Ghana
Psychiatry

January 2024

Manuscript completed in January 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
PDF

ISBN 978-92-9403-575-2 doi: 10.2847/950246 BZ-02-23-299-EN-N© European Union Agency for Asylum (EUAA), 2024
Cover photo/illustration: Dedraw Studio, Paper cut layered human head stock illustration, ©
iStock by Getty Images, 6 March 2022, https://www.istockphoto.com/vector/paper-cutlayered-human-head-gm1379780777-442796562
Reproduction is authorised provided the source is acknowledged. For any use or reproductionof photos or other material that is not under the EUAA copyright, permission must be sought
directly from the copyright holders.

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

1

EUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements......................................................................................................................... 1
Contents .......................................................................................................................................... 2
Disclaimer ........................................................................................................................................ 3
Glossary and abbreviations ........................................................................................................... 4
Introduction ..................................................................................................................................... 5
Methodology ......................................................................................................................................... 5
Terms of reference .......................................................................................................... 5
Collecting information ..................................................................................................... 5
Quality control ................................................................................................................... 5
Sources ............................................................................................................................... 6
1.

Psychiatry ............................................................................................................................ 7
1.1. Prevalence of psychiatric diseases ........................................................................................ 7
1.2. Overview of the health sector.................................................................................................. 8

2.

Access to treatment .......................................................................................................... 11

3.

Insurance and national programmes ..............................................................................134.

Non-governmental organisations (NGOs) ......................................................................14

5.

Cost of treatment ..............................................................................................................15

6.

Cost of medication ............................................................................................................18

Annex 1: Bibliography .................................................................................................................. 23
Annex 2: Terms of Reference (ToR) ............................................................................................ 25

2

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

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 31 October 2023. 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.

3

EUROPEAN UNION AGENCY FOR ASYLUMGlossary and abbreviations
Term

Definition

CAMHA

Care and Action of Mental Health in Africa

CHAG

Christan Health Association of Ghana

CHPS

Community-Based Health Planning Services

ECT

Electroconvulsive Therapy

EMDR

Eye Movement Desensitisation and Reprocessing

FDA

Food and Drug Authority

GBD

Global Burden of Disease

GHS

Ghanaian Cedi

MDD

Minor Depressive Disorders

MEHSOG

Mental Health Society of Ghana

MHA

Mental Health Authority

NGO

Non-Governmental Organisation

NHIS

National Health Insurance Scheme

PHC

Primary Healthcare

PTSD

Post Traumatic Stress Disorder

UK

United Kingdom

WHO

World Health Organisation

4

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Introduction
Methodology
The purpose of the report is to provide information on access to psychiatric treatment in
Ghana. This information is relevant to the application of international protection statusdetermination (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 8 September
2023, peer review occurred between 9 - 29 September 2023, and additional information wasadded to the report as a result of the quality review process during the review implementation
up until 31 October. 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

5EUROPEAN UNION AGENCY FOR ASYLUM

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 publications,academic publications, reports by non-governmental organisations and internationalorganisations. All sources that are used in this report are outlined in the Bibliography section.
Key informant interviews were carried out in July 2023. Interviews were conducted mainlywith officers who work within organisations of Ghana’s healthcare system. A complete
anonymised list of interviewees can be found in the bibliography.

6

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

1.

Psychiatry

Psychiatry is the field of medicine that specialises in the diagnosis, treatment and preventionof mental, emotional and behavioural disorders. This report looks at mood disorders like
depression, anxiety disorders like post-traumatic stress disorder (PTSD), psychotic disorders
like schizophrenia and bipolar disorder, and sleeping disorders. Additionally, it focuses on
addiction problems, e.g. alcohol and opioid addiction.

1.1.

Prevalence of psychiatric diseases

Although the government in the past decade has increased the attention given to mental
health, some challenges remain. This includes the need for an accurate database to establish
the actual prevalence and incidence of mental disorders. 4 The World Health Organization(WHO) estimates that 2.3 million of Ghana’s population lives with mental disorders and only
about 2 % receive psychiatric care. 5 The Global Burden of Disease (GBD) 2017 estimates a
population prevalence of 0.20 % for schizophrenia, 0.51 % for bipolar disorder, 2.56 % formajor depressive disorder (MDD), 0.43 % for epilepsy, 0.51 % for alcohol use disorders, and0.53 % for drug use disorders. 6
Ghana has a higher prevalence than the global average for MDD (2.56 % vs 2.49 %). Ghana
has a similar prevalence to Sub-Saharan Africa regional prevalence for each disorder except
drug use disorders, which have a 0.53 % prevalence in Ghana and 0.38 % in the region, andalcohol use disorder, which has a 0.51 % prevalence in Ghana and 0.91 % in the region. Malesin Ghana have a lower prevalence of alcohol use disorder compared to regional data: 1.36 %for the Sub-Saharan Africa region and 0.54 % in Ghana. 7
Within Ghana, there are differences between certain demographic groups, in the prevalenceof some conditions. Young adults (aged 20-29) have a higher prevalence of schizophrenia(0.51 %), bipolar disorder (1.59 %), MDD (6.34 %) and substance use disorders (2.42 %). Mood
disorders are more prevalent among women (3.14 %), young adults (6.34 %) and the elderly(7.92 %). 8 The suicide rate in Ghana is higher among men (12.1 per 100 000) than women (1.3
per 100 000) and treatment coverage was estimated to be highest for schizophrenia andlowest for MDD. 9

