Malaria is endemic and perennial in Ghana, with pronounced seasonal variations in the northern part of the country. The length of malaria transmission varies by geographic region in Ghana, depending on the length of the dry season (December to March), during which there is little transmission.
There are two distinct rainy seasons in the southern and middle parts of the country, from April to June and September to November. The North, however, is characterized by one rainfall season that begins in May, peaks in August, and lasts until September. There is a six to seven month transmission season in a larger part of the north of the country and a shorter three to four month transmission season in the upper part of the north, with the highest number of cases occurring between July and November.
In the southern part of Ghana, the transmission season is nine months or more, with a small peak from May to June and a larger peak from October to November. Although Ghana’s entire population is at risk of malaria infection, children under five years of age and pregnant women are at higher risk of severe illness due to lowered immunity.
With 2.1% of global malaria cases and deaths, and 1.9% of global malaria deaths, Ghana is among the 15 highest burden malaria countries in the world. It accounts for 4.3% of malaria cases in West Africa Between 2017–2020, however, Ghana made significant progress in malaria control – cases decreased by 19% (from 201 cases per 1000 of the population at risk to 163 cases) – although deaths remained similar at 0.39 per 1000 of the population at risk over the same period.  To reduce the burden of malaria in the country, the high burden, high impact approach was introduced in Ghana in November 2019.
Access to insecticide-treated nets (ITNs) increased steadily from 30% in 2008 to 67% in 2019. ITN use has not increased as rapidly, however, from 21% in 2008 to 43% in 2019. The ratio of ITN use:access is between 0.4 and 0.6 in most of the country, with lower values in urban/peri-urban areas. Per the 2019 Malaria Indicator Survey (MIS), ITN use:access ratio is 0.47 in urban areas and 0.77 in rural areas. During the 2018 mass campaign, many individuals in urban settings either refused to register or did not redeem their nets after registration. The commonly cited reasons were that they are not able to hang rectangular nets in their rooms and they prefer other methods of mosquito control (e.g., use of mosquito sprays). This informed the National Malaria Control Programme’s (NMCP’s) decision to reduce the ITNs needed for urban settings for the 2021 mass campaign.
ITN use among children under five years of age and pregnant women has followed the same trend as that of the general population in Ghana. ITN use among children under five has increased from 22 percent in 2006 to 54 percent in 2019 while use among pregnant women increased from 20 percent in 2008 to 49 percent in 2019. 
Ghana’s strategy for drug-based prevention includes both nationwide intermittent preventive treatment in pregnancy (IPTp) for the prevention of malaria during pregnancy and Seasonal Malaria Chemoprevention (SMC) targeting treatment of children under five years of age with SPAQ.
Ghana has achieved the highest rate of two doses of IPTp(2) for pregnant women in sub-Saharan Africa – 78% in 2016 and 80.2% in 2019 [2,6]. The percentage of pregnant women receiving the third dose of IPTp (IPTp3) also increased from 39% to 60% between 2014 and 2016, and to 61% in 2019. 
Following the positive impact of SMC on severe malaria (protective efficacy of 48% in the Upper West Region), the program was expanded to the Upper East region and was extended to a further 23 districts in the Northern region in 2019.  In 2021, the National Malaria Control Programme (NMCP) will expand SMC to Oti region to achieve coverage of all SMC-eligible regions in Ghana .
Facility-based case management
The Guidelines for Case Management of Malaria in Ghana (March 2020) describe the overall approach to diagnosis and treatment of malaria in Ghana.
There are four levels of the health system where malaria is diagnosed and managed: 
- Community level: households, licensed chemical sellers, community-based agents, and volunteers
- Primary health facility level: CHPS compounds, health centers, private clinics and pharmacies, polyclinics, and similar institutions
- Secondary health facility level: district hospitals
- Tertiary health facility level: regional hospitals and teaching hospitals
When severe malaria is identified, parenteral treatment – intravenous (IV) or intramuscular (IM) medication – or rectal artesunate should begin promptly, and severe malaria cases should be referred immediately to a hospital after instituting pre-referral management.
The following are included as pre-referral management: IM artesunate, IM artemether, or IM quinine. Rectal artesunate can be given to children less than 6 years of age. In a hospital setting, the order of preference of treatment is: IV/IM artesunate, IM artemether, and IV/IM quinine. 
Data from the drug efficacy sites in 2019 indicates that the recommended first line antimalarials continue to be efficacious.
Community Health Planning and Services (CHPS) and integrated Community Case Management (iCCM)
The Community Health Planning and Services (CHPS) programme is funded by the Government of Ghana, with Global Fund support for artemisinin-based combination therapies (ACTs) and rapid diagnostic tests (RDTs). The services offered include, home visits, integrated outreach services for growth promotion, immunisation, family planning, community-based disease surveillance and response system and community durbars.  The government planned to expand coverage from 4,400 functional CHPS zones to 6,548 by 2020 (DHIMS Analysis).
A major component of the CHPS strategy is that traditional community leaders must accept the concept and commit to supporting it. Malaria treatment is included in the Community Health Planning Services. Services provided by accredited CHPS are free for those having an active national insurance card.
Community Health Officers (CHOs), who are selected by the community , implement Ghana’s Integrated Community Case Management (iCCM) model through home visits for service delivery in their catchment area.
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. It also plans to procure all its ACTs without international funding (donor support), beginning in 2020.
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. 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.
Severe malaria policy and practice
|Malaria in pregnancy|
|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.
Severe malaria commodity needs
Total artesunate injection needs – forecasts
- 2021 – 849,604 vials
- 2022 – 859,715 vials
Artesunate rectal capsules (ARC) needs (100mg)
- 2021 – 16,797
- 2022 – 16,997