INDEPTH Training and Research Centres of Excellence (INTREC) Ghana Country Report October, 2012 Sheila Addei 1 Yulia Blomstedt 2 Margaret Gyapong 1 Martin Bangha 3 Raman Preet 2 Karen Hofman 4 John Kinsman 2 1 Dodowa Health Research Centre, Dodowa, Ghana 2 Umeå Centre for Global Health Research, Epidemiology and Global Health, Dept. of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden 3 INDEPTH Network, Accra, Ghana 4 MRC/Wits Rural Public Health and Health Transitions Unit, University of Witwatersrand School of Public Health, Johannesburg, South Africa Correspondence to: [email protected] and [email protected] The INTREC Ghana Country Report by Sheila Addei, Yulia Blomstedt, Margaret Gyapong, Martin Bangha, Raman Preet, Karen Hofman, John Kinsman is licensed under a Creative Commons Attribution 3.0 Unported License. INTREC – Ghana Country Report TABLE OF CONTENTS List of Figures and Tables Abbreviations 1. Executive Summary . 1 2. Introduction . 7 3. Methods . 10 a) Ghana country context . 10 b) Curricular review . 10 c) Literature Review . 11 d) Stakeholder interviews . 12 4. Ghana country profile . 14 5. Review of SDH teaching curricula . 23 a) Institutions that offer SDH-related courses . 23 b) Summary of the available SDH-related courses . 24 c) Training gaps . 28 d) Internet availability for SDH education purposes . 29 6. SDH and health inequities in Ghana . 32 7. On-going work on SDH . 42 8. SDH-related policies in Ghana. 46 a) SDH-relevant policies within the health sector . 46 b) SDH-relevant policies outside the health sector . 47 c) Forthcoming policies relevant to SDH . 49 9. Findings from stakeholder interviews . 51 10. Conclusions and Recommendations . 58 References . 64 Acknowledgements . 69 Annex 1 – Courses related to SDH offered in Ghana . 70 Annex 2 – Ghana country needs for SDH . 89 Annex 3 – Ongoing work on SDH in Ghana . 105 Annex 4 – SDH policies and policy reviews in Ghana . 117 INTREC – Ghana Country Report LIST OF FIGURES AND TABLES Figure 1: Ghana and its bordering countries . 14 Figure 2: Ghana population pyramid . 15 Table 1: Disease specific age-standardized death rates for four main NCDs 19 Table 2: Behavioral risk factors for NVDs in Ghana . 20 Table 3: Metabolic risk factors for NVDs in Ghana . 20 Table 4: Alcohol abstinence in Ghana . 21 Table 5: Internet capacity in Ghana . 30 INTREC – Ghana Country Report ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome CHPS Community Based Health Planning and Services Zone CMLE Comprehensive medical and laboratory Examination CRS Catholic Relief Services CSO Civil Society Organization CVD Cardiovascular Disease DFID Department for International Development DHRC Dodowa Health Research Center GDP Gross domestic Product GIMPA Ghana Institute of Management and Public Administration GSGDA Ghana Shared Growth and Development Agenda GSS Ghana Statistical Service INGO International Non Governmental Organization INTREC INDEPTH Training and Research Centers of Excellence ITN Insecticide Treated Net KHRC Kintampo Health Research Center KNUST Kwame Nkrumah University of Science and Technology LEAP Livelihood Empowerment Against Poverty MDA Ministries, Departments and Agencies MMDA Metropolitan, Municipal and District Assemblies MOH Ministry of Health NCD Non Communicable Disease NDPC National Development Planning Commission NGO Non-Governmental Organization NHIS National Health Insurance Scheme SDH Social Determinants of Health SPH School of Public Health UCC University of Ghana UG University of Ghana UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization WVI World Vision International INTREC – Ghana Country Report 1. EXECUTIVE SUMMARY Introduction The WHO’s Commission on Social Determinants of Health argued in 2008 that the dramatic differences in health status that exist between and within countries are intimately linked with degrees of social disadvantage. These differences are unjust and avoidable, and it is the responsibility of governments, researchers, and civil society to work to reduce them. Part of this work requires the production of setting-specific, timely, and relevant evidence on the relationship between social determinants of health and health outcomes, and yet this information is limited, especially in low- and middle-income countries (LMICs). Thus there is a strong need for the development capacity-building activities to enable such research. INTREC has been established with this concern in mind. Its dual aims include (i) providing SDH- related training for INDEPTH researchers from Africa and Asia, thereby allowing the production of evidence on associations between SDH and health outcomes; and (ii) enabling the sharing of this information through facilitating links between