Ghana
Gastroenterology
MedCOI

July 2024

Manuscript completed in July 2024
Neither the European Union Agency for Asylum (EUAA) nor any person acting on behalf of the
EUAA is responsible for the use that might be made of the information contained within thispublication.
Luxembourg: Publications Office of the European Union, 2024
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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Acknowledgements
The EUAA acknowledges International SOS as the drafter of this report.
The report has been reviewed by International SOS and EUAA.

3

EUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements........................................................................................................................ 3
Disclaimer ........................................................................................................................................ 5
Glossary and abbreviations ........................................................................................................... 6
Introduction ..................................................................................................................................... 8
Methodology ......................................................................................................................................... 8
Terms of reference ..................................................................................................................... 8
Collecting information................................................................................................................ 8
Quality control .............................................................................................................................. 8
Sources ................................................................................................................................................... 9
1.

Incidence and prevalence of gastrointestinal diseases ............................................... 10
1.1. Gastroesophageal reflux disease (GERD)........................................................................... 10
1.2. Peptic ulcer ................................................................................................................................. 10
1.3. Inflammatory bowel disease (IBD) ......................................................................................... 11
1.4. Stomach cancer and colorectal cancer (CRC) .................................................................... 112.

Access to treatment ..........................................................................................................122.1. Insurance and national programmes ....................................................................................13

3.

Cost of treatment ..............................................................................................................13

4.

Cost of medication ............................................................................................................ 17

Annex 1: Bibliography ...................................................................................................................21
Oral sources, including anonymous sources ............................................................................. 21
Public sources..................................................................................................................................... 21
Annex 2: Terms of Reference (ToR) ............................................................................................ 23

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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Disclaimer
This report was written according to the EUAA COI Report Methodology (2023). The report isbased on publicly available sources of information, as well as oral anonymised sources whoare based in Ghana. All sources used are referenced.
The information contained in this report has been researched, evaluated and analysed withutmost care. However, this document does not claim to be exhaustive. If a particular event,person or organisation is not mentioned in the report, this does not mean that the event has
not taken place or that the person or organisation does not exist.
Furthermore, this report is not conclusive as to the determination or merit of any particularapplication for international protection. Terminology used should not be regarded asindicative of a particular legal position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal
sense as applied in the EU Asylum Acquis, the 1951 Refugee Convention and the 1967
Protocol relating to the Status of Refugees.
Neither the EUAA, nor any person acting on its behalf, may be held responsible for the use
which may be made of the information contained in this report.
On 19 January 2022 the European Asylum Support Office (EASO) became the European Union
Agency for Asylum (EUAA). All references to EASO, EASO products and bodies should beunderstood as references to the EUAA.
The drafting of this report was finalised on 27 March 2024. Any event taking place after thisdate is not included in this report. More information on the reference period for this report canbe found in the methodology section of the Introduction.

5

EUROPEAN UNION AGENCY FOR ASYLUMGlossary and abbreviations
Term

Definition

CEA

Carcinoembryonic Antigen

CHPS

Community-Based Health Planning and Services

CRC

Colorectal CancerCT

Computed Tomography

ERCP

Endoscopic Retrograde Cholangiopancreatography

FDA

Food and Drugs Authority

GDD

Gastro-Duodenal Disease

GERD

Gastroesophageal Reflux Disease

HDL

High-Density Lipoprotein

IBD

Inflammatory Bowel Disease

KATH

Komfo Anokye Teaching Hospital

KBTH

Korle Bu Teaching Hospital

KCl

Potassium ChlorideLDL

Low-Density Lipoprotein

MOH

Ministry of Health

MRI

Magnetic Resonance Imaging
6

GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

TermDefinition

NaCl

Sodium Chloride

NaHCO₃

Sodium Bicarbonate

NHIS

National Health Insurance Scheme

PET

Positron-Emission Tomography

PHC

Primary Healthcare

PPI

Proton Pump Inhibitor

PUD

Peptic Ulcer Disease

TNF

Tumour Necrosis Factor

7

EUROPEAN UNION AGENCY FOR ASYLUM

Introduction
Methodology
The purpose of the report is to provide information on access to gastrointestinal diseases
treatment in Ghana. This information is relevant to the application of international protection
status determination (refugee status and subsidiary protection) and migration legislation in
EU+ countries.

Terms of reference
The terms of reference for this Medical Country of Origin Information Report were developedby EUAA.
The terms of reference for this Medical Country of Origin Information Report can be found in
Annex 2: Terms of Reference (ToR). The initial drafting period was finalised on 9 November
2023, peer review occurred between 10 November – 22 December 2023, and additional
information was added to the report as a result of the quality review process during the review
implementation up until 27 March 2024. The report was internally reviewed subsequently.

