention and control, advocate stronger National Health Insurance Scheme coverage, and explore revenues from tobacco, alcohol and unhealthy-food taxes, special levies, diaspora bonds, digital taxes and voluntary mobile-phone solidarity contributions.[11][25]Recurrent annual health-budget allocation targets for NCDs are 10% in 2013, 13% in 2015 and 15% in 2016; however, no total programme budget or quantified funding gap is specified in the supplied material.[25]

Monitoring & Evaluation

Monitoring and evaluation combine strategic indicators, routine health information, risk-factor surveillance, periodic capacity assessments and independent review. The framework recognises weak and incomplete non-communicable disease surveillance, while setting out measures to integrate data collection, improve reporting quality and track implementation progress.[1][10]

• Develop indicators and annual targets for plan activities, initially emphasising process and output measures because changes in morbidity may take several years to become observable.[11]Annual implementation tables for 2012 to 2016 assign responsibilities to agencies including the Ghana Health Service, Ministry of Health, Ghana Education Service and non-governmental organisations.[20][23]
• Monitor governance through the proportion of regions and districts with NCD focal persons, coordination and steering-committee meetings, distribution of strategic frameworks, programme-manager appointments, policy coverage and national capacity surveys.[20]
• Strengthen routine data systems by incorporating NCD morbidity into the District Health Information Management System, building the Centre for Health Information Management’s capacity to collate public- and private-sector data, training information officers, improving validation and coding, and establishing selected disease registries.[10]
• Use the expanded Integrated Disease Surveillance and Response system, which includes diabetes, hypertension, road traffic accidents and mental illness, alongside routine health management information systems.[10]Monitor NCD morbidity, mortality, multiple diagnoses, disease severity, emergency presentations, risk factors and the health system’s capacity to provide essential services.[10]
• Conduct national risk-factor surveys every five years, preferably between Ghana Demographic and Health Surveys, covering tobacco, alcohol, physical activity, diet, body mass index, blood pressure, blood glucose, cholesterol and triglycerides.[10]Conduct periodic national and district assessments of plans, infrastructure, human resources, essential care and medicine access.[10]
• Track prevention targets, including reductions in tobacco use, harmful alcohol consumption, physical inactivity, overweight and obesity, salt consumption, and inadequate fruit and vegetable intake.[16][17]Specific policy measures include average salt consumption of 5 grams or less daily by 2025, a 40% reduction in food salt content over five to seven years, and industrially produced trans fats below 2% of fats and oils used in food manufacture and cooking.[14]
• Measure early detection and clinical performance through facility registers and forms capturing overweight and obesity, screening coverage, functional diagnostic equipment, trained personnel, specialist clinics, outreach sessions, guideline availability, and secondary prevention for cardiovascular disease and diabetes.[8][18][24][22]
• Strengthen cancer surveillance through additional registries, review meetings and improved registration data, while conducting periodic chronic-risk-factor and youth surveys.[22]
• Require the National Multisectoral Steering Committee on Non-Communicable Diseases to review national plans and assess progress, with periodic updates to the National Development and Planning Commission.[19]Civil-society organisations are expected to advocate for the national response and monitor progress against objectives.[11]
• Commission a formal independent evaluation of the national response every five years and implement recommendations promptly.[11]The earlier strategic framework also identifies a need for independent evaluation of implementation progress after 2013.[12]

Detailed indicator definitions, reporting templates and a single comprehensive evaluation methodology are not consistently specified in the supplied material.[3][19]

Costing & Financing

Financing is framed as a major implementation requirement: NCD prevention, management and care have received low funding amid competing priorities, limited political interest and little or no development-partner support.[1]The plan seeks increased, earmarked and innovative resources, but does not provide a complete costed programme budget, quantified funding gap or unit-cost assumptions.[11]

• Allocate a rising share of the recurrent annual health budget to NCDs, with targets of 10% in 2013, 13% in 2015 and 15% in 2016.[25]
• Mobilise earmarked funds and explore special levies on profitable companies, diaspora bonds, voluntary mobile-phone solidarity contributions, digital taxes, tobacco excise taxes and excise taxes on unhealthy food.[11]
• Consider directing a proportion of alcohol and cigarette taxes and levies to NCD control, especially tobacco and alcohol interventions, and use tax subsidies to support medicine affordability.[13]
• Advocate expansion of the National Health Insurance Scheme benefits package to cover screening of healthy people for NCDs and cancer, while mobilising private-sector resources for screening campaigns.[11]
• Apply cost-effectiveness and affordability in selecting interventions, technologies, medicines and delivery systems for a resource-constrained setting.[3]
• Recognise the wider economic burden: NCDs generate direct health-service costs and indirect productivity losses from illness, disability and premature death, with indirect costs potentially matching or exceeding direct costs.[26]A 10% increase in NCD mortality is associated with a 0.5% reduction in annual economic growth.[26]
• Note contextual estimates of Ghana’s per-capita health expenditure of 45 US dollars in 2009 and per-capita gross domestic product of 1,190 US dollars.[26]Globally, suboptimal blood pressure was estimated to cost 370 billion US dollars in 2001, equivalent to about 10% of overall healthcare expenditure.[26]
• Identify resource requirements for infrastructure, workforce training, diagnostics, equipment, medicines, technologies and health-insurance coverage, without assigning monetary values.[8][9]

Strategy development was funded by the Government of Ghana, the West Africa Health Organization and the World Health Organization.[7]Funding adequacy and political will are identified as major threats to implementation.[12]