1. Communicable and Noncommunicable Diseases

1.1. HIV, Tuberculosis and Hepatitis 

1.1.1 Accelerating progress towards pediatric HIV and TB targets including triple elimination of mother to child transmission 

WHO supported Ghana to develop a pediatric DTG transition plan based on which funds and logistics were mobilized from the Global Fund and PEPFAR for implementation. As of December 2023, 78% of children living with HIV on ART were on the optimal pediatric DTG with viral suppression in children improved to 70% compared to below 50% before the pediatric DTG transition.

1.1.2 Resource mobilization to END HIV, Hepatitis and TB in Ghana 

The technical leadership of WHO in close collaboration with the JUTA and other partners enabled the country to receive over 240 million dollars for ending HIV, Malaria, TB and strengthening health systems in Ghana through the global fund GC7 grant. The support began by generating critical evidence to guide the grant application through program reviews for HIV, TB and Malaria. The WHO-led reviews mobilized over 20 international experts for an in-country mission from various partners including UNAIDS, L’initiative and the STOPTB partnership. The review also included a rapid assessment of the Hepatitis program in Ghana. The results and recommendations from the program reviews formed the foundation for prioritization of interventions for the successful grant application. WHO leadership and technical support continued for the grant writing process beginning with presentations to the CCM. The country coordinating mechanism (CCM) was supported to develop a comprehensive plan which included the identification of technical assistance needs for the grant application developed through broad stakeholder engagements. The leadership of WHO was essential for ensuring an open and transparent country dialogue including playing the role of the neutral arbitrator for very complex conflicts that arose during the prioritization of interventions for the grant application. In the end, the country’s grant application was fully approved by the global fund board and judged as technically sound and positioned to end the three epidemics of HIV, TB and Malaria while building a strong and resilient health system.

1.1.3 HIV prevention services for key Populations including the expansion of HIV prevention services to Persons who inject drugs 

With the technical support of WHO, the country was through the Ghana AIDS commission, National AIDS Control Program and the West African Program to Combat AIDS (WAPCAS) explored HIV prevention services to Person who Inject drugs (PWID) under a pilot project. A rapid situational analysis was conducted to inform the design and implementation of the pilot. The results and findings of the pilot informed the expansion of a PWID program in the Global Fund GC7 application.

1.1.4: Reducing Stigma and Discrimination for HIV, TB and Hepatitis Services 

Technical support was provided to the country to implement human rights, stigma and discrimination interventions for HIV and TB in the global fund NFM 3 grant. The interventions implemented mainly by civil society led organizations (CHAG and WAPCAS) included the capacity building of police officers, the use of peer paralegals to educate community members on the rights as well as pro-bono legal services to help address abuses against PLHIV and KPs. The national HIV program was also supported to integrate stigma reduction into training conducted for health care workers. In addition, support was provided for the inclusion of Human rights issues into community led monitoring activities and the resolution of identified issues.Technical support was also provided for the efficient expansion of human rights interventions under the Global Fund GC7 grant.

 1.1.9: Improving Civil Society and government collaboration for HIV, Hepatitis and TB response in Ghana 

The WHO continues to facilitate and support increased collaboration between civil society implementors and government for the HIV, TB and Hepatitis response. Through the technical support of WHO, civil society organizations under the leadership of the Christian Health Organization revised the community led monitoring for HIV structure in Ghana. The revised approach improved the engagement of government partners and decision makers, especially at the facility and district level in the use of findings from the community led monitoring. There is also ongoing support to the country to streamline the collection, analysis, and use of data from community led HIV and TB services. This will ensure there is improved acknowledgement of civil society’s contribution to the national progress.

1.2 Malaria and neglated tropical diseases

1.2.1 Comprehensive end term malaria program review and an elimination readiness assessment 

WHO provided technical assistance for a comprehensive end term malaria program review and an elimination readiness assessment using the WHO MEAT (Malaria Elimination Assessment Tool). The findings and information from the reviews was utilized for the development of the first National Strategic Plan for Malaria Elimination in Ghana. This strategic plan then formed the basis for the Global Fund application which was again supported by WHO.