Collecting information
EUAA contracted International SOS (Intl.SOS) to manage the report delivery including datacollection. Intl.SOS recruited and managed a local consultant to write the report and a publichealth expert to edit the report. These were selected from Intl.SOS’ existing pool ofconsultants. The consultant was selected based on their experience in leading comparable
projects and their experience of working on public health issues in Ghana.
This report is based on publicly available information in electronic and paper-based sources
gathered through desk-based research. This report also contains information from multiple
oral sources with ground-level knowledge of the healthcare situation in Ghana who wereinterviewed specifically for this report. For security reasons, all oral sources are anonymised.

Quality control
This report was written by Intl.SOS in line with the European Union Agency for Asylum (EUAA)
COI Report Methodology (2023), 1 the EUAA Country of Origin Information (COI) Reports
Writing and Referencing Guide (2023) 2 and the EUAA Writing Guide (2022). 3 Quality control of
the report was carried out both on content and form. Form and content were reviewed by
Intl.SOS and EUAA.

EUAA, Country of Origin Information (COI) Report Methodology, February 2023, url
EUAA, Country of Origin Information (COI) Reports Writing and Referencing Guide, February 2023, url
3
EUAA, The EUAA Writing Guide, April 2022, url
12

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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

The accuracy of information included in the report was reviewed, to the extent possible,
based on the quality of the sources and citations provided by the consultants. All thecomments from reviewers were reviewed and were implemented to the extent possible, undertime constraints.

Sources
In accordance with EUAA COI methodology, a range of different published sources have been
consulted on relevant topics for this report. These include governmental and academic
publications. All sources that are used in this report are outlined in Annex 1: Bibliography.
Key informant interviews were carried out in September 2023. Interviews were conducted
mainly with officers who work within organisations of Ghana’s healthcare system. A complete
anonymised list of interviewees can be found in the Annex 1: Bibliography.

9EUROPEAN UNION AGENCY FOR ASYLUM

1.

Incidence and prevalence ofgastrointestinal diseases

Gastroenterology is a medical speciality that focuses on the digestive system andits disorders. This report looks at the management of gastrointestinal diseases in Ghana withrespect to the following conditions: gastroesophageal reflux disease (GERD), peptic ulcer,
inflammatory bowel disease (IBD), stomach cancer and colorectal cancer (CRC).

1.1.

Gastroesophageal reflux disease (GERD)

Between 1990 and 2017, the age-standardised prevalence of gastroesophageal reflux disease(GERD) per 100 000 population decreased marginally from 9 974.1 to 9 971.5. 4

1.2.

Peptic ulcer

There is a lack of cohort studies drawn from the general population, making accurate
evaluation of incidence of gastro-duodenal disease (GDD) in Africa elusive.5 The agestandardised prevalence rate estimated for peptic ulcer disease (PUD) (globally) in 2019
ranged from 15.19 to 330.32 per 100 000 population; for Ghana it was much lower, ranging
from 0.43 to 1.26. 6
In Ghana, Komfo-Anokye Teaching Hospital (KATH), Kumasi, which serves the central-northern
regions, has a lower incidence of PUD in comparison with Korle Bu Teaching Hospital (KBTH),
Accra, which serves the southern regions of Ghana, (Accra: 19.6 % vs Kumasi: 3 %). 7
A study in Ghana found that the mean age of patients with GDD (which includes PUD) was 51.4
years, with a median age of 52 years and a range of 15 to 95 years. 8

4
GBD 2017 Gastro-oesophageal Reflux Disease Collaborators, The global, regional, and national burden ofgastrooesophageal reflux disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global
Burden of Disease Study 2017, June 2020, url, p. 573
5Archampong, T. N., et al., Gastro-duodenal disease in Africa: Literature review and clinical data from Accra,
Ghanal, url, p. 3352
6
Xie, X., et al., The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a populationbased study, February 2022, url, p. 6
7
Archampong, T. N., et al., Gastro-duodenal disease in Africa: Literature review and clinical data from Accra,
Ghanal, url, p. 3347
8
Archampong, T. N. A., et al., Factors associated with gastro-duodenal disease in patients undergoing upper GI
endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana, June 2016, url, p. 613

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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

1.3.

Inflammatory bowel disease (IBD)

The community prevalence of inflammatory bowel disease (IBD) in Ghana is not known. 9 In
Ghana, consistently more males than females are affected with IBD. The age cohort
prevalence was fairly even across all age cohorts within the period 1997 to 2004, but now
over the period 2004 to 2011, 39.3 % and 25 % are found in the age group 20 to 30 and 31 to
40 years, respectively, with the rest of the case fairly evenly spread across the other age
cohorts.10 Although relatively uncommon, IBD incidence rose by 65 % over the period 1997 to
2004 and 2004 to 2011. 11 Non-specific chronic colitis, ulcerative colitis and Crohns’ diseaseaccount for 50 %, 42.9 % and 7.1 %, respectively, of diagnosed IBD. 12

1.4.