researchers and decision makers, and by ensuring that research findings are presented to decision makers in an actionable, policy- relevant manner. This Ghana country report provides the baseline situation analysis for the Ghanaian component of INTREC. Specifically, the report addresses three primary areas of concern: 1. SDH-related training in Ghana, as a baseline for INTREC to build on 2. The core SDH issues of concern in the country 3. Ongoing SDH-related work in Ghana, both in terms of government policies and in terms of the efforts made non-governmental organizations The report ends with a series of recommendations for action, directed at government and NGOs, as well as at INTREC itself. Methods 1) Ghana country context Relevant databases pertaining to Ghana were defined via the internet. The internet search for data and material included keywords or acronyms, such as “Ghana”, “fact sheet”, “country information”, “World Bank”, “WHO” (World Health Organization). More specific key words or acronyms were employed for different sub-sections, including “demography”, “geography”, “MDGs” (Millennium Development Goals), “NCDs” (non-communicable diseases), “HIV/AIDS”, “tobacco”, etc. The data were then presented along with a commentary on the statistical patterns and public health challenges that the country faces. Furthermore, this section was 1 INTREC – Ghana Country Report complemented by the information about the epidemiologic studies conducted in Ghana by INDEPTH HDSS sites. 2) Curricular review A list of universities in Ghana was developed and their websites were then visited to see which SDH-related courses and programmes were offered. The details of these programmes were then sought either via internet or by direct contact with the respective institutes. Additionally, information on Ghana’s capacity for use of the internet in educative purposes has been assessed. 3) Literature and policy review The literature review was done through conducting searches on Google and Google scholar search engines as well as PubMed and Hinari search engines. The search was conducted using phrases like “social determinants of health” ,”Health Inequalities”, “Health Inequities” and “Determinants of Disease”. This was done to obtain relevant reports and documents that could provide information on SDH country needs, ongoing work on SDH in Ghana, and SDH-related policies and forthcoming policy reviews. Documents accessed included peer reviewed literature, some book chapters, donor reports, annual reports of various organizations and published and unpublished thesis as well as newspaper reports. In addition to this there was the opportunity to obtain further information on SDH-related policies from the Third Ghana Policy Fair, which was held at the Accra International Conference Centre from 16 to 21 April 2012. From this platform, and through interaction with officers present at the stands, policy documents and related information were obtained on relevant SDH-related policies in Ghana. 4) Interviews A total of twelve (12) In-depth interviews were conducted with professional stakeholders whose work relates to SDH in the following sectors: government ministries and departments within and outside the health sector, local and international NGOs, and development partners. The interviews were recorded with a digital audio recorder and transcribed by a transcriber. The transcripts were analyzed thematically. Various themes were drawn up based on the issues being explored. Codes were also formulated based on the issues. The transcripts were coded using derived codes. Coded issues were organized into a matrix taking into consideration the issue being addressed and the organization addressing the issue. The report was written based on the issues identified through the coding of each interview transcript, taking into consideration the issues as addressed across varied sectors where applicable. 2 INTREC – Ghana Country Report Results 1) In Ghana, the term “social determinants of health” is not widely used either in the work environment or in academic circles both within and outside the health sector. There is the need to create awareness about the term, as well as the recognition that addressing SDH will enable improvements in health equity. 2) With regards to training in the area of SDH, there are several SDH-related courses being offered in the School of Public health at the University of Ghana, as well in a few other institutions. Public health practitioners who are trained in these courses have a vital role to play in championing SDH approach to development, and therefore the relevance of SDH issues must be made explicit in their training. Since training in this area is currently limited, it is very