 1.2.2: Strengthened surveillance for gambiense Human African Trypanosomiasis (g-HAT) 

There was joint monitoring, supervision, and capacity building for the 12 sentinel hospitals on g-HAT surveillance and elimination across the country. There has been no confirmed g HAT case since 2014. As an achievement, Ghana was validated for the Elimination of gambiense Human African Trypanosomiasis (g-HAT) as a Public Health Problem in 2023 bringing to three the number of NTDs eliminated or eradicated in the country. This major achievement has been due to the health leadership and technical assistance provided by the three level WHO.

1.3 Expanded Programme on Immunization (EPI)/ Vaccine Preventable Diseases Surveillance 

WHO support to the Ministry of Health and the Ghana Health Service facilitated the delivery of routine immunization services, ensured the deployment of COVID-19 vaccines to the highest priority groups, and implemented malaria vaccine deployment in 96 districts. Additionally, support was provided to strengthen surveillance of vaccine-preventable diseases, including sentinel surveillance for specific diseases.

1.4 Non-Communicable Diseases and Mental Health 

1.4.1 Diabetes Spotlight Event in Ghana 

In Ghana, the burden of noncommunicable diseases (NCDs) is rising rapidly, contributing to diminished health, productivity, and economic growth. Diabetes is one of the top five causes of NCD mortality in Ghana, accounting for over 7,300 deaths in 2019. Considering the rising burden of diabetes and the first-ever global coverage targets for diabetes adopted by WHO Member States in May 2022, WHO and the World Diabetes Foundation (WDF) proposed an integrative project in Ghana in partnership with the Ministry of Health (MoH) that promotes health systems strengthening and lays the groundwork for scaling-up priority interventions  for diabetes prevention and control. To foster commitments for the current WDF project and ensure alignment among key stakeholders, WHO Ghana in partnership with the Ministry of Health hosted a spotlight meeting on diabetes.

1.4.2 Conduct of first national STEPS Survey in Ghana

An effective national response to NCDs relies on robust evidence that demonstrates both the disease burden but also the prevalence of risk factors across populations. Such information can help inform policy decisions on sectoral reforms, allocation of scarce resources and the reorientation of health service delivery. Towards this end, the Government of Ghana with support from WHO implemented its first nationally representative NCD risk factor survey.

The objective of the survey was to better understand the prevalence of both behavioral (tobacco smoking, unhealthy diets, physical inactivity, harmful alcohol consumption) and metabolic (elevated blood pressure, fasting glucose, cholesterol, obesity), risk factors, with a view to strengthening the quality of national data on NCDs and inform policy reform across relevant sectors.

1.4.3 Ghana conducts a comprehensive needs assessment on the status of implementation for the protocol on illicit trade of tobacco and tobacco products 

Following Ghana’s ratification of the Protocol (in the year 2021), there was a need to assess the state of illicit tobacco trade and develop a roadmap for the implementation of the Protocol with support from the FCTC secretariat. The rationale behind the conduct of a needs assessment on the protocol with the requesting government, Ghana, was to:

• Identify the objectives to be accomplished under the Protocol
• Identify available resources for implementation
• Identify any gaps
• To establish a baseline of needs.

Preliminary recommendations based on result of various consultations were made to the Government of Ghana to strengthen the implementation of the Protocol and accelerate the full application of all its provisions.

 1.4.4 Empowering adolescents to lead change using health data 

The health and wellbeing of adolescents play a critical role in their overall growth and development. However, the lack of comprehensive local data on adolescent health, particularly in lower-resource settings hampers efforts to promote healthy behaviors and policies for adolescents, especially those in schools.

In Ghana, this initiative, which is being implemented in partnership with the Ghana Health Service and the Ghana Education Service has empowered adolescents in the Sekondi-Takoradi Metropolis to have a voice on their health needs and contribute to developing sustainable solutions towards overcoming health barriers.

In Sekondi-Takoradi/Ghana, the baseline surveys have been conducted from December 2022- February 2023 and photovoice in April 2023. The results from these baseline data were used in a data-to-action workshop in Sekondi-Takoradi from 25th – 27th April 2023.

1.5 Mental Health 1.5.1 WHO supports capacities for primary healthcare staff in mental health 

Improving the capacities of primary healthcare staff in mental health is important in making quality mental health care accessible. The WHO Special Initiative sought to provide quality mental health service to 5.2 million more Ghanaians by improving the competencies of primary health care staff to provide quality person-centered mental health service delivery in the country. The initiative’s focus was to strengthen the mental health services focusing on the newly created regions, namely Western North, Savannah, Oti and Ahafo. The initiative scaled-up quality interventions and services for people with mental health conditions, including substance use and neurological disorders using human rights approaches. At the end of 2023, through the initiative 1.2 million people had access to new mental health services, 5000 new cases mental health received services, 550 primary healthcare staff trained using mhGAP modules and 5000 people completed the Quality Rights e-training. The training’s beneficiaries were tasked with using existing structures to disseminate to other clinicians in their area of operations. Financial support for this activity was provided by Norad.

 1.5.2 Mental Health and Psychosocial Support for Teachers 

Responding to health emergencies requires a compressive approach involving health and non-health agencies. As part of the COVID-19 pandemic response, various agencies were oriented on basic mental health and psychosocial support. Primary health staff and teachers were trained to improve their own well-being and support pupils as well as community members to recover from the effects of the pandemic and build resilience.

2. Universal Health Coverage/Life Course

2.1 Health Financing/Economics 

Achieving the health system goals of improving health outcomes, providing financial risk protection, and increasing system responsiveness requires direct contributions from health financing and clear relationships to other health systems functions. As health care financing is at the heart of Ghana’s health sector governance, WHO in 2023 provided support to the Government in scaling up the capacity of the Ministry of Health, at all levels, to address health systems challenges.

 2.2 Human Resources for Health 

Ghana is taking a new look at its workforce challenges and prioritizing investment for better and smarter health workforce. In addressing the mismatches of supply, demand and need, Ghana will use strong scientific evidence to support the claims. The Health Labour Market Analysis (HLMA) is to provide evidence to inform decisions and interventions on the health workforce.

2.3 Strategic Health Information 

There has not been a working strategic document for Health Information Systems to guide the data collection systems, data analysis and enabling data use at all levels and in over 1600 budget management centers (BMCs). Ghana now has a working document Health Information Systems Strategy to provide such directions. The country bridged the gap on Health-Related SDG data availability from 64% as indicated by the Ghana WHO SCORE Assessments in 2018 to an estimated 90% (GHS Harmonized Health Facility Assessments dissemination 2023). It also strengthened and improved CRVSS by fully migrating to ICD11 to standardized data reporting for morbidity and mortality in over 700 hospitals as part of the WHA Resolutions in 2021.

 2.4 Quality and Safety 

Patient safety and Healthcare quality are essential elements in the provision of care prioritized by the government and driven at the high-level to guide all actions for ensuring Quality of care. An Essential Health Services Package (EHSP) that is in draft was developed to be harmonized with the insurance benefit package ensuring that the services that the country has determined as essential are covered by the health benefits package. The Ministry of Health, Ghana Health Service, Food and Drugs Authority (FDA), National Blood Service (NBS) and other agencies continue to face challenges in availability of quality and safe medical products including medical devices and blood and blood products for quality service delivery. Though the FDA is equipped to continuously assess and monitor medical products imported and locally manufactured in their role as a Maturity Level 3 NRA, gaps in regulatory capacity still exist. WHO’s support is continually needed for regulatory strengthening to ensure a safe healthcare system where medical products meet quality standards.

2.5 Fight Against Antimicrobial Resistance (AMR) 

Antimicrobial resistance (AMR) poses a risk to public health. AMR-related deaths accounted for 1.27 million globally, with 99 deaths per 100,000 persons from sub-Saharan African. In Ghana AMR was linked to 25300 deaths with E. Coli, Klebsiella, and Staph aureus among the top 5 pathogens implicated. This high burden is however not comparable to resources allocated to tackle AMR threat. Ghana is implementing policies and national action plan (NAP) on AMR. WHO in 2023 continued to provide financial, technical, strategic leadership, brokering, and coordinating successful key interventions in the NAP. Key among these included operational research capacity for local evidence-based decisions, the WHO Extended Spectrum Beta Lactamase E. coli tricycle surveillance, the AMR Multi Partners Trust Fund project (AMR MPTF), AMR data to GLASS, celebration of world AMR awareness week among others.