Stomach cancer and colorectal cancer (CRC)

Stomach cancers in Ghana is among the most prevalent new gastrointestinal cancers
recorded in the year 2020. 13 Stomach cancers are more prevalent in males than females in
Ghana.14
There are varying prevalence or incidence rates for colorectal cancer (CRC) depending on the
study referenced. The number of new cases of CRC has increased: in the 1960s, there were
4.1 new cases each year; 15 a study of confirmed cases of colorectal cancer diagnosed
between January 1997 and December 2007 in Accra, found an annual incidence of 32.6 newcases and a crude incidence rate of 11.18 per 100 000 over this 11-year span. Over the sametime period, the crude incidence rates per 100 000 were found to differ between males (12.53)
and females (9.87). 16
A study published in 2017 found that the overall crude annual incidence of CRC at a teaching
hospital in Kumasi, Ghana, was 4.62 per 100 000 populations. 17

CGKII101, Consultant Gastroenterologist, Interview, September 2023
Archampong, T. N. A. and Nkrumah, K. N., Inflammatory bowel disease in Accra: what new trends?, 2013, url, p. 44
11
Archampong, T. N. A. and Nkrumah, K. N., Inflammatory bowel disease in Accra: what new trends?, 2013, url, p. 40
12Archampong, T. N. A. and Nkrumah, K. N., Inflammatory bowel disease in Accra: what new trends?, 2013, url, p. 42
13
Boi-Dsane, N. A. A., et al., Cross-Sectional Study for Investigation of the Association Between Modifiable Risk
Factors and Gastrointestinal Cancers at a Tertiary Hospital in Ghana, March 2023, url, p. 8
14
Boi-Dsane, N. A. A., et al., Cross-Sectional Study for Investigation of the Association Between Modifiable Risk
Factors and Gastrointestinal Cancers at a Tertiary Hospital in Ghana, March 2023, url, p. 2
15
Agyemang-Yeboah, F., et al., Colorectal cancer survival rates in Ghana: A retrospective hospital-based study,
December 2019, url, p. 2
16
Dakubo, J.C, et al., Colorectal carcinoma: an update of current trends in Accra, 2010, url, p. 179
17
Agyemang-Yeboah, F., et al., Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital
Kumasi, Ghana, October 2017, url, p. 2
9

10

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EUROPEAN UNION AGENCY FOR ASYLUM

The studies in Ghana have shown that there is a significant difference in the survival rate of
CRC according to the different stages. 18 The median survival time was 15 months. The overall
survival rate for CRC over the five-year period was 16 %. This indicates that 16 % of patientswith CRC were alive after five years. 19

2.

Access to treatment

Ghana has a pluralistic health sector in terms of ownership (public and private) and in terms ofhealthcare models (orthodox, traditional and alternative medicine). 20 Healthcare services areprovided by the public sector, as well as by private sector service providers made up of forprofit providers and non-profit faith-based health facilities. 21 The health system is organised inthree levels: the primary level, with a focus on primary healthcare (PHC) services, includes thecommunity-based health planning and services (CHPS) compound, the sub-district healthcentre/clinic and the district hospital. The secondary and tertiary levels have regional andteaching hospitals, respectively. 22
Public and private facilities, at all levels of the health system, can provide care within limits set
by the Standard Treatment Guidelines 2017. 23 The primary level of care has the capacity toidentify and make differential diagnosis of some of the conditions. This capacity is mostly at
the district hospital level where they can more definitively diagnose, commence basic careand may refer the patient to the appropriate secondary or tertiary facility for definitive casemanagement. All patients can access care at the nearest point of service to them at any levelof the health system. Based on the severity of the condition and the capacity of the point ofservice to manage the condition, care will be continued, or the patient will be referred to thenext higher level of care for further appropriate case management. Patients can however walk
into any emergency room in any secondary or tertiary facility and will be attended to. 24
Treatment is geographically accessible in all the regions but more so in urban towns. This is
primarily because of the presence of secondary and/or tertiary facilities, providing better
access to specialist services compared to rural areas. There are no restrictions to patients’
access to treatment; everyone has access to all services that are available at all levels of thehealth system. In general, the most significant barriers to treatment access for all theconditions include unavailability of the treatment needed, which is limited by the level of care
at which it is sought and the staff expertise available, and inability to pay for the care available.
Here, patients who have registered with the National Health Insurance Scheme (NHIS) or
private medical insurance schemes will have their cost of care (either inpatient or outpatient)
Agyemang-Yeboah, F., et al., Colorectal cancer survival rates in Ghana: A retrospective hospital-based study,
December 2019, url, p. 1
19
Agyemang-Yeboah, F., et al., Colorectal cancer survival rates in Ghana: A retrospective hospital-based study,
December 2019, url, p. 1
20
Ghana, MOH, National Health Policy: Ensuring healthy lives for all (Revised Edition), January 2020, url, p. 23
21
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
22
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
23
Ghana, MOH, GNDP, Standard Treatment Guidelines, Seventh Edition, 2017, url, pp. 22-27
24
CGKII101, Consultant Gastroenterologist, Interview, September 2023
18