CMKII101, consultant psychiatrist, interview, July 2023, Accra
WHO, Africa, Ghana, Redefining mental healthcare in Ghana, October 2022, url
6
WHO, Ghana, WHO Special Initiative for Mental Health Situational Assessment, January 2022, url, p. 5
7
WHO, Ghana, WHO Special Initiative for Mental Health Situational Assessment, January 2022, url, p. 5
8WHO, Ghana, WHO Special Initiative for Mental Health Situational Assessment, January 2022, url, p. 5
9WHO, Ghana, WHO Special Initiative for Mental Health Situational Assessment, January 2022, url, p. 6457

EUROPEAN UNION AGENCY FOR ASYLUM

1.2.

Overview of the health sector

Ghana has a pluralistic health sector in terms of ownership (public and private) and in terms ofhealthcare models (orthodox, traditional and alternative medicine). 10 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. 11 The health system is organised inthree levels: the primary level, with a focus on primary healthcare (PHC) services, starts withthe community-based health planning services (CHPS) compound, followed by the sub-district
health centre/clinic and lastly the district hospital. The secondary and tertiary levels haveregional and teaching hospitals, respectively. 12
Public and private facilities, at all levels of the health system, can provide care within limits set
by the Standard Treatment Guidelines 2017. 13 The primary level of care has the capacity toidentify and make differential diagnosis of some of the psychiatric conditions. This capacity ismostly at the district hospital level where medical staff can make more definitive diagnosis,
commence basic care and also refer the client to the appropriate secondary or tertiary facility
for definitive case management. 14
The Mental Health Authority (MHA) is the Ministry of Health’s agency that oversees theoperations of psychiatric hospitals. It formulates and operationalises the government’s mental
health plans, policies and enforcement of the Mental Health Act (846) (2012) to ensure
humane and culturally appropriate services. 15
Ghana has three psychiatric hospitals, namely Accra Psychiatric Hospital and Pantang
Hospital, both in the capital Accra, and the Ankaful Psychiatric Hospital in the Central region.
Thus, all the psychiatric hospitals are in southern Ghana but are end-referral points serving
country-wide and nationalities in the West African sub-region. The teaching hospitals, namely
the Korle Bu, Komfo Anokye, Ho, Cape Coast, and Tamale teaching hospitals, also provide
tertiary mental health services, including both inpatient and outpatient care. 16
Table 1 lists some of the facilities that treat mental diseases and undertake rehabilitation. 17

Ghana, MOH, National Health Policy: Ensuring healthy lives for all (Revised Edition), January 2020, url, p. 23
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
12
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
13
Ghana, MOH, GNDP, Standard Treatment Guidelines, Seventh Edition, 2017, url, pp. 207-242
14
CMKII101, consultant psychiatrist, interview, July 2023, Accra
15
Ghana, Republic of Ghana Mental Health Act (846) (2012), Section 11, June 2012, url
16
CMKII101, consultant psychiatrist, interview, July 2023, Accra
17
CMKII101, consultant psychiatrist, interview, July 2023, Accra
10
11

8

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Table 1. Mental health treatment and rehabilitation facilities in Ghana
Facility

WebsiteGhana Health Service facilities

https://ghs.gov.gh

Christan Health Association of
Ghana (CHAG)

https://chag.org.gh/

Accra Psychiatric Hospital

https://accrapsychiatrichospital.org

Pantang Hospital & Drug
Treatment & Rehabilitation
Centrehttps://pantanghospital.gov.gh

Ankaful Hospital

https://www.ghana.gov.gh/mdas/06165edcb1

Ankaful Rehabilitation Center
Korle Bu Teaching Hospital(KBTH)

https://kbth.gov.gh/departments-centres/psychiatry-department/

Komfo Anokye Teaching
Hospital (KATH)

https://kath.gov.gh/

Ho Teaching Hospital

https://www.hth.gov.gh/

Tamale Teaching Hospital

https://www.moh.gov.gh/tamale-teaching-hospital/

Cape Coast Teaching Hospital

http://www.ccthghana.org/

Serenity Place

https://gh.africabz.com/greater-accra/serenity-place-392989

The Brains and Sleep Medical
Centre Ltd

https://thebraincentregh.com/

Compassion Rehabilitation
Center

https://compassionrc.com

9EUROPEAN UNION AGENCY FOR ASYLUM

Facility

WebsiteHouse of St. Francis Clinic

https://www.recoveryafrica.org/house-of-st-francis

WellCare Ghana

https://www.facebook.com/WellCareGH

Redemption Place

https://www.africabizinfo.com/GH/redemption-place-residential

Hope Sobriety Home

https://www.cybo.com/GH-biz/hope-sobriety-home

Peep-Ters Extension Institutehttps://rehabs.africa/providers/the-peep-ters-extension-institute/

New Hope Rehab Centre

https://newhopewellnesscenterfoundation.org/about-us

Willing Way Foundation

https://willingwayghana.org

Nyaho Medical Center

https://www.nyahomedical.com

37 Military Hospital, Therapy &Wellness Dept.

https://www.ghana.gov.gh/mdas/ee0f1b1bcc

The Bank Hospital

https://thebankhospital.com

Trust Hospital

https://thetrusthospital.com/about-us/

Kumasi Chesire Homes

https://www.cybo.com/GH-biz/kumasi-cheshire-homeValley View Clinic, Dzorwulu

https://valleyviewclinic.org

Iris Place Rehabilitation Center,North Legonhttps://rehabs.africa/providers/iris-place/

Nazareth Home for God’s
Childrenhttps://www.catholicmission.org.au/Ghana

Brottier Househttps://nicelocal.com.gh/kumasi/medical/brottier_recovery_home

10

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Facility

WebsiteShekhinah Clinic

https://shekhinahclinic.org/

Recovery Pathway Clinic

https://www.facebook.com/RecovPathways/about

Adiebeba Specialist Hospital,
Kumasihttps://www.adiebebahospital.com

Mercy Rehabilitation Center,
Cape Coast

https://www.nchs.org.gh/institutions/specialized-facilities/

Resources for the treatment of mental diseases and human resources in Ghana are limited.
There is a low provider-patient ratio, which translates to relatively long waiting time to receive
specialist care. 18

2.

Access to treatment

As described in the introduction, treatment is available at all levels of the health system, within
the prescribed limits of the Standard of Treatment Guidelines 2017. 19 All patients can accesscare at the nearest point of service to them at any level of the health system. Based on theseverity of the condition and the capacity of the point of service to manage the condition, care
will be continued, or the patient will be referred to the next higher level of care for further
appropriate case management. 20
The distribution of mental health services is skewed toward the southern part of the country,with limited services available in the northern regions. Services and resources are largely
concentrated in psychiatric hospitals rather than more accessible community settings. There isa significant treatment gap (the difference between need and available treatment), especiallyfor mood and substance use disorders. Additionally, there are systems-level challenges infinancing psychotropic medications that limit their availability and procurement. Shortages inhuman resources also persist. Concurrently, social stigma linked to mental disorders remains
prevalent and limits help-seeking. 21
Most regional hospitals have mental health units, which are often managed by mental healthnurses and general practitioners. Some regional hospitals have specialist mental health
CMKII101, consultant psychiatrist, interview, July 2023, Accra
Ghana, MOH, GNDP, Standard Treatment Guidelines, 2017, url
20
CMKII101, consultant psychiatrist, interview, July 2023, Accra
21
WHO, Ghana, WHO Special Initiative for Mental Health Situational Assessment, January 2022, url, p. 2
18

19

11

EUROPEAN UNION AGENCY FOR ASYLUM

providers, such as psychiatrists and clinical psychologists, or both. Tertiary level care isprovided by specialists in teaching hospitals and psychiatric hospitals. 22 Only the Accra
Psychiatric Hospital makes provision for the admission of children and adolescents. 23 Owing
to the limitation of human resource, people needing specialist mental health professionals (i.e.
psychiatrists and psychologists) often have long waiting times. This is especially problematic
for follow-up. 24
A few private mental health practices offer care by psychiatrists and psychologists. These arelocated mainly in Accra and Kumasi. Very few private practices offer inpatient care and theyoften refer to the tertiary level care where admission is required. 25
Various treatment options for mental disorders are available in Ghana. These include
psychotherapies / counselling, pharmacotherapy, support groups, electroconvulsive therapy(ECT), hospital and residential treatment programmes. 26
Additionally, Ghanaians seek alternate health from traditional medical practitioners as a firstline, and this is recognised by the Ministry of Health (MHA) and hence such alternate practices
are incorporated in the Mental Health Act. 27 In alternative care facilities, there are different
forms of care. Some use herbal medications, spiritual psychism, divination, prayers and otherforms of spiritual practices for healing. 28
There are no national treatment programmes for specific psychiatric diseases. Alcohol andother substance use disorders benefit from drug treatment and rehabilitation programmes in
the psychiatric hospitals and in many private rehabilitation facilities. Suicide hotlines havebeen established across the country and these are managed by the MHA. In 2022, theauthorities launched the toll-free number ‘0800678678’ that offers support for people withpsychosocial difficulties, and can link them to mental health experts to access support .29
Treatment is geographically available in all the regions. However, urban towns, primarily
because of the presence of secondary and or tertiary facilities, have better access to specialist
services than populations in rural areas. In theory, everyone has access to all services that areavailable at all levels of the health system. The inability to pay for the care available is among
the main barriers to accessing treatment. Patients who have registered with the National
Health Insurance Scheme (NHIS) or private medical insurance schemes will have their cost ofcare (either inpatient or outpatient) 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 forand cost of services than the NHIS.30

CMKII101, consultant psychiatrist, interview, July 2023, Accra
CMKII101, consultant psychiatrist, interview, July 2023, Accra
24
CMKII101, consultant psychiatrist, interview, July 2023, Accra
25
CMKII101, consultant psychiatrist, interview, July 2023, Accra
26
CMKII101, consultant psychiatrist, interview, July 2023, Accra
27
CMKII101, consultant psychiatrist, interview, July 2023, Accra
28
Kpobi, L. and Swartz, L., Indigenous and faith healing in Ghana: A brief examination of the formalising process andcollaborative efforts with the biomedical health system, July 2019, url, p. 1
29
Ghanaian Times, Business Ghana, MHA unveils toll-free No. for psycho-social support, 23 September 2022, url
30
CMKII101, consultant psychiatrist, interview, July 2023, Accra
22
23

12

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Uninsured patients pay out-of-pocket for all services received at outpatient as well as inpatient
points of care. These include the cost of consultation, diagnostic services, medicines andinpatient accommodation fees, as necessary. If insured and if the treatment or medication iscovered by NHIS, on presentation of one’s insurance card, whether NHIS or private, no direct
payment is made as the insurance company re-imburses the service provider at a later dateon submission of claims. 31
The social welfare officers in the district are responsible to ensure that people living withmental illnesses and vagrants receive assistance to receive mental healthcare, including
paying for their medical bills. 32
Stigma is a considerable barrier that prevents a person suffering from mental healthconditions from seeking healthcare. Stigma towards mental disorders impacts negatively on
how patients, their family and friends are perceived and their health seeking behaviours. The
stigma extends to health professionals who provide mental health services and that has
impacted the recruitment and training of personnel for this area of health. 33 Few healthprofessionals want to specialise in mental health, hence there are a limited number ofpsychiatrists and psychologists in the country. 34

3.

Insurance and national programmes

The NHIS does not cover the cost of mental health disorders because care for mental health is
supposed to be free, but this has not been achieved. The NHIS scheme however sometimes
supports psychiatric hospitals by releasing funds for the purchase of some psychotropic
medications, which patients will receive for free. In effect, people suffering from mental healthdisorders must pay out of pocket for services they access. Private schemes cover mental
healthcare as they do other health conditions. The extent of cover is dependent on thescheme but covers inpatient and outpatient as well as medication. 35
Ghana does not have a government covered programme for mental health disorders. The
Foreign, Commonwealth and Development Office and the WHO are currently supporting the
Ministry of Health and its agencies in their efforts to improve access to high-quality mental
health services. 36
There is a disability programme with specific focus on mental health called the Ghana Somubi
Dwumadie, also known as the Ghana Participation Programme. The programme primarily
engages in community education, the establishment and development of community-based
mental self-help groups, promoting access to community-based mental health care services
CMKII101, consultant psychiatrist, interview, July 2023, Accra
CMKII101, consultant psychiatrist, interview, July 2023, Accra
33
CMKII101, consultant psychiatrist, interview, July 2023, Accra
34
CMKII101, consultant psychiatrist, interview, July 2023, Accra
35
CMKII101, consultant psychiatrist, interview, July 2023, Accra
36
CMKII101, consultant psychiatrist, interview, July 2023, Accra
31

32

13

EUROPEAN UNION AGENCY FOR ASYLUM

and secure livelihood opportunities for persons with mental health disabilities. 37 The
programme is currently running until the end of 2023. It is a four-year programme funded by
the United Kingdom (UK) aid and run by a consortium consisting of non-governmentalorganisations (NGOs) and universities, including Basic Needs Ghana and Kings College
London. 38

4.

Non-governmental organisations(NGOs)

There are several NGOs working in mental health. 39 Significant among many of such NGOs
are BasicNeeds Ghana, 40 the Mental Health Society of Ghana (MEHSOG), the Mental HealthFoundation of Ghana, 41 MindFreedom Ghana, 42 the Care and Action of Mental Health in Africa(CAMHA), 43 PsychoMental Health Foundation and the Ghana Mental Health Association. 44
Most of these NGOs play the role of advocating to eliminate human rights abuses against
people living with mental disorders and for improved services. 45 Some organise specialist-led
outreach programmes, supply free psychotropic medications where possible, and havecreated community self-help groups lead by community volunteers who liaise between
patients and their family and the Ghana Health Service community mental health units.
Additionally, they are involved in building capacity of health staff, traditional/faith-based
medical practitioners, as well as livelihood opportunities for service users, and they support
mental health research at the community level and make mental health services accessible torural communities. 46
Support groups have been formed by people living with bipolar disorder. The Alcoholic
Anonymous and a Janssen Schizophrenia Support programme for patients on the
antipsychotic medication paliperidone palmitate (Invega Sustenna, a Janssen Pharmaceuticalproduct) are a few programmes that support patients with psychiatric diseases. 47

Ghana Somubi Dwumadie, Our Management Team, url
Ghana Somubi Dwumadie, Self-help groups support service users in times of crisis and give them a sense of
belonging, A four-year disability inclusion programme in Ghana, 2020, url
39
CMKII101, consultant psychiatrist, interview, July 2023, Accra
40
BasicNeeds Ghana, 2020, url
41
Mental Health Foundation Ghana, Mental Health and Human Rights Info, n.d., url
42
Mind Freedom Ghana, Explore the Nation in Mental Health Care, 2022, url
43
CAMHA, What we’re all about, n.d., url
44
CMKII101, consultant psychiatrist, interview, July 2023, Accra
45
CMKII101, consultant psychiatrist, interview, July 2023, Accra
46
CMKII101, consultant psychiatrist, interview, July 2023, Accra
47
CMKII101, consultant psychiatrist, interview, July 2023, Accra
37

38

14

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

The Cheshire Home and Brottier House, 48 established by NGOs and operating on donor
support, provides treatment and rehabilitation; however, none of the other NGOs provide
treatment services. 49

5.

Cost of treatment

The Mental Health Act (2012) legislates free treatment for patients seeking mental healthcare
in public institutions, 50 but this has not been operationalised. 51 The cost of treatment in the
public sector is regulated by fees approved by the parliament. These fees are by and large
adhered to in all the public facilities. The cost for treatment in psychiatric hospitals is
subsidised by the government and hence patients do not pay full cost. The NHIS does notcover the cost of treatment of mental disorders. 52 The difference between the subsided andthe full cost of care is paid by the patient out of pocket. 53
The cost of treatment 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 and market forces. 54
The cost of treatment is generally higher in private than in public facilities and also increases
from primary to tertiary level of care. 55
In Table 2 and Table 3 below, the public outpatient and inpatient treatment prices are derived
from information provided by interviewee CMKII01, 56 and the private outpatient and inpatient
treatment prices are based on information provided by interviewee CMKII02. 57

WHO, Ministry of Health, WHO-AIMS Report on Mental Health System in Ghana, 2020, url, p.14
CMKII101, consultant psychiatrist, interview, July 2023, Accra
50
Ghana, Government of Ghana, Mental Health Act 2012 (Act 846), section 88,2012, url
51
CMKII101, consultant psychiatrist, interview, July 2023, Accra
52
CMKII101, consultant psychiatrist, interview, July 2023, Accra
53
CMKII101, consultant psychiatrist, interview, July 2023, Accra
54
CMKII102, administrator at a private hospital, interview, July 2023, Accra
55
CMKII101, consultant psychiatrist, interview, July 2023, Accra
56
CMKII101, consultant psychiatrist, interview, July 2023, Accra
57
CMKII102, administrator at a private hospital, interview, July 2023, Accra
48

49

15

EUROPEAN UNION AGENCY FOR ASYLUMTable 2: Cost of consultation for adults in public tertiary and private health facilities
Specialist

Publicoutpatient
treatment
price in GHS

Privateoutpatient
treatment
price inGHS

Privateinpatienttreatment
price inGHS

30 - 100 per
consultation

65 - 200
per day
covering
bed, foodand direct
medicalcare

200 - 800
perconsultation

250 - 1 200
per day
covering
bed, food,and direct
medicalcare

Out-of-pocket payment

30 -100 per
consultation

65 - 200
per day
covering
bed, foodand direct
medicalcare

200 - 800for
consultation

Price notfound

Out-of-pocket payment

Psychiatrist(Clinical)
psychologist

Publicinpatienttreatment
price in
GHS

Reimbursement/
special programme/
free/ comments

Table 3: Cost of treatment for adults in public tertiary and private health facilities
Public treatment price in
GHS

Private treatment price in
GHS

Reimbursement/
special programme/
free/ comments

Psychotherapy
session withcognitive
behaviouraltherapy (onesession)40 - 150 per session

100 - 800 per session

Out-of-pocket payment

Psychotherapy
session with
EMDR (onesession)Not found

400 - 800 per session

Out-of-pocket payment

Psychotherapy
session with

40 -150 per session

100 - 800 per session

Out-of-pocket payment

Treatment

16

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Treatment

Public treatment price in
GHS

Private treatment price in
GHS

Reimbursement/
special programme/
free/ comments

other type of
psychotherapy
Clinical
admittance in
psychiatric clinic(daily rates)

3 000 per week covering
bed, food and direct
medical care

3 360 - 5 600 per week
covering bed, food anddirect medical care

Some reimbursement
to service provider bysome private insurance
service for treatment
only when it isadministered by aregistered psychiatrist(Psychiatric)
nurse at home(hour and dailyrates)

Information not foundPsychiatrictreatment of
alcohol drug
addiction in
specialised clinic(detox.); daily
admission rate

3 800 per month

5 000 - 7 000 per monthdetox, including laboratory

Out-of-pocket payment

Psychiatrictreatment ofdrug addiction ina specialised
clinic (rehab.);daily admission
rate

6 000 per month

8 000 - 10 000

Out-of-pocket payment

Psychiatrictreatment ofdrug addiction;
outpatient care;
rate of one
consultation

30 - 100 per consultation
only

200 - 800 per consultation

Out-of-pocket payment

80 - 150 per hour
1 200 per day

17

Out-of-pocket payment

EUROPEAN UNION AGENCY FOR ASYLUM

6.

Cost of medication

The cost of medication in the public sector is regulated by the NHIS medicines list. 58 The NHIS
medicines list is expected to reflect the official charges for medicines in public facilities. This isoften not adhered to because the prices of NHIS’ medicines are lower than 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. 59
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, recover their costs. These fees andcharges may be revised at any time and the revisions are primarily influenced by foreignexchange rates. 60
The cost of medication is generally higher in private as compared to public facilities, and also
increases from primary to tertiary level of care. 61 Most medicines are available in the wholecountry. The private sector pharmacies maintain a more complete stock of medicines thanpublic facilities and medicines are more readily available in urban than in rural communities. 62
As far as possible, medicines found in the country are registered by the Food and Drugs
Authority (FDA) for use. The implication of this is that the quality of the medicines can beassured, to a large extent. For a product to be registered, it means that it has gone throughand 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. 63
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. Public facilities prices as available in the NHIS
medicines’ list. No brand names are covered under the medicines’ list. 64
In situations where needed medicines are not available in the country, citizens may makearrangements 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. These scarce
medicines may or may not be registered by the FDA. These medications are oftenprescription-only medications and often need to be accompanied by the prescription. 65

Ghana, NHIS, Medicine List, February 2023, url
CMKII101, consultant psychiatrist, interview, July 2023, Accra
60
CMKII102, administrator at a private hospital, interview, July 2023, Accra
61
CMKII101, consultant psychiatrist, interview, July 2023, Accra
62
CMKII101, consultant psychiatrist, interview, July 2023, Accra
63
CMKII101, consultant psychiatrist, interview, July 2023, Accra
64
CMKII101, consultant psychiatrist, interview, July 2023, Accra
65
CMKII101, consultant psychiatrist, interview, July 2023, Accra
58

59

18

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Though the NHIS does not cover the cost of treatment of mental disorders, it supports mental
health services with some funds, periodically, for the procurement of psychotropic
medications to be made available across the country. These medicines are also subsidised
and in the psychiatric hospitals they may be free when in stock. 66
In Table 4 below ‘Pharmacy’ refers to the private sector and ‘Hospital’’ refers to the public
sector. The prices in pharmacies as well as insurance coverage and reimbursement
information are based on information provided by interviewee CMKII01. 67 Public facilities
prices are as listed in the NHIS medicines list. Medicines in public health facilities are genericand not branded. 68
Concerning the coverage and reimbursement of the medication prices in the table below, thefollowing principles apply:1.

Psychiatric medications are not covered by NHIS, but they can be found for free inpublic health facilities, upon availability. They can be covered also by private healthinsurance schemes.

2. If medications are not available for free in public facilities or bought in pharmacy or notcovered by any private insurance, cost is paid out of pocket by the patient. Uninsured
patients pay also out of pocket.
Table 4: Medicine prices in public and private health facilities
Generic Name

Brand nameStrengthFormof unit

Number

Price

Place

of units inper box(pharmacy,

thein GHS

hospital, …)

container
Amitriptyline

Amitriptyline

10 mgtablet56

23.2

Hospital

Citalopram

10 mgtablet28

9.5

Hospital

2830(also used for neuropathic pain)
Citalopram

20 mg
Clomipramine

Anafranil®

25 mgtablet30

183

Pharmacy

Duloxetine

Duloxetine

30 mgtablet28

16.8

Hospital

Cymbalta

30 mgtablet28

56

Pharmacy

Escitalopram

20 mg

tablet28

26.32

Hospital

Escitalopram

CMKII101, consultant psychiatrist, interview, July 2023, Accra
CMKII101, consultant psychiatrist, interview, July 2023, Accra
68
Ghana, NHIS, Medicine List, February 2023, url
66
67

19

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand nameStrengthFormof unit

Number

Price

Place

of units inper box(pharmacy,

thein GHS

hospital, …)

container
Cipralex®

20 mg

tablet28

918.40

Pharmacy

Fluoxetine

20 mg

capsule30

30

Hospital

Prozac®

20 mg

capsule30

98

Pharmacy

Imipramine

Imipramine

25 mg

tablet30

21.84

Hospital

Nortriptyline

Nortriptyline

25 mgtablet90

765

Pharmacy

Paroxetine

20 mg

capsule28

45.36

Hospital

Seroxat®

20 mg

capsule28

93

Pharmacy

Sertraline

50 mg

tablet28

50.7

Hospital

Lustral®

50 mgtablet28

649

Pharmacy

Trazodone

trazodone

50 mgtablet84

117.6

Pharmacy

Alfuzosin (also used

Xatral®

10 mgtablet30

681

Pharmacy

Lamotrigine

50 mgtablet28

14.84

Hospital

Lamictal™

50 mg

tablet30

677

Pharmacy

Topiramate

25 mgtablet60

43.2

Hospital

Topamax™

25 mg

tablet60

223

Pharmacy

Amisulpride

Amisulpride

200 mgtablet28

78.68

Hospital

Chlorpromazine

Chlorpromazine

50 mg

injection

1

6.5

Hospital

Chlorpromazine

50 mg

tablet500

235

Hospital

Largactil™

50 mg

tablet100

459

Pharmacy

Flupentixol

20 mg

injection

1

84.7

Hospitals

Fluoxetine(also used forneuropathic pain)
Paroxetine

Sertralinewith prostate complaints)
Lamotrigine (alsoanti-epileptic)
Topiramate (alsoanti-epileptic)

Flupentixol

20

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Generic Name

Brand nameStrengthFormof unit

Number

Price

Place

of units inper box(pharmacy,

thein GHS

hospital, …)

container
Haloperidol

Haloperidol

5 mgtablet28

21.84

Hospital

Haldol®

5 mgtablet30

105

Pharmacy

Clozapine

Clozcare 100

25 mg

tablet30

356.4

HospitalOlanzapine

Olanzapine

5 mg

tablet28

32.48

Pharmacy

Quetiapine

Quetiapine

25 mg

tablet28

36.4

Hospital

Risperidone

Risperidone

1 mg

tablet30

32

Hospital

Exeter®

2 mg

tablet28

252

Pharmacy

Flupentixol decano-

Flupentixol

20 mg

Injection

1

84.7

Hospital

ate depot injection

decanoate
40 mg

Injection

10

840-1

Pharmacy

depot
Depixol®
Haloperidol decano-

Haloperidol

ate depot injection

depot

Paliperidone

Paliperidone

palmitate depot

palmitate depot

200
50 mg

injection

5

950 -

Hospital

1 080
50 mg

injection

1

1 262

Hospital

injection
Diazepam

Diazepam

5 mgtablet100

17

Hospital

Lorazepam

Lorazepam

2 mgtablet28

Free

Hospital

Lorazepam

2 mgtablet100

21.84

Pharmacy

Carbamazepine

200 mgtablet100

35

Hospitaly

Exeter™

200 mgtablet100

82

Pharmacy

Lithium

200 mgtablet100

Free

Hospital

5 mg

tablet60

182

Pharmacy

Carbamazepine

Lithium carbonate

carbonate
Melatonin

Novo melatron®

21

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand nameStrengthFormof unit

Number

Price

Place

of units inper box(pharmacy,

thein GHS

hospital, …)

container
Nitrazepam

Dormicum®

1.5 mgtablet20

290

Pharmacy

Trihexyphenidyl

Trihexyphenidyl

5 mgtablet28

28

HospitalThiamine

Thiamine

100 mgtablet100

63

HospitalThiamine

100 mgtablet100

116

Pharmacy

22

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Annex 1: Bibliography
Oral sources, including anonymous sources
CMKII101, a consultant psychiatrist, interview, Accra, July 2023. The person wishes to remain
anonymous.
CMKII102, an administrator at a private hospital, interview, Accra, July 2023. The person
wishes to remain anonymous.

Public sources
BasicNeeds Ghana, 2020, https://basicneedsghana.org/, accessed 18 August 2023
CAMHA (Care & Action in Mental Health for Africa), What we’re all about, n.d.,
https://www.camha.org/about-us/, accessed 18 August 2023
Ghana Somubi Dwumadie, Our Management Team, n.d., https://www.ghanasomubi.com/ourteam, accessed 18 August 2023
Ghana Somubi Dwumadie, Self-help groups support service users in times of crisis and givethem a sense of belonging, A four-year disability inclusion programme in Ghana, 2020,
https://www.ghanasomubi.com, accessed 19 June 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 18 August 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 18 August 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 18 August2023
Ghana, NHIS (National Health Insurance Scheme), Medicine List, February 2023,
https://nhis.gov.gh/medlist, accessed 22 August 2023
Ghana, Republic of Ghana Mental Health Act (846) (2012), June 2012,https://www.refworld.org/pdfid/528f243e4.pdf, accessed 18 August 2023

23

EUROPEAN UNION AGENCY FOR ASYLUM

Ghanaian Times, BusinessGhana, MHA unveils toll-free No. for psycho-social support,
September 2022, https://www.businessghana.com/site/news/general/271049/MHA-unveilstoll-free-No-for-psycho-social-support, accessed 20 June 2023
Kpobi, L. and Swartz, L. (2019). Indigenous and faith healing in Ghana: A brief examination of
the formalising process and collaborative efforts with the biomedical health system, African
Journal of Primary Health Care & Family Medicine, Vol. 11, Issue 1, July 2019,https://phcfm.org/index.php/phcfm/article/view/2035/3225, pp. 1-5, accessed 18 August 2023
Mental Health Foundation Ghana, Mental Health and Human Rights Info, n.d.,
https://www.hhri.org/organisation/mental-health-foundation-ghana/, accessed 18 August 2023
Mind Freedom Ghana, Explore the Nation in Mental Health Care, 2022,
https://mindfreedomghana.org/, accessed 18 August 2023
WHO (World Health Organization), Africa, Ghana, Redefining mental healthcare in Ghana,
October 2022, https://www.afro.who.int/countries/ghana/news/redefining-mental-healthcareghana, accessed 18 August 2023
WHO (World Health Organization), Ghana, WHO Special Initiative for Mental Health Situational
Assessment, January 2022, https://cdn.who.int/media/docs/default-source/mentalhealth/special-initiative/who-special-initiative-country-report---ghana---2021.pdf, accessed 18
August 2023
WHO (World Health Organization), Ministry of Health, WHO-AIMS Report on Mental Health
System in Ghana, 2020, https://www.afro.who.int/sites/default/files/202211/WHO%20AIMS%202020%20Report%20on%20Ghana%27s%20mental%20health%20system.pdf, accessed 18 August 2023

24

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY

Annex 2: Terms of Reference (ToR)
Psychiatry; mood disorders like depression, anxiety disorders like PTSD, psychotic disorders
like schizophrenia, bipolar disorder, sleeping disorders. Addiction problems: e.g. alcohol- andopioid addiction
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 psychiatric diseases [mood disorders(e.g., depression), psychotic disorders (e.g., schizophrenia, bipolar disorder) ,anxiety disorders ( e.g., PTSD) and addiction problems ( e.g., alcohol and opioid
addictions)] / types of these diseases (epidemiologic data).

•

How is the health care organized for these diseases?

•

How are these diseases treated – at specific centres, in primary health care
centres, secondary care / hospitals, tertiary care etc.?

•

Which kinds of facilities can treat the 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 these 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 psychiatric diseases?

•

Are there any national or international plans or (donor) programmes for certain
diseases; if yes, could you elaborate on such programme(s) and what it entails?

Access to treatment•

Are there specific treatment programmes for these psychiatric diseases: mooddisorders like depression, anxiety disorders like PTSD, psychotic disorders likeschizophrenia, bipolar disorder, sleeping disorders. Addiction problems: eg
alcohol- and opioid addiction? If so, what are the eligibility criteria to gain access toit and what they contain?

•

Are there specific government (e.g., insurance or tax) covered programmes forthese diseases? If so, what are the eligibility criteria to gain access to it?

25EUROPEAN UNION AGENCY FOR ASYLUM•

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 psychiatric disease (after being
diagnosed with the disease)? In other words: for any necessary treatment, where
can the patient find help and/or specific information? Where can s/he receive
follow-up treatment? Are there waiting times for treatments (e.g., for psychiatrichospitals,, etc)?

•

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 ora public or private institution? Is treatment covered by social protection or an
additional / communal health insurance?

•

Any occurrences of healthcare discrimination for people with psychiatric disease?

Note: a standardised list of treatments was also included in the original ToR, as can beviewed in the report.

Insurance and national programmes
Include if relevant, otherwise delete section.
•

National coverage (state insurance).

•

Programmes funded by international donor programmes,•

Include any insurance information that is specific for patients with psychiatricdiseases.

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 could not befound if that is the case.

•In the table, indicate the price for inpatient and outpatient treatment in public andprivate facility and if the treatments are covered by any insurance or by the state.

26

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY•

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.

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?

•

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.

NGOs
Include if relevant, otherwise delete section.
•

Are any NGOs or international organisations active for patients of psychiatricdiseases? What are the conditions to obtain help from these organisations? What
help or support can they offer?

27

EUROPEAN UNION AGENCY FOR ASYLUM•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 in case of NGOs providing care only to children for instance).

28

GHANA TOPICAL MEDCOI REPORT: PSYCHIATRY29