Empowering health workers and mobilizing communities to improve early detection and treatment of noncommunicable diseases in Ghana

In 2019, noncommunicable diseases (NCDs), including cardiovascular disease, diabetes, cancer and chronic respiratory diseases, became the leading cause of death in most countries, accounting for approximately 74% of deaths globally. In Ghana, 45% of all deaths were due to NCDs (2019), yet the capacity to address NCDs in primary health care (PHC) is limited 1. In 2020, Ghana was selected as one of five countries for the NCD Flagship Initiative (2020–2024) by the Norwegian government in collaboration with WHO. The aim of this initiative was to address the NCD burden by strengthening key components of PHC in the health system in six regions. It has led to an improvement in NCD services in health facilities, making it possible for NCD cases to be identified in a timely manner and referred for appropriate treatment, thus minimizing further complications. In addition, work on NCDs in the country has sparked high-level political momentum, with the President of Ghana cohosting an International Strategic Dialogue on NCDs and the Sustainable Development Goals in April 2022. This took place alongside a National Strategic Roundtable on NCDs that provided an avenue for partners to discuss sustainable support for the NCDs in Ghana.

How did Ghana, with the support of the WHO Secretariat, achieve this?

In Ghana, the probability of premature mortality due to NCDs was estimated at 22% (2019), and many of these deaths are highly preventable 1. To address the growing burden of NCDs, WHO Ghana in collaboration with the national authorities jointly established a multisectoral NCD Steering Committee and put in place prevention policies for NCD risk factors. However, care for people living with NCDs is still at an early stage.

Through a regional and national consultation and comprehensive proposal development, WHO Ghana was selected for the NCD Flagship Initiative. All three levels of WHO worked closely with the Ministry of Health to provide technical support to conduct training for the WHO package of essential noncommunicable (PEN) disease interventions and facilitate the rollout of NCD screening at selected sites. This included provision of medical diagnostics and devices (500 blood pressure devices, 200 weighing scales, 200 height measures, 100 glucometers and strips, and 200 tape measures) distributed to 25 community health posts, five health centres and one district hospital in six implementing districts. In December 2022, a total of 515 health care workers across different occupational groups (physicians, nurses, midwives, health information officers and laboratory technicians) at regional/district level were trained on WHO PEN to strengthen early detection, initiation of treatment and follow-up care for NCDs. The PEN modules covered different disease areas across the main NCDs as well as NCD risk factors, palliative care, mental health, paediatric NCDs and medical ethics, and included procedures for entering NCD data into the district health information software (DHIS2). This will enable health workers to identify NCD cases and prescribe appropriate treatment or referral if necessary. 

Due to lack of training, we are currently not conducting cervical cancer screening at our health facility, but with the WHO PEN training, I am happy that now I am able to clearly identify cancer infected cervix and will start screening in my health centre soon.” - Vivian Opoku-Kyremeh, Midwife at Dumasua Health Center in the Sunyani West Municipality

Screening for diabetes and hypertension was conducted at sites such as Birim Central Municipality, in the Eastern Region of Ghana, from July–September 2022. To successfully plan and deliver the NCD screening session and mobilize the community to attend, WHO Ghana worked closely with the Ghana Health Service, community health committees, traditional councils and faithbased organizations. The teams applied the WHO PEN package and relevant tools, such as a NCD screening register, which was uploaded onto the “Kobo collect tool” for data collection of screened individuals. Raw data was then downloaded, cleaned and analysed by the Ghana Health Service team, showing that 73.2% of women and 26.8% of men were screened for diabetes and hypertension out of a total eligible population of 2858 people aged 30–70 years of age. Findings indicate that of those screened, 5.9% had been previously diagnosed with diabetes, but 94.1% did not know their status; 29.1% of people screened had raised blood pressure and 9.7% of those screened were referred to the next medical care level 2. These findings provide a snapshot of the NCD burden in Birim Central Municipality, which will enable district managers to better plan and allocate resources to ensure that appropriate care is available. The screening event also raised awareness in the community, empowering people to seek care for NCDs.

Currently, our screening efforts for diabetes are focused on people who present symptoms. But using the WHO PEN module, our health centre is now going to implement routine screening for early detection and treatment.” - Vog-Enga Sebastian, Physician Assistant, Seikwa Health Center

Screening services that are opportunistic, routine and community-based should be strengthened at PHC level to enable people living with NCDs to be detected and referred for treatment and benefit from follow-up care. By empowering health workers with the tools and skills to detect and treat NCDs and providing both technical and financial support for community-based screenings, WHO and its partners have worked to catalyse demand for improved NCD services at the district, health facility and community level. In parallel, the Norway NCD Flagship Initiative further supports national level action to develop robust governance, advocacy and financing for NCDs, and to effectively embed NCDs within the health information system and provide continuous support for monitoring impact.

The vision is to reduce the negative impacts of NCDs and ensure that there is access to equitable, comprehensive, affordable, and quality treatment and care.” - Dr John Otoo, Deputy Director for Public Health, Eastern Regional Health Directorate

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”