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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

covered, as determined by their insurance package, while those without any form of insurance
will have to pay out of pocket for these services. Private health insurance schemes provide a
better coverage in terms of services that will be paid for and cost of services than the NHIS.25
The available treatment options for PUD and GERD in Ghana include proton pump inhibitors(PPI), lifestyle and dietary changes, and surgery (in severe cases); for stomach cancer and
CRC, the available treatment options include surgery, chemotherapy, adjuvant therapy, andscreening; and for IBD, the available treatment options include medications, surgery, andlifestyle and dietary changes. 26
Currently, in Ghana, there are endoscopic services in tertiary medical centres but not at mostregional or district hospitals. 27

2.1.

Insurance and national programmes

The public NHIS and private health insurance schemes cover both inpatient and outpatient
cost of care to different degrees, with the private schemes generally providing more coverthan the NHIS. 28 The NHIS covers the consultation fees for all general and specialist clinic
attendances, as well as hospital admission (bed and feeding) are covered. A limited number oflaboratory tests are covered but the cost of specialised laboratory and diagnostic imaging
investigations and treatment are not covered by the NHIS and must be paid for by private
insurance schemes or out of pocket. 29
As of 2019, the NHIS had a membership of over 12 million Ghanaian. 30 The NHIS is available
for registration to all individuals living in Ghana. 31

3.

Cost of treatment

The cost of treatment in the public sector is primarily regulated by the NHIS. The NHIS tariffs
are expected to be the official fees and charges in public facilities. This is often not adhered tobecause the insurance tariffs are below the market prices. Facilities, mainly the teaching
hospitals, will go on to secure parliamentary approval for higher rates for fees and charges
that the NHIS tariffs are unable to fully cover. These additional fees and charges are paid outof pocket by patients. Other public facilities will have instances where staff request for
unofficial fees and charges for services rendered. 32 The cost of treatment in the private sector
CGKII101, Consultant Gastroenterologist, Interview, September 2023
CGKII101, Consultant Gastroenterologist, Interview, September 2023
27
Archampong, T. N., et al., Gastro-duodenal disease in Africa: Literature review and clinical data from Accra,
Ghana, July 2019, url, p. 3346
28
CGKII101, Consultant Gastroenterologist, Interview, September 2023
29
CGKII101, Consultant Gastroenterologist, Interview, September 2023
30
NHIS, NHIS active membership soars, July 2020, url
31
CGKII101, Consultant Gastroenterologist, Interview, September 2023
32
CGKII101, Consultant Gastroenterologist, Interview, September 2023
25

26

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EUROPEAN UNION AGENCY FOR ASYLUM

is not regulated and different service providers set different fees and charges that enable
them to, at least, fully recover their costs. These fees and charges may be revised at any time,
and the revisions are primarily influenced by foreign exchange rates and market forces. 33
The public facilities’ prices are derived from the NHIS tariffs for tertiary hospitals (2023). 34
Information for the private sector prices, as well as on insurance and reimbursement
information, is provided by Interviewee CGKII102. 35
Concerning the coverage and reimbursement of the treatment prices in Table 1 and Table 2
below, the following principles apply to all listed treatments:
1.

Public and some private sector facility treatment prices are covered by NHIS andsometimes private insurance.

2. If insured, on presentation of one’s insurance card, whether NHIS or private, nopayment is made by the patient, as the insurance company re-imburses the facility at alater date on submission of claims.
3. In public facilities, any price difference between the listed NHIS tariffs and the priceasked by the facility is borne by the patient (some facilities obtain parliamentary
approval to increase their prices). In private facilities where NHIS coverage is
accepted, the price difference between the NHIS tariffs and the private price is borneby the patient.
4. Uninsured patients pay out of pocket for all services at public and private facilities.

Table 1. Cost of gastroenterology specialist consultations in public tertiary and private healthfacilities
Specialist

Publicoutpatient
treatment pricein GHS

Public inpatient
treatment price in
GHS

Gastroenterologist

147

128 (cost of admission,
not including
consultation fee)

Surgeon147

128 (cost of admission,
not including
consultation fee)

CGKII102, Administrator of a Private Hospital, Interview, September 2023
NHIS tariffs for tertiary hospitals (2023)”
35
CGKII102, Administrator of a Private Hospital, Interview, September 2023
33

34

14

Privateoutpatient
treatment
price in GHS

Private inpatient
treatment pricein GHS

280 to 400

600 to 1 000

280 to 400

600 to 1 000

GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGYSpecialist

Publicoutpatient
treatment pricein GHS

Oncologist

147

Public inpatient
treatment price in
GHS

128 (cost of admission,
not including
consultation fee)

Privateoutpatient
treatment
price in GHS

Private inpatient
treatment pricein GHS

300 to 400

600 to 1 000

Table 2. Cost of gastroenterology laboratory, diagnostic imaging and specialist treatment
interventions in public tertiary and private health facilities
Public treatment price in
GHS

Private treatment price in
GHS

Sodium – 20

Sodium – 30 to 45

Calcium – 40

Calcium – 60 to 70

Potassium – 20

Potassium – 30 to 40

Chloride – 20

Chloride – 30 to 40

Phospate – 30

Phospate – 40 to 50

Magnesium – 30

Magnesium – 40

Laboratory test: reticulocytes counting in
blood

36

100 to 130

Laboratory test: tumor marker: CEA(Carcinoembryonic antigen)84

150 to 170

Amylase – 45

Amylase – 140 to 155

Lipase – 46

Lipase – 100 to 130

77

100 to 130

Laboratory test: electrolytes: sodium,
calcium, potassium, chloride, phosphate,and magnesium

Laboratory test: pancreas function(amylase, lipase)

Laboratory test: lipid proﬁle (totalcholesterol, HDL cholesterol, LDL
cholesterol, triglycerides)

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EUROPEAN UNION AGENCY FOR ASYLUM

Public treatment price in
GHS

Private treatment price in
GHS

Laboratory test: faecal calprotectin: stool
test for intestinal inﬂammation/ diseaseactivity

78

90 to 110

Diagnostic imaging: oesophago-gastroduodenoscopy

520

Not found

Diagnostic imaging: sigmoidoscopy

350

Not found

Diagnostic imaging: MRI scan

978995 to 1 100

Diagnostic imaging: computed
tomography (CT scan) with contrast

1 268

1 750 to 2 100

Diagnostic imaging: colonoscopy

560

800 to 1 100

Diagnostic imaging: computed
tomography (CT scan)490

1 100 to 1 300

Diagnostic imaging: endoscopy

560

Not found

Diagnostic test: colon biopsy

700

1 700 to 2 500

Oncology: radiation therapy

10 000 to 15 000

30 000 to 40 000

Surgery; speciﬁcally gastrointestinal:colostomy operation and closure

1 612

8 000 to 15 000

Surgery: speciﬁc gastrointestinal;(segmental) duodenal resection

1 900

8 000 to 15 000

Surgery: speciﬁc gastrointestinal:
ileostomy

1 600

8 000 to 15 000

16GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Public treatment price in
GHS

Private treatment price in
GHS

Surgery, speciﬁcally fundoplication
surgery for gastroesophageal reﬂux
disease (GERD)

Not found8 000 to 15 000

Surgery: speciﬁcally gastrointestinal
surgery

1 900

8 000 to 15 000

Gastroenterology: enema

400

500 to 900

Surgery; speciﬁcally gastrointestinal:colostomy operation and closure

1 600

8 000 to 15 000

Diagnostic test: gastric tissue biopsy

700

1 700 to 2 500

4.

Cost of medication

The cost of medication in the public sector is regulated by the NHIS medicines’ list. 36 The
NHIS medicines’ list is expected to include the official charges for medicines in public facilities.
This is often not adhered to because the insurance tariffs are below the market prices.
Facilities, mainly the teaching hospitals, will go on to secure parliamentary approval for higher
fees and charges to ensure they are able to recover the cost of services and medicines that
the NHIS may not fully cover. These additional fees and charges are paid out of pocket bypatients. 37
The cost of medicines in the private sector is not regulated, and different service providers set
different fees and charges that enable them to, at least, fully recover their costs. These fees
and charges may be revised at any time and the revisions are primarily influenced by foreignexchange rates.
The cost of medication is generally higher in private facilities as compared to public facilities,
and also increases from primary to tertiary level of care. 38 Most medicines are available in thewhole country. The private sector pharmacies maintain a more complete stock of medicines

NHIS, Medicine List, February 2023, url
CGKII101, Consultant Gastroenterologist, Interview, September 2023, Accra
38
CGKII101, Consultant Gastroenterologist, Interview, September 2023, Accra
36
37

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EUROPEAN UNION AGENCY FOR ASYLUM

than public facilities and medicines are more readily available in urban versus ruralcommunities. 39
Mostly, medicines found in the country are registered by the Food and Drugs Authority (FDA)
for use which means that the quality of the medicines can be assured. For a product to beregistered, it must have gone through and passed the rigorous testing and product source
verification processes carried out by the FDA of Ghana. However non-registered, as well as
fake, medicines are also found in the country. Some of the medicines are on the Essential
Medicines List and the National Health Insurance Medicines List. Their inclusion on the list
encourages pharmacies and health facilities to stock them, reducing situations when stocks
run out. 40
In situations where medicines are not available in the country, citizens may make arrangements
for friends and family living abroad to purchase and send to them these medicines or they may
seek the support of pharmacies to order the medicines for them. These scarce medicines may
or may not be registered by the FDA. These medications are often prescription-only medications
and often need to be accompanied by the prescription. 41
In Table 3, ‘Pharmacy’ refers to the private sector and ‘Hospital’ refers to the public sector.
Public facilities prices are based on the NHIS medicines’ list. 42 No brand names are covered
under the medicines’ list. 43 Prices for private facilities as well as information on insurance andreimbursement are provided by interviewee CGKII103. 44
Concerning the coverage and reimbursement of the medication prices in the table below, thefollowing principles apply:
1.

Both public and private sector prices can be covered by NHIS or/and private
insurance.

2. If insured, on presentation of one’s insurance card, whether NHIS or private, nopayment is made by the patient, as the insurance company re-imburses the facility at alater date on submission of claims.
3. In private facilities, where NHIS coverage is accepted, the price difference between the
NHIS tariffs and the private price is borne by the patient.
4. Uninsured patients pay out-of-pocket for all medications at public and private facilities.

CGKII101, Consultant Gastroenterologist, Interview, September 2023, Accra
CGKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
41
CGKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
42
NHIS, Medicine List, February 2023, url
43
CGKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
44
CGKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
39

40

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GHANA TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Table 3. Cost of medicines in both public and private sectors
Generic Name

Brand nameStrengthof unit

Form

Number ofunits in thecontainerPrice
per boxprice in
GHS

Place
(pharmacy,
hospital,…)Omeprazole

Acidom®

20 mg

tablet1032

Pharmacy

Esomeprazole

Nexium™

20 mg

tablet14

282

Pharmacy

Esomeprazole

20 mgtablet30

184

Hospital

Pantoprazole

Pantodenk®

20 mgtablet28

86.8

Pharmacy

Aluminiumhydroxide

Aluminiumhydroxide

500 mgtablet10

1.3

Pharmacy

Amoxicillin

Exeter™

500 mgcapsule21

27.3

Pharmacy

Amoxicillin

500 mgcapsule500

61.6

Hospital

Tetracycline

Tetracycline

500 mgcapsule10

4.5

Pharmacy

Metronidazole

Flagyl®

400 mgtablet14

193

Pharmacy

Clarithromycin

Fromilid®

500 mgtablet14

91

Pharmacy

Mesalazine

Pentasa®

1gtablet60

1 142

Pharmacy

Sulfasalazine

Salazopyrin®

500 mgtablet100

1 232

Pharmacy

Corticosteroids

Prednisolone

5 mgtablet28

16.8

Pharmacy

Prednisone

Prednisone

5 mg

tablet100

15

Hospital

Azathioprine

Azathioprine

25 mg

tablet28

140

Pharmacy

Ciclosporin

Neoral®

100 mgcapsule30935

Pharmacy

Tacrolimus

Prograf®

0.5 mgcapsule50405

Pharmacy

Loperamide

Imodium®

2 mg

capsule632

Pharmacy

Colodium®

2 mg

capsule10

6

Hospital

Questran™

4g

powder

50 sachets

590

Pharmacy

Colestyramine

19EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand nameStrengthof unit

Form

Number ofunits in thecontainerPrice
per boxprice in
GHS

Place
(pharmacy,
hospital,…)

Octreotide

Sandostatin®

50 mcg/ml

injection

1

156.6

Pharmacy

Bismuthsubsalicylate

Peptobismol®

200 mlSuspension

1

185

Pharmacy

Macrogol

Movicol

13.8gmpowder20

426

Pharmacy

Macrogol +electrolytes[KCl, NaCl,NaHCO₃(=bicar
bonate)]Macrogol +electrolytes

13.8 gmsachet1

12

Pharmacy

Lactulose

Lactulex™®

200 mlliquid1

94.9

Pharmacy

Bisacodyl

Dulcolax®

10 mg

Suppository

12

90

Pharmacy

Sucralfate

Sucralfate O®

1 gm/
10 ml

Suspension

1

27.5

Pharmacy

Misoprostol

Cytotec®

200 mcg

tablet1

3.8

Pharmacy

20

GHANA TOPICAL REPORT: GASTROENTEROLOGY

Annex 1: Bibliography
Oral sources, including anonymous sources
CGKII101, A Consultant Gastroenterologist, Interview, Accra, September 2023. The person
wishes to remain anonymous.
CGKII102, An Administrator of a Private Hospital, Interview, Accra, September 2023. The
person wishes to remain anonymous.
CGKII103, A Pharmacist of a Private Hospital, Interview, Accra, September 2023. The person
wishes to remain anonymous.

Public sources
Agyemang-Yeboah, F., Yorke, J., Obirikorang, C., Batu, E. N., Acheampong, E., Amankwaa
Frempong, E., Anto, E. O. and Amankwaa, B., Patterns and presentations of colorectal cancer
at Komfo-Anokye teaching hospital Kumasi, Ghana, in: Pan African Medical Journal, Vol. 28,
Article No. 121, October 2017, https://www.panafrican-medjournal.com/content/article/28/121/full, accessed 5 December 2023
Agyemang-Yeboah, F., Yorke, J., Obirikorang, C., Batu, E. N., Acheampong, E., Amankwaa
Frimpong, E., Anto, E. O. and Amankwaa, B., Colorectal cancer survival rates in Ghana: A
retrospective hospital-based study, in: PLoS One, Vol. 13, Issue 12, Article No. e0209307 [nopagination], December 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300283/,
accessed 5 December 2023
Archampong, T. N. A. and Nkrumah, K. N., Inflammatory bowel disease in Accra: what new
trends?, in: West African Journal of Medicine, Vol. 32, Issue 1, pp. 40-44, 2013,https://www.ajol.info/index.php/wajm/article/view/112621/102370, accessed 5 December 2023
Archampong, T. N. A., Asmah, R. H., Wiredu, E. K., Gyasi, R. K. and Nkrumah, K. N., Factors
associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the
Korle-Bu Teaching Hospital, Accra, Ghana, in: African Health Sciences, Vol. 16, Issue 2, pp. 611619, June 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994551/, accessed 5
December 2023
Archampong, T. N., Asmah, R. H., Richards, C. J., Martin, V. J., Bayliss, C. D., Botão, E., David,
L., Beleza, S. and Carrilho, C., Gastro-duodenal disease in Africa: Literature review and clinicaldata from Accra, Ghana, in: World Journal of Gastroenterology, Vol. 25, Issue 26, July 2019,
pp. 3344-3358, https://www.wjgnet.com/1007-9327/full/v25/i26/3344.htm, accessed 5
December 2023

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EUROPEAN UNION AGENCY FOR ASYLUM

Boi-Dsane, N. A. A., Amarh, V., Tsatsu, S. E., Bachelle, S. V., Bediako-Bowan, A. A. A., Koney, N.
K. K. and Dzudzor, B., Cross-Sectional Study for Investigation of the Association Between
Modifiable Risk Factors and Gastrointestinal Cancers at a Tertiary Hospital in Ghana, in:Cancer Control, Vol. 30, pp. 1-10, March 2023,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9998415/, accessed 5 December 2023
Dakubo, J.C., Naaeder, S.B., Tettey, Y. and Gyasi, R.K., Colorectal carcinoma: an update ofcurrent trends in Accra, in: West African Journal of Medicine, Vol. 29, Issue 3, 2010,https://doi.org/10.4314/wajm.v29i3.68218, pp. 178-83, accessed 22 December 2023
GBD 2017 Gastro-oesophageal Reflux Disease Collaborators, The global, regional, andnational burden of gastrooesophageal reflux disease in 195 countries and territories, 1990–
2017: a systematic analysis for the Global Burden of Disease Study 2017, in: Lancet
Gastroenterol Hepatol, Vol. 5, June 2020, pp. 561-581
https://www.thelancet.com/action/showPdf?pii=S2468-1253%2819%2930408-X, accessed 22
December 2023
Ghana, MOH (Ministry of Health), GNDP (Ghana National Drugs Programme), Standard
Treatment Guidelines, Seventh Edition, 2017, https://www.moh.gov.gh/wpcontent/uploads/2020/07/GHANA-STG-2017-1.pdf, accessed 5 December 2023
Ghana, MOH (Ministry of Health), Health Sector Medium Term Development Plan 2022-2025,
December 2021, https://www.globalfinancingfacility.org/sites/gff_new/files/Ghana-GFFInvestment-Case.pdf, accessed 5 December 2023
Ghana, MOH (Ministry of Health), National Health Policy: Ensuring healthy lives for all (Revised
Edition), January 2020, https://www.moh.gov.gh/wpcontent/uploads/2020/07/NHP_12.07.2020.pdf-13072020-FINAL.pdf, accessed 5 December
2023
Ghana, NHIS (National Health Insurance Scheme), Medicine List, February 2023,
https://nhis.gov.gh/medlist, accessed 5 December 2023
Ghana, NHIS (National Health Insurance Authority), Tariffs for Tertiary Hospitals, February
2023, accessed 5 December 2023, not available online
NHIS (National Health Insurance Scheme), NHIS active membership soars, July 2020,
https://www.nhis.gov.gh/News/nhis-active-membership-soars5282#:~:text=Ghana's%20National%20Health%20Insurance%20Scheme,Accra%20region%20
with%201.7%20million, accessed 5 December 2023
Xie, X., Ren, K., Zhou, Z., Dang, C. and Zhang, H., The global, regional and national burden of
peptic ulcer disease from 1990 to 2019: a population-based study, in: BMC Gastroenterology,
Vol. 22, Article No. 58 [no pagination], February 2022, https://doi.org/10.1186/s12876-02202130-2, accessed 22 December 2023

22

GHANA TOPICAL REPORT: GASTROENTEROLOGY

Annex 2: Terms of Reference (ToR)
Gastroenterology
Note for drafters: These are guidelines on the information to be included. If one aspect is
not relevant, e.g., there is no national institute to treat this disease or no international
donor programme, there is no need to mention it. Keep the focus on treating medicine –preventive care can be mentioned but is of less interest to the target group.

General information
•

•
•
•

•
•
•
•

Briefly describe prevalence and incidence of gastrointestinal diseases(gastroesophageal reflux disease, peptic ulcer, inflammatory bowel disease,stomach and colorectal cancers) / types of these diseases (epidemiologic data).
How is the health care organized for gastrointestinal diseases?
How is these diseases treated – at specific centres, in primary health care centres,
secondary care / hospitals, tertiary care etc.?
Which kinds of facilities can treat these diseases [public, private not for profit (e.g.,
hospitals run by the church), private for-profit sector]? Include links to facilities’
websites if possible.
How are the resources organized in general to treat patients with gastrointestinal
diseases? Are there sufficient resources available to treat all patients?
Is there a particular type of these diseases for which no (or only partial) treatment
exists in the country?
Is there a (national) institute specialised in treating gastrointestinal diseases?
Are there any national or international plans or (donor) programmes for
gastrointestinal diseases; if yes, could you elaborate on such programme(s) andwhat it entails?

Access to treatment
•
•
•

•
•

Are there specific treatment programmes for gastrointestinal diseases? If so, what are
the eligibility criteria to gain access to it and what they contain?
Are there specific government (e.g., insurance or tax) covered programmes for
gastrointestinal diseases? If so, what are the eligibility criteria to gain access to it?
Are there any factors limiting the access to healthcare for patients? If so, are theyeconomic, cultural, geographical, etc.? Are there any policies to improve access tohealthcare and/or to reduce the cost of treatments and/or medication? What is thenumber of people having access to treatment? Keep focus on e.g., waiting times rather
than the exact number of specialists in the field.
If different from information provided in the general section; is the treatment
geographically accessible in all regions?
What is the ‘typical route’ for a patient with this disease (after being diagnosed with thedisease)? In other words: for any necessary treatment, where can the patient find help
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EUROPEAN UNION AGENCY FOR ASYLUM

•
•
•

•

and/or specific information? Where can s/he receive follow-up treatment? Are there
waiting times for treatments?
What must the patient pay and when?
Is it the same scenario for a citizen returning to the country after having spent a
number of years abroad?
What financial support can a patient expect from the government, social security or apublic or private institution? Is treatment covered by social protection or an additional /communal health insurance? If not, how can the patient gain access to a treatment?
Any occurrences of healthcare discrimination for people with gastrointestinal
diseases?

Insurance and national programmes•••

National coverage (state insurance).
Programmes funded by international donor programmes, e.g., Global Fund, UNAIDS,UNICEF, Gates foundation, Clinton foundation etc.
Include any insurance information that is specific for patients with this disease.

Cost of treatment
Guidance / methodology on how to complete the tables related to treatments:
•
•
•

•
•
•
•

Do not delete any treatments from the tables. Instead state that they are not available
or information could not be found if that is the case.
In the table, indicate the price for inpatient and outpatient treatments in public andprivate facility and if the treatments are covered by any insurance or by the state.
For inpatient, indicate what is included in the cost (bed / daily rate for admittance,
investigations, consultations…). For outpatient treatment, indicate follow up or
consultation cost.
Is there a difference in respect to prices between the private and public facilities?
Are there any geographical disparities?
Are the official prices adhered to in practice?
Include links to online resources used, if applicable (e.g., hospital websites).

Note: a standardised list of treatments was also included in the original ToR, as can beviewed in the report. Any treatment without a found price was removed at the editorial
stage.

Cost of medication
Guidance / methodology on how to complete the tables related to medications:••

Do not delete any medicines from the tables. Instead state that they could not befound if that is the case.
Are the available medicines in general accessible in the whole country or are there
limitations?
24

GHANA TOPICAL REPORT: GASTROENTEROLOGY

•
•
•

•
•

Are the medicines registered in the country? If yes, what are the implications of it
being registered?
Indicate in the tables: generic name, brand name, dosage, form, pills per package,
official prices, source, insurance coverage.
Are (some of the) medicines mentioned on any drug lists like national lists, insurance
lists, essential drug lists, hospital lists, pharmacy lists etc.? If so, what does such a list
mean specifically in relation to coverage?
Are there other kinds of coverage, e.g., from national donor programmes or otheractors?
Include links to online resources used, if applicable (e.g., online pharmacies).

Note: a standardised list of medication was also included in the original ToR, as can beviewed in the report. Any medication without a found price was removed at the editorial
stage.

NGOs••

Are any NGOs or international organisations active for patients with gastrointestinal
diseases? What are the conditions to obtain help from these organisations? What help
or support can they offer?
Which services are free of charge and which ones are at a cost? Is access provided to
all patients or access is restricted for some (e.g., in case of faith-based institutions or incase of NGOs providing care only to children for instance).

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EUROPEAN UNION AGENCY FOR ASYLUM

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