Ghana

Malaria burden

With 3% of global malaria cases and deaths, Ghana is among the 15 highest burden malaria countries in the world.  Ghana reported the highest increase in absolute case numbers, (500,000 new cases) from 2017 to 2018, which represents a 5% increase versus 2017 levels (from 213 to 224 per 1000 of the population at risk). In comparison to 2015 levels, cases rose by 3%, from 217 to 224 of the population at risk. Deaths, on the other hand, fell by 12%, from 0.42 to 0.37 per 1000 of the population at risk.1

To reduce the burden of malaria in the country, the high burden, high impact approach was introduced in Ghana in November 2019.2

Ghana achieved the highest rate of Intermittent Preventive Treatment in pregnancy (IPTp2) for pregnant women in sub-Saharan Africa (78 %).  The percentage of pregnant women receiving the third dose of IPTp also increased from 39% to 60% as noted in the 2016 national household survey.2

As a result of improved access to testing, the reported rates of malaria cases in children under five has gradually risen from 12% in 2016 to 33% in 2017.2 Although 73% of households own at least one ITN, usage rates were noted to be lower. For instance, net use among pregnant women and children under five is 52% and 50%, respectively.2

Following the positive impact of Seasonal Malaria Chemoprevention (SMC) on severe malaria (protective efficacy of 48% in the Upper West Region), the program was expanded to the Upper East region and is being extended to a further 23 districts in the Northern region in 2019.3,4 

Integrated Community Case Management (iCCM) and Community Health Planning and Services (CHPS)

The iCCM strategy corresponds to the lowest level of health care delivery in the country and is implemented via community-based agents (CBAs) selected by the community.2 

iCCM has been integrated into Community Health Planning and Services (CHPS) strategy. The government plans to expand coverage from 4,400 functional CHPS zones to 6,548 by 2020 (DHIMS Analysis).2

The CHPS strategy started in 1999 following a pilot phase conducted in 1994 in response to the principle of ‘Health for All’.3 A major component of the CHPS strategy is that traditional community leaders must accept the concept and commit to supporting it.3 Malaria treatment is included in the Community Health Planning Services.2 Services provided by accredited CHPS are free for those having an active national insurance card.2

Health funding

As of 2017, less than 25% of the country’s spending on health was from national resources. In accordance with its vision of “Ghana Beyond Aid”, the government aims to procure all malaria commodities with local funding.2 It also plans to procure all its ACTs without international funding (donor support), beginning in 2020.2 

The government also made a commitment to universal health coverage when it passed the law to establish the National Health Insurance Scheme (NHIS) at the end of 2003.5  As of 2017, the NHIS covered 45% of Ghana’s population. All necessary malaria services and medicines are covered at no cost to NHIS members.2

Inpatient and mortality rates

Photo: World Malaria Report 2018 Ghana country profile

Severe malaria distribution

Photo: World Malaria Report 2018 Ghana country profile

Malaria transmission rate by area (2012)

High infection area: Forest zone

  • Rural area: 269
  • Urban area: 13.5

Higher infection rate:

  • Higher rate in poorest households (52%) than the richest households (3%)
  • Higher rate in non-literate mothers (43%) than secondary education or higher (5%)

Seasonality of transmission:

  • Endemic and perennial in all parts
  • Highly seasonal malaria transmission in northern regions
  • 50-59% of clinical malaria cases occur during 4 months (July-October) in the Savannah regions: Northern, Upper East, Upper West regions

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong IV artesunate
Alternative IM artemether
Alternative IV quinine
Recommendation Pre-referral
Strong Rectal artesunate
Alternative IM artesunate
Alternative IM quinine
Alternative IM artemether
Malaria in pregnancy
Trimester Treatment
First IV or slow IM quinine
First alternative IV or IM artesunate
Second/third IV or IM artesunate

*First trimester: Avoid delay of treatment; if only one of the drugs artesunate, artemether or quinine is available, then it should be started immediately.

 

Sources of health financing

Photo: World Malaria Report 2018 Ghana country profile

Severe malaria commodity needs

  • 1,500,000 ampules of injectable artesunate (100 mg/1ml)
  • 100,000 rectal artesunate suppositories (Doses of 50mg and 200mg)
    • 100mg ERP approved suppositories are now recommended for use by the Expert Evaluation Committee of the Global Fund.