2.6 Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) 

The cumulative capacity of 1,011 health workers was built in the provision of quality of care for Reproductive, Maternal, Newborn, Child and Adolescent healthcare in line with WHO recommendations and standards. 346 national health insurance officers and health workers were trained in optimizing national health insurance claims processing for family planning services. Maternal Death Surveillance and Response (MDSR) guidelines was revised in line with WHO recommendations. Geriatric service standards and protocol were developed to provide guidance in the provision of care for elderly persons. Ten (10) electronic tablets bought for 10 schools to implement WHO Web-based platform.

3. Responding to Public Health Emergencies

3.1 Country prepared for health emergencies 

3.1.1 IHR Steering Committee and SPAR Reporting 

The World Health Organization supported the operationalization of the International Health Regulation Steering Committee (IHRSC) in collaboration with the International Health Regulation National Focal Point (IHR NFP). Multisectoral collaboration driven through the IHRSC enable the convening of meetings and assessment of Ghana’s capacities under the IHR. Consequently, Ghana’s report for the IHR States Parties Self-Assessment Annual Report (SPAR) for 2022 was concluded and submitted on time, contributing to the WHO AFRO’s attainment of 100% SPAR reporting. For the first time, the IHR SC developed an Annual operational Plan (AOP) for the National Action Plan for Health Security (NAPHS) to guide implementation and monitoring of prioritized activities for 2023

 3.1.2 Simulation Exercises to strengthened Health Security 

Under the International Health Regulations (2005) [IHR (2005)] Monitoring and Evaluation Framework, after action reviews (AAR) and simulation exercises (SimEx) are two critical components which measure the functionality of a country’s health emergency preparedness and response under a “real-life” event or simulated situation. The WHO supported a simulation training workshop for 11 regions (Ahafo, Bono, Central, Northeast, Upper East, Volta, Western North, Upper West, Eastern, Bono-East and Savannah) in Ghana.

3.2 Epidemics and pandemics prevented 

3.2.1 National Genomic Surveillance Strategy 

Genomic Surveillance plays a vital role in evidence-based decision-making by increasing our understanding of pathogens, their evolution and circulation. At the global level, WHO developed a global strategy for genomic surveillance of epidemic and pandemic-prone pathogens. At the country level, the EPR cluster supported the development of a contextualized strategy to promote, strengthen, and scale up genomic surveillance for pathogens with epidemic and pandemic potential for quality, timely, and appropriate public health actions. In collaboration with the Ministry of Health, WHO facilitated the formation of a multi-sectoral Technical Working Group (One Health Approach) and provided technical assistance in the development, review and validation of the strategy. The strategy has been finalized and is awaiting ministerial approval and launch. The strategy will shape genomic surveillance of priority diseases in the country.

3.2.2 National Infection Prevention and Control Strategy 

Infection Prevention and Control situation in healthcare settings highlights the level of quality of care and patient safety. Sub optimal adherence to IPC practices has been noted to be responsible for most Healthcare Associated Infections (HAIs). It is refreshing to note that up to 70% of HAIs can be prevented by scaling up an array of effective IPC interventions. Investing in IPC is one of the most effective and cost-saving interventions to ensure quality healthcare.

3.2.4 Risk Communication and Community Engagement 

Risk Communication and Community Engagement focuses on informing and engaging the public on how to reduce risks and better protect themselves. This is achieved by engaging with communities through two-way communication to ensure access to accurate, trusted and timely information. It empowers individuals, families and communities to make life-saving decisions. The WHO provided RCCE support to the country, particularly regarding COVID-19, routine vaccination, Anthrax disease and other health emergencies. SBCC materials including communication strategies, jingles, posters, leaflets, factsheets etc. on Oral Polio Vaccine Immunization, cholera, and Lassa Fever were developed.

 3.3 Health emergencies rapidly detected and responded to 

3.3.1 Lassa Fever Outbreak Response 

Ghana reported the Lassa Fever outbreak in February 2023. WHO provided technical support in Coordination, Surveillance, and medical countermeasures (case management, infection prevention and control, and mental health and psychosocial support).

3.3.2 Anthrax outbreak response 

A suspected outbreak of Anthrax in humans in Binduri District, Upper East Region was reported on the 1st of June 2023. WHO provided technical support in Coordination, Surveillance, and medical counter measures. Technical support was provided in the production of situation reports, contact monitoring, capacity-building in Infection Prevention and Control and risk communication.

 3.3.3 Flooding in the Volta Region 

In September 2023, the Volta River Authority, the operator of the Akosombo Dam, conducted a controlled spillage of the dam due to high inflows of water upstream which threatened its integrity. The spillage flooded about 184 communities in nine districts downstream. An estimated 35,857 persons were displaced as a result. The United Nations Country Team (UNCT) undertook a multi-sectoral rapid assessment which generated data which was leveraged to mobilize support to mitigate the impact of foods.

3.3.4 Ventilators to boost the health of people in Ghana 

WHO with financial support from the Government of Germany procured twelve (12) ventilators for the Ministry of Health which have been installed and are in use in intensive care units of five teaching hospitals (Korle Bu, Komfo Anokye, Cape Coast, Tamale) Holy Family and Upper West Regional hospital Wa across the country. These ventilators have contributed to strengthening the national capacity to provide critical care in these beneficiary facilities.

4 Healthier Population

4.1 Food safety and Nutrition 

4.1.1 Strengthening food safety emergency management 

As part of efforts to upgrade Ghana’s food safety core capacity for the International Health Regulations (IHR) from level 4 to 5, two main benchmarks were required – the availability of a surveillance system for the detection and monitoring of foodborne diseases and food contamination, and the existence of a functional mechanism for the response and management of food safety emergencies. In response, a desktop stimulation exercise of food safety events was conducted to assess and review the response, collaboration, and communication mechanisms of the Food Safety Emergency Response Plan (FoSERP).

 4.1.2 Promoting food safety in Ghana 

In Ghana, foodborne diseases such as Cholera, Typhoid fever, Dysentery and Viral Hepatitis pose a significant health burden for health authorities and the health system. These diseases may arise from exposure to contaminated food and unsafe water, heightened by poor hygiene, lower levels of literacy and education. As part of activities for the 2023 World Food Safety Day, the World Health Organization supported Ghana Food and Drugs Authority to conduct market activation in 5 regions to highlight the need to ensure healthier markets for food safety.

4.1.3 Revising Ghana’s Essential Nutrition Package 

Ghana’s UHC Roadmap has one of its objectives as ensuring access to quality nutrition services at the PHC level. Scaling up the Essential Nutrition Actions was identified as one of the key interventions to ensure universal access to nutrition services. Since 2014 Ghana has implemented the Seven Essential Nutrition Actions (ENA), however WHO updated guidance adopted the life course approach and proposes primary health care as the main platform for delivery of essential services. The life-course approach is proposed to tackle malnutrition in all its forms across the entire life-course. This necessitated the revision of Ghana Seven Essential Nutrition Actions (ENAs) package.

 4.2 Climate change 

4.2.1 Harmonizing climate change vulnerability and adaptation assessment in Ghana 

To strengthen the health sector’s response to climate change, there was need to review, validate and harmonize the results of existing assessment reports with the goal of updating current climate and health risks including facilitating acceptability and adoption of findings.

Through this support, there is improved understanding of the burden of prioritized climate sensitive health outcomes, health system capacity to respond to climate sensitive health outcomes including adaptation policies to address current and future risks. The finalized report will present evidence on adaptation options which will feed into the development of the health sector national adaptation plan for climate change. This is key to ensure adequate mainstreaming of climate change into health policy.

4.3 Water, Sanitation and Hygiene (WASH) 

4.3.1 Training of Trainers Workshop on Water, Sanitation and Hygiene Preparedness and Response on Cholera

Cholera is an acute infection caused by ingestion of food or water contaminated with fecal matter containing Vibrio cholera. A strong human response is key to the effective preparedness, response and management of cholera outbreaks. To further strengthen capacity, there is need to capacitate and have a pool of expertise that can support government response to cholera outbreaks.

 4.4.1 Supporting enabling environment for gender equality in health

An enabling environment for the health sector to identify and tackle gender-based health inequalities is key to leaving no one behind. Under the “Strengthening local and national Primary Health Care and Health Systems for the recovery and resilience of countries in the context of COVID-19” and Canadian Global Initiative for Vaccine Equity (CanGIVE) in Ghana, the WHO Ghana has been supporting the Ministry of Health and agencies to foster an environment for effective mainstreaming of gender in health policies and strategies, including capacity strengthening activities to implement gender responsive health services.

In collaboration with the Ministry of Health and Ghana Health Service, WHO supported the convening and facilitation of capacity building trainings to improve understanding on health inequalities and inequities in service access and quality.