Ghana

Our work

iDSI has been building strong partnerships in Ghana for over 10 years, led by the Global Health and Development Group at Imperial College London (the team formerly known as NICE International). As the first Sub-Saharan African nation to introduce a tax-funded National Health Insurance Scheme (NHIS) in 2003, Ghana is committed to achieving universal health coverage (UHC) by 2030. To enable this vision, iDSI has continued collaborations with governmental, clinical and academic partners in-country to strengthen evidence-based decision making in healthcare for Ghana’s population of 29 million.

Key impacts

  • Developed Ghana’s first national economic evaluation study on hypertension management, potentially informing price negotiation and procurement
  • Instigated the Health Technology Assessment (HTA) institutionalisation process, including bringing together the Ghanaian Technical Working Group on HTA and setting out the capacity requirements and key steps for a formal HTA function to be able to inform NHIS
  • Brought together over 100 policy makers, academics and industry representatives for a ground breaking event in Accra

Our work focuses on providing direct technical assistance and capacity building for HTA to support government decision-making capacity as Ghana moves “beyond aid”, and to ensure the long-term financial sustainability of the National Health Insurance Scheme. In 2018, the Norwegian Institute of Public Health becomes an iDSI core partner, joining forces with the Global Health and Development Group to support Ghanaian partners in implementing the government’s long-term vision for HTA.

Improving the quality and efficiency of healthcare services in Ghana through Health Technology Assessment

As part of iDSI, the Global Health and Development Group at Imperial College London collaborated with academia and government in Ghana to produce a Health Technology Assessment (HTA) study, modelling different policy scenarios for the cost-effective management of hypertension under the current National Health Insurance Scheme (NHIS).

Hypertension affects a significant proportion of the Ghanaian population, 9% in rural areas and 16% in urban areas, and anti-hypertensive medicines accounted for a staggering 60% of the NHIS drugs budget. Furthermore, hypertension is a risk factor for non-communicable diseases (NCDs) and treating NCD events is costly – so it is in the interest of any country to prevent and treat hypertension in cost-effective ways. Targeting priority policy problems and reinforcing the link between HTA capacity-building efforts was high on the agenda for iDSI’s collaboration with Ghanaian partners.

iDSI, with the University of Southampton Health Technology Assessment Centre, helped to convene and collaborated with a Technical Working Group comprised of Ghanaian policymakers and researchers. These included representatives from the Ministry of Health, National Health Insurance Authority, University of Ghana, and Kwame Nkrumah University of Science and Technology.

The study included economic evaluation and budget impact analysis of main classes of anti-hypertensive medicines currently used for uncomplicated, essential hypertension in Ghana.

Impact

The study was presented by iDSI representatives at the Ghana National Health Summit in 2017. Results included evidence-informed formulated policy scenarios as a means for achieving cost effective management of hypertension for Ghanaian policy makers. As a result, the Government now has the information and bargaining power to negotiate down drug prices on hypertensive drugs across the board, by a conservative estimate of 10%. This in turn could lead to estimated cost savings for hypertensive drugs of at least GHS 60m (US$12.5m). If the cost savings were subsequently reinvested into prescribing the most cost effective antihypertensive drugs for otherwise untreated patients, this could lead to an additional 53,422 disability-adjusted life years (DALYs) averted.

In 2018 the Ghanaian government signed an Aide Memoire cementing the role of HTA in optimising drug procurement and supply chains for UHC, reflecting discussions and conclusions from the 2018 National Health Summit and containing commitments of health partners towards providing quality healthcare for Ghanaians.

The study also resulted in a strategic plan for HTA institutionalisation and a National Medicines Policy in Ghana, which promoted the responsible use of medicines by healthcare providers and consumers and reaffirmed the government’s commitment towards UHC and the role that HTA plays in ensuring control over national budgets and optimal resource allocation.

Setting Priorities Fairly: Sustainable policies for effective resource allocation decisions

In September 2018 iDSI and Health Technology Assessment international (HTAi) hosted a first-of-its-kind event in Accra, Ghana – the first interdisciplinary event including academic, government, private and public sectors focused on health technology assessment (HTA) and related sustainable resource allocation policies in Sub-Saharan Africa. The two-day event set out to address the difficulties that low- and middle-income countries face in attempting to attain UHC, and put the spotlight specifically on how HTA can provide solutions. Almost 100 policy representatives from across Africa and Europe attended workshops that provided an overview of HTA, covering core technical components and how HTA could be integrated within a broader decision-making process.

Impact

The event was hosted by the Ministry of Health Ghana and endorsed by the Honorable Minister for Health, Mr Kwaku Agyemang-Manu. Speakers presented on their experiences of HTA in Sub-Saharan African nations in plenary and parallel sessions covering a wide array of issues pertinent to HTA. By leveraging the collective inputs from a great mix of delegates with a vast collection of knowledge, the event builds on the momentum within Ghana on the institutionalisation of HTA within the broader health system. iDSI and HTAi anticipate the ideas and recommendations that stem from the event will further incite partnerships, development, innovation.

iDSI continues to build and strengthen networks across Sub-Saharan Africa, including through collaborations with our newest core partners the Norwegian Institute of Public Health (NIPH) and Clinton Health Access Initiative (CHAI).

HTA institutionalisation in Ghana

As Ghana is moving “beyond aid” while still facing with an increasing disease burden relating to both infectious and non-communicable diseases, and the threat of pandemics, HTA needs to be ‘institutionalised’ so that evidence-informed resource allocation becomes the norm rather than the exception. This is a necessary step for achieving and sustaining UHC. The donor-driven domestic resource mobilisation agenda and the accompanying calls for strategic purchasing and efficiencies can only be implemented through addressing wasteful spending and ensuring the value for money of new prospective investments.

In 2018, colleagues from the Ministry of Health, Ghanaian universities (Kwame Nkrumah University of Science and Technology and University of Ghana), the Global Fund for AIDS, TB and Malaria, and iDSI (Global Health and Development Group, GHD; Norwegian Institute of Public Health, NIPH) discussed how to work together to implement the government’s vision for embedding HTA into decision-making within the wider health system.

Next steps

What became apparent from the discussions was the need to build institutions which move the HTA process from involving ad-hoc project specific activities led by a Technical Working Group, to an arrangement involving a standing committee (or committees) with an associated secretariat and analytical support provided by the Ministry of Health and universities. This is the wish of the President who recommended that HTA moves into legislation alongside tackling antimicrobial resistance and rational medicines use. iDSI is continuing discussions with Ghanaian counterparts to scope out and help them realise the next steps through capacity-building and advising on institutional set-up for HTA.

Key reads:

Improving the quality and efficiency of healthcare services in Ghana through HTA

Messages from Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation

Interested in Ghana’s progress towards UHC? View our timeline published in September 2018.

Want to know more about our HTA work in Ghana? View slides from a special lecture delivered in June 2018.

Improving healthcare spending

Who we work with

Our work on the cost-effective management of hypertension is a collaboration between GHD, the University of Southampton HTA Centre and the Ghanaian Technical Working Group on the first HTA in the country.
Our partnerships include the National Health Insurance Authority (NHIA), the Chief Pharmacist’s office at the Ministry of Health and the National Drugs Programme.

Academic partnerships

Other collaborations extend to the academic sector, with the University of Ghana School of Public Health in Accra, and Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi.