Alexis Travis, PhD

This month I had the opportunity to travel back to Ghana to celebrate my Grandmother’s 100th Birthday. As a first-generation Brit with Ghanaian immigrant parents, I spent many summers in Ghana visiting family. It had been 12 years since I last visited the country and a lot has changed! The roads have improved, there are more street lights (including solar powered lamps), universal primary education has been established, tourism is booming and there are even some malls. However, what I have always loved most about Ghana is the people and by and large they are still the same joyous people that I am so fond of. This was also the first trip that I have taken to Ghana since I started practicing public health in the United States. Living in the City of Worcester, Massachusetts, which has a large Ghanaian community, I have been able to work on projects with Ghanaians to address health concerns in the community. So, of course I was intrigued to learn more about health in Ghana and what issues we can address in the Ghanaian immigrant community back in the U.S.

I was fortunate to be able to meet with Professor Richard M.K. Adanu, family friend and Dean of the University of Ghana School of Public Health. Admittedly, I had a very ambitious agenda for a 1-hour meeting, but I was optimistic. In 2003 the National Health Insurance Scheme (NHIS) was established through the National Health Insurance Act, which covers 10.5 million Ghanaians today (NHIA, 2017). As a strong advocate for access to care, I believe the beauty of public health in Ghana is the NHIS, a system that has been described as the most sophisticated universal healthcare system in Africa by people such a Bill Gates.

Here are some of my key takeaways;

Coverage isn’t where it needs to be - NHIS is a good program, which allows access to care including in-patient, out-patient, oral health, maternity and emergency care. However, there are gaps in coverage including HIV anti-retroviral drugs which are currently exempt and there are several issues with reimbursement rates which do not fully cover the cost of service. This results in additional charges, which are a burden for the patient and slow reimbursement and payment of providers. That being said, the system does what it was designed to do, which is remove payment at the point of service for minimum services.

NCDs are increasing – Non-communicable diseases such as Hypertension and diabetes are on the rise. In addition, 7% of women and 2% of men are classified as obese in Ghana. This could be due, in part to lifestyle factors including culture sedentary lifestyle, dietary habits, and differences between male and female activity due to work.

Maternal child health is a priority - Ghana participated in the United Nation’s Millennium Development Goals (MDGs) and adopted 8 goals that were addressed between 2000 and 2013. Of these goals several pertain to maternal and child health including reducing infant mortality and improving maternal health. Although Ghana did not reach its goal for reducing the Maternal Mortality Ratio (MMR), the maternal mortality rate has fallen by 50% between 1990 to 2013. The current MMR is 380 maternal deaths per 100,000 live births. This can be attributed many initiatives including training midwives.

Tobacco control is in place, but smoking isn’t a major concern - Ghana’s latest public health act was passed in 2012 and covers communicable disease, vaccines, quarantine, vector control, environmental sanitation, tobacco control measures, food and drugs, and clinical trials (Parliament of the Republic of Ghana, 2012). Smoking is banned in public places and a complaint line has been established for anyone who wants to report violations. However, there isn’t a smoking quit line because smoking is more of a social activity, seen in settings like night clubs. There is a focus on public health and a great sense of social responsibility in Ghana. This conversation was just the beginning of my journey into global health and I am looking forward to working on collaborative projects moving forward. People working with the Ghanaian immigrant community (and indeed any immigrant communities) would benefit from learning more about the challenges at home. Mental health is a big concern, due to stigma and an insufficient number of mental health providers many Ghanaians suffer in silence or are not able to get the care they need. Additionally, the absence of primary prevention in Ghana has affected how people access care and when, so setting new behavioral norms around health can only be done within the context of culture and health literacy must be considered.

References:

Parliament of the Republic of Ghana (2012). Public Health Act, 2012. Retrieved from www.moh.gov.gh/wp-content/uploads/2016/02/Public-Health-Act-851.pdf

National Health Insurance Authority (2017). NHIS Review. Retrieve from www.nhis.gov.gh/nhisreview.aspx

United Nations in Ghana (2017). Millennium Development Goals. Retrieved From http://gh.one.un.org/content/unct/ghana/en/home/global-agenda-in-ghana/millennium-development-g

Alexis Travis, PhD

Lansing, Michigan, United States 4K followers 500+ connections

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Michigan State University

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