Global Health

Ghana has made considerable progress in key health indicators over the past two decades. Between 2007 and 2017, under-five mortality decreased by 37% from 82 to 52 deaths per 1,000 live births, with pregnancy-related maternal mortality decreasing by 24% from 451 to 343 per 100,000 live births. Ghana’s malaria prevalence in children under five decreased significantly from 21% in 2016 to 14% in 2019. 

However, regional disparities persist, as northern Ghana lags in critical health outcomes, including under-five malnutrition and severe anemia, higher levels of child mortality, and lower coverage of basic health services. Limited access to improved water sources and widespread open defecation remain significant challenges in many rural communities, particularly in the northern regions. Low contraceptive prevalence throughout the country (25% use of modern methods by married women) and high fertility rates in the north continue to negatively affect the health of mothers and children. HIV remains high within key populations - 4.6% for female sex workers and 18% for men who have sex with men. Although access to health services is reasonably high, service quality continues to be weak. 

Despite these challenges, the GoG remains committed to achieving universal health coverage by 2030, with a focus on primary health care, and USAID remains ready to support.

COVID-19 RESPONSE

Ghana confirmed its first case of COVID-19 on March 12, 2020. President Nana Akufo-Addo established a COVID-19 Coordination Unit and Emergency Operations Center (EOC) to coordinate the country’s response. The United States Government (USG) has played a critical role in supporting Ghana’s COVID-19 response by working hand in hand to strengthen the following areas:

• Case management and oxygen therapy
• Continuity of other essential health services
• Donation of COVID-19 vaccines
• Operational deployment of the vaccines
• Supply chain for COVID-19 vaccine delivery
• Pharmacovigilance to monitor adverse events of the vaccines
• Social and behavior change to develop and disseminate messages for COVID-19 prevention and demand generation for the uptake of vaccines. 

The USG has donated four Pressure Swing Adsorption oxygen generating plants to the GoG, in addition to 28 high-flow, high-pressure oxygen concentrators to healthcare facilities across Ghana’s 16 regions. The USG has also supported Ghana’s COVID-19 national case management team to train clinicians in COVID-19 critical, severe, moderate, and mild case management and oxygen therapy, using a combination of didactic methods and clinical rounds. As of April 7, the USG has donated 9,605,158 COVID-19 vaccine doses to the GoG and is providing operational support to Ghana to achieve its goal of vaccinating 20 million people by June 2022. 

REPRODUCTIVE, MATERNAL, NEWBORN, AND CHILD HEALTH

USAID partners with the Ghana Health Service (GHS) to improve maternal, newborn, and child health services. Assistance focuses on building health workers’ competencies to provide quality and comprehensive Maternal, Newborn, and Child Health (MNCH) services, enabling GHS to: 

• Build the capacity of midwives to improve and institutionalize newborn care, care for small and sick newborns, and Emergency Obstetric and Newborn Care (EmONC).
• Deliver a comprehensive method mix of family planning contraceptives, including long-acting reversible contraceptives. 

In 2021, USAID, through a local social marketing organization, expanded knowledge and use of chlorhexidine gel to prevent neonatal sepsis through provider outreach and social marketing approaches to new mothers and distributed 209,104 units of the gel to retail outlets throughout Ghana.

NUTRITION

As part of the USG’s Global Health and Feed the Future Initiatives, USAID partners with the GoG, through on-budget support, to improve the nutritional status of women and children under five. The flagship activity, Resilience in Northern Ghana II (RING II), is designed to sustain improvements in the delivery of services that promote the nutrition and resilience of vulnerable populations in northern Ghana. RING II builds government capacity to plan, finance, and deliver local services and empowers citizens to participate in the improvement of the delivery of social sector services. Other multi sectoral interventions include:

• Supporting community services to treat and prevent severe acute malnutrition.
• Improving cultivation and consumption of nutritious foods.
• Promoting behaviors to improve young child feeding, anemia prevention and management, and dietary diversity.
• Ensuring vulnerable citizens have access to social services.

A USAID study found that between 2015 and 2019, in USAID-supported districts in the Northern, Savannah, and North East regions, the proportion of children consuming a minimum acceptable diet increased from 10 percent to 65 percent.

MALARIA

USAID, in partnership with the Centers for Disease Control and Prevention, leads the United States President’s Malaria Initiative (PMI) to scale up proven malaria prevention and treatment measures. PMI supports the GoG’s National Malaria Control Program to strengthen its capacity in designing, implementing, and monitoring malaria control interventions, tailored to specific regional and district malaria needs. PMI supports the following high impact interventions in Ghana: 

• Procurement and distribution of bednets 
• Indoor residual spraying 
• Seasonal malaria chemoprevention 
• Intermittent preventive treatment for pregnant women, and diagnosis 
• Treatment of malaria with efficacious drugs

PMI supports Ghana’s health system through supply chain strengthening and improvement of the District Health Information Management System to ensure quality, timely, and complete malaria data reporting. Ghana has one of the highest rates of intermittent preventive treatment among pregnant women in Sub-Saharan Africa (78%), and the country records over 80% of malaria laboratory confirmation before the administration of malaria treatment. Routine health data shows that malaria deaths fell by 88.5%, from 2,072 in 2015 to 238 deaths in 2021. 

HIV/AIDS

The USG’s President’s Emergency Plan for AIDS Relief (PEPFAR) Initiative in Ghana works closely with the Ghana AIDS Commission, the Ghana Health Service’s National AIDS Control Programme, and civil society organizations to achieve objectives outlined in Ghana’s HIV and AIDS Strategic Plan 2021-2025. USAID focuses on:

• Improving direct service delivery toward epidemic control in the Western, Western North, and Ahafo Regions.
• Supporting effective and sustainable case finding, treatment initiation, and continuity of treatment, plus viral load suppression toward achieving the PEPFAR and UNAIDS 95-95-95 goals.

In the past two years, PEPFAR support has been key in promoting Multi-Month Dispensing of antiretrovirals, currently at 73% of total prescriptions; ensuring 93% of persons transitioned to the improved WHO Tenofovir, Lamivudine, and Dolutegravir (TLD) line of treatment; and piloting the use of Pre-Exposure Prophylaxis and HIV self-testing. In 2021, 4,349 persons were identified as HIV positive, 4,134 (95%) were linked to treatment, and our technical assistance helped maintain approximately 29,000 people on treatment in the Western, Western North, and Ahafo regions by the end of 2021.

HEALTH SYSTEMS STRENGTHENING

USAID supports the Ministry of Health to strengthen the overall national health care system and policy environment. USAID invests in sustainable supervision structures to ensure that a high quality of care is provided at all levels of Ghana’s health system. USAID also: 

• Assists with health financing, operations research and data for decision-making, leadership enhancement, health workforce development, supply chain reform, service delivery models, and management systems at decentralized levels of the sector. 
• Works closely with the private sector, including the Ghana Social Marketing Foundationand Total Family Health Organization, to improve access to affordable, life-saving health commodities.

USAID has supported the GoG to operationalize the Ghana Integrated Logistics Management Information System in 1,508 sites to date in order to streamline the real-time tracking and forecasting of health supplies and commodities at all levels of the health system. 

SOCIAL PROTECTION

USAID partners with UNICEF to support the Ministry of Gender, Children and Social Protection (MoGCSP) to strengthen social protection and welfare systems for improved health outcomes of marginalized women and children. USAID supported the MoGCSP to:

• Pilot cash transfers to poor households with pregnant women and infants through the GoG’s Livelihood Empowerment Against Poverty (LEAP) program with the aim to improve the nutrition of infants during the crucial first 1,000 days of life when the consequences of malnutrition are particularly severe.

The successful pilot prompted the GoG to change its eligibility criteria, enabling the program to reach pregnant women and infants nationwide. A government-to-government agreement with the MoGCSP between 2016 - 2021 resulted in key reforms in the foster care system in Ghana to promote family-based care rather than institutionalization.