1GhanaNeurology

January 2024

Manuscript completed in January 2024
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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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Acknowledgements
The EUAA acknowledges International SOS as the drafter of this report.
The report has been reviewed by International SOS and EUAA.

EUROPEAN UNION AGENCY FOR ASYLUMContent
Acknowledgements......................................................................................................................... 1
Content ............................................................................................................................................ 2
Disclaimer ........................................................................................................................................ 3
Glossary and abbreviations ........................................................................................................... 4
Introduction ..................................................................................................................................... 6
Methodology ......................................................................................................................................... 6
Terms of reference....................................................................................................................... 6
Collecting information ................................................................................................................. 6
Quality control ............................................................................................................................... 6
Sources1.

................................................................................................................................... 7

Neurology............................................................................................................................ 8
1.1. General information .................................................................................................................... 8
1.2. Overview of the health sector.................................................................................................. 92.

Access to treatment ......................................................................................................... 10

3.

Insurance and national programmes .............................................................................. 11

4.

Non-governmental organisations (NGOs) ......................................................................12

5.

Cost of treatment ..............................................................................................................12

6.

Cost of medication ............................................................................................................15

Annex 1: Bibliography ...................................................................................................................19
Annex 2: Terms of Reference (ToR) .............................................................................................212

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

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

AFAN

African Federation of Neurological Associations

CHPS

Community-Based Health Planning Services

CT

Computed Tomography

EEG

ElectroEncephalogram

FDA

Food and Drugs Authority

GFAEI

Ghana Fights Against Epilepsy Initiative

GHS

Ghanaian Cedi

GMA

Ghana Medical Association

IBE

International Bureau for Epilepsy

ILAE

International League Against Epilepsy

IM

IntramuscularIV

Intravenous

MDS

Movement Disorder Society

MhGAP

Mental Health Gap Action Program

MRI

Magnetic Resonance Imaging

4

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

TermDefinitionNGO

Non-Governmental Organisation

NHIS

National Health Insurance Scheme

NSG

Neurology Society of Ghana

PD

Parkinson's Disease

PCH

Primary Healthcare

WFN

World Federation of Neurology

WHO

World Health Organization

5

EUROPEAN UNION AGENCY FOR ASYLUM

Introduction
Methodology
The purpose of the report is to provide information on access to neurology 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
1

2

6

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

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.

7EUROPEAN UNION AGENCY FOR ASYLUM

1.

Neurology

Neurology is a branch of medicine that deals with the diagnosis and treatment of disorders
and diseases of the nervous system, which includes the brain, spinal cord, and peripheral
nerves. This report looks at the situation of care for epilepsy, cerebral vascular accident (CVA)/“stroke” and Parkinson’s disease in Ghana.

1.1.

General information

Ghana faces a burden of neurological disorders; however, as in many developing countries,
there is a lack of comprehensive data on the clinical spectrum of these disorders. 4 There is nodata on the prevalence or incidence of stroke and Parkinson’s disease (PD) across society, but
studies using hospital data indicate the common neurological disorders. A review ofneurological outpatient visits at Korle Bu Teaching Hospital, the national referral centre, lists
the top five neurological disorders as:•

epilepsy (23.0 %)•peripheral neuropathies (19.6 %)•movement disorders (14.7 %)•cerebrovascular diseases (11.1 %)•headache disorders (7.7 %) 5

A review in Kumasi showed similar results. 6 Of the movement disorders, idiopathic PD was
predominant. 7
In a multicentre, hospital-based, prospective cohort study, the incidence rate of stroke overall,over an 18-month period, was 14.19 events per 1 000 person-years. The incidence rate amongindividuals aged < 40 years was 3.48, 40-49 years was 9.50, 50-59 years was 15.57, 6069 years was 21.41, 70-79 years was 12.82 and 80+ years was 16 per 1 000 person-years. 8
Epilepsy prevalence is 1 % of the population with a treatment gap of 85 %. It is estimated that
only 15 % of the estimated 270 000 people living with epilepsy receive treatment and care. 9

Sarfo, F. S., et al., Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana, June 2016, url, p.
69
5
Akpalu, A., et al., Neurological disorders encountered at an out-patient clinic in Ghana’s largest medical center: A
16-year review, July 2021, url, p. 2
6
Sarfo, F. S., et al., Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective
cohort study, Journal of the Neurological Sciences, September 2018, url, p. 17
7
Akpalu, A., et al., Neurological disorders encountered at an out-patient clinic in Ghana’s largest medical center: A
16-year review, July 2021, url, p. 5
8
Sarfo, F. S., et al., Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective
cohort study, September 2018, url, p. 19
9WHO, Africa, Ghana, "Fight against Epilepsy" Initiative in Ghana, WHO Programme on reducing the epilepsy
treatment gap 2012–2016, 2018, url, p. 19
48

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

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 diagnoses of some neurological conditions. This capacity isfound mostly 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
Regional hospitals have specialists who are trained to manage simple neurological disorders,e.g. stroke, paraparesis and facial nerve palsy, among others. 15 In addition, secondary care atregional level can manage headaches, tremors and peripheral neuropathies but they need torefer to higher levels of care. 16 Tertiary care at the Teaching Hospital level, which houses
specialist neurology departments where most of the neurologists are situated, has theexpertise to appropriately manage the majority of neurological presentation seen in Ghana. 17
Though there is no institute specialised in the treatment of neurological disease, the Korle Bu
and Komfo Anokye Teaching Hospitals in Accra and Kumasi, respectively, have the mostneurological expertise; and both have a neurology unit that runs a general neurology andsubspeciality clinic including a stroke clinic. 18 There are no private specialist neurologicalcentres/facilities but there are a few private health facilities, which provide specialist
neurological consultations as part of their service package. Most of these facilities are in Accra
and Kumasi where neurologists working in the respective teaching hospitals can provide parttime services in the private sector. 19

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, 1 December, 2021, url, p. 11
12
Ghana, MOH, Health Sector Medium Term Development Plan, 2022-2025, 1 December 2021, url, p. 11
13
Ghana, MOH, GNDP, Standard Treatment Guidelines, 2017, url, pp. 129, 205
14
CNKII01, consultant neurologist, interview, July 2023, Accra
15
CNKII01, consultant neurologist, interview, July 2023, Accra
16
CNKII01, consultant neurologist, interview, July 2023, Accra
17
CNKII01, consultant neurologist, interview, July 2023, Accra
18
CNKII01, consultant neurologist, interview, July 2023, Accra
19
CNKII01, consultant neurologist, interview, July 2023, Accra
10
11

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EUROPEAN UNION AGENCY FOR ASYLUM

Neurology care, at the specialist level, is provided by both physician specialist (internists) andsub-speciality neurologists. There are few sub-specialists in the field of neurology, and it isestimated that there are currently only 12 neurologists serving the population of 32 million. 20
With respect to stroke care, the required infrastructure and diagnostic technology are notreadily available and there is a human resource capacity gap of cadres of health workers tomeet care needs. 21 The available services for neurological care is generally consideredinadequate. 22

2.

Access to treatment

Treatment is available at all levels of the health system, within the prescribed limits of theStandard Treatment Guidelines 2017. 23 All patients can access care at the nearest point ofservice to them at any level of the health system. Based on the severity of the condition andthe capacity of the point of service to manage the condition, the patient will be referred to thenext higher level of care for further appropriate case management. A referral to the teaching
hospitals to see a specialist, from a primary/secondary facility, has a usual waiting time (apartfrom an emergency) of 2-6 weeks. 24 Other rehabilitation services, such as physiotherapy,
speech therapy and occupational therapy, as part of care for persons with cerebral vascular
accident (CVA), are available at the tertiary level. Physiotherapy is also readily available at thesecondary level and at some district hospitals. To support patients with both acute andchronic conditions, there are an increasing number of private home care service providers
who are able to provide the needed care. 25
Treatment is geographically accessible in all the regions. However, urban towns have better
access to neurological services than rural areas, primarily because of the presence there ofsecondary and/or tertiary facilities. There are no restrictions to patients’ access to treatment;
everyone has access to all services that are available at all levels of the health system. 26 There
are barriers to access though: in particular for epilepsy, stigma and discrimination are major
obstacles to early identification, treatment and social integration. 27 In general, the mostsignificant barriers to treatment access for all the conditions include the inability to pay for thecare available. 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) covered, as determined by their insurance package, while those without any formof insurance will have to pay out of pocket for these services. Private health insurance

CNKII01, consultant neurologist, interview, July 2023, Accra
Baatiema, L., et al., Towards best practice in acute stroke care in Ghana: a survey of hospital services, February
2017, url, p. 7
22
CNKII01, consultant neurologist, interview, July 2023, Accra
23
Ghana, MOH, GNDP, Standard Treatment Guidelines, 2017, url
24
CNKII01, consultant neurologist, interview, July 2023, Accra
25
CNKII01, consultant neurologist, interview, July 2023, Accra
26
CNKII01, consultant neurologist, interview, July 2023, Accra
27
WHO, Africa, Ghana, "Fight against Epilepsy" Initiative in Ghana, WHO Programme on reducing the epilepsy
treatment gap 2012–2016, 2018, url, p. 24
20
21

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GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

schemes cover more types of services and are able to pay higher economic tariffs for services
covered than what the NHIS offers. 28
The main sources of financing for the majority of people living with neurological conditions is
the National Health Insurance. However, this often only covers the cost of inpatient (bed andfeeding) and outpatient care (consultation), as well as in both services, some laboratory
investigations and categories of medicines. Anything not covered by insurance will have to be
paid for out of pocket at the point of service. 29
Patients pay for all services received at outpatient, as well as inpatient points of care. These
include the cost of consultation, diagnostic services, medicines and inpatient accommodation
fees, as necessary. If insured, payment is done by the patient through their NHIS card and thefacility is reimbursed at a later stage. If uninsured, then payment is being done out of pocket,
and it is expected to be made before services are provided. Payment is on-site and pay perservice. 30
With the exception of the NHIS, there is no government financial support for patients withneurological conditions. The NHIS coverage for neurological diseases is consideredinadequate as it does not fully cover the cost of diagnostics and medicines. 31 The access totreatment, as described, is the same for those returning home. There is no discrimination toaccess to treatment for any of the conditions but there is a high level of stigma related toepilepsy (which does not translate into discrimination). This situation, with respect to access totreatment, is the same for citizens returning to Ghana. 32

3.

Insurance and national programmes

The public NHIS and private health schemes cover both inpatient and outpatient cost of care
to different degrees, with the private schemes generally providing more cover than the
NHIS. 33
International donor programmes that are supporting the care of neurological conditions in
Ghana are few and include the free medication programme for PD sponsored by theMovement Disorder Society (MDS) and the Grigori Foundation in Milan, which supports accessto Madopar® (levodopa + benserazide) free of charge to registered patients. There are also
the World Health Organization (WHO) and the Ghana Fights Against Epilepsy Initiative (GFAEI),
which aim at reducing the treatment gap in epilepsy care (currently at 85 %). 34

CNKII01, consultant neurologist, interview, July 2023, Accra
CNKII01, consultant neurologist, interview, July 2023, Accra
30
CNKII01, consultant neurologist, interview, July 2023, Accra
31
CNKII01, consultant neurologist, interview, July 2023, Accra
32
CNKII01, consultant neurologist, interview, July 2023, Accra
33
CNKII01, consultant neurologist, interview, July 2023, Accra
34
WHO, Africa, Ghana, "Fight against Epilepsy" Initiative in Ghana, WHO Programme on reducing the epilepsy
treatment gap 2012–2016, 2018, url, p. 24
28

29

11

EUROPEAN UNION AGENCY FOR ASYLUM

4.

Non-governmental organisations(NGOs)

There are a number of NGOs that have interest in and provide support for people affected bythese neurological conditions. Those organisations are:
1.

The Ghana Epilepsy Society - an affiliate of the International League Against Epilepsy(ILAE) and the International Bureau for Epilepsy (IBE). 35

2. The Neurology Society of Ghana (NSG) - an affiliate of the African Federation of
Neurological Associations (AFAN) and the World Federation of Neurology (WFN). 36
3. MDS African Section - offers support for patients and provides education andadvocacy, as well as facilitates access to free medication (access to Madopar) for
patients suffering from Parkinson’s disease. 37
4. BasicNeeds-Ghana, an NGO - is involved in improving livelihoods of patients living withepilepsy. 38
Services provided by these NGOs are free of charge and unrestricted to patients and service
providers who need these. 39

5.

Cost of treatment

The cost of treatment in the public sector is 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 lower than the market prices and do not cover the current
cost of the services. Facilities, mainly the teaching hospitals, will obtain parliamentary approvalfor higher rates for fees and charges that the NHIS tariffs are unable to fully cover. These
additional fees and charges are paid out of pocket by patients. Other public facilities will haveinstances where staff request unofficial fees and charges for services rendered. 40
The cost of treatment is generally higher in private than in public facilities and also increases
from primary to tertiary level of care. 41 The cost of treatment in the private sector is not
regulated and different service providers set different fees and charges that enable them to, atleast, fully recover their costs. These fees and charges may be revised at any time, and the

ILAE-Africa, Ghana Epilepsy Society, 2023, url
CNKII01, consultant neurologist, interview, July 2023, Accra
37
International Parkinson and Movement Disorder Society (MDS)-African Section, n.d., url
38
BasicNeeds Ghana, 2020, url
39
CNKII02, administrator at a private hospital, interview, July 2023, Accra
40
CNKII01, consultant neurologist, interview, July 2023, Accra
41
CNKII01, consultant neurologist, interview, July 2023, Accra
35

36

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GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

revisions are primarily influenced by foreign exchange rates. 42 The cost of treatment isgenerally higher in private compared to public facilities and increases from primary to tertiarylevel of care. 43
In Table 1 and Table 2, the public outpatient and inpatient treatment prices are based on NHIS
prices, 44 and the private outpatient and inpatient treatment prices, as well as reimbursement
and insurance information are provided by interviewee CNKII02. 45
Concerning the coverage and reimbursement of the treatment prices in the tables 1 and 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 treatment for adults in public tertiary and private health facilities
Specialist

Publicoutpatient
treatment pricein GHS

Public inpatient
treatment price in
GHS**

Privateoutpatient
treatment pricein GHS

Private inpatient
treatment pricein GHS**

Neurologist*

80.70

128.59400 - 1 000

400 - 600

Neurosurgeon*

80.70

128.59400 - 1 000

400 - 600Internist*

80.70

128.59300 - 600

400 - 600

Rehabilitation
specialist*

80.70

128.59300 - 600

400 - 600

CNKII02, administrator at a private hospital, interview, July 2023, Accra
CNKII01, consultant neurologist, interview, July 2023, Accra
44
Ghana, NHIS, Tariffs for Tertiary Hospitals, February 2023
45
CNKII02, administrator at a private hospital, interview, July 2023, Accra
42
43

13

EUROPEAN UNION AGENCY FOR ASYLUM* Rates quoted are per consultation excluding medication, investigations and procedures that
may be needed.
** Inpatient prices are calculated per day.
Table 2: Laboratory investigation prices for public and private institutions
Public treatment pricein GHS

Private treatment price in
GHS

Laboratory research: Medication level inthe blood (e.g. for antipsychotics/ forantiepileptics and/ or for lithium
carbonate)

Information not found

100 - 200

Laboratory research of blood; INR, e.g. incase of acenocoumarol anticlotting

60

100

Diagnostic imaging by means of EEG(electroencephalogram)

350

450

Diagnostic imaging by computed
tomography (CT) scan

423.44800

Diagnostic imaging by magnetic
resonance imaging (MRI) scan

611.79

1 400

Diagnostic imaging: Angiography(=arteriography) of cerebral arteries

275.201 700 - 2 000

Lumbar puncture

400

600

Clinical admittance in neurology
department (daily rates)

127

400 - 600

Clinical admittance in (neuro)
rehabilitation department/ clinic (dailyrates)

127

210

Outpatient treatment by physicaltherapist (one session)

85.56

200 - 300

14

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

6.

Cost of medication

The cost of medication in the public sector is regulated by the NHIS medicines list. 46 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 lower than the market prices.
Facilities, mainly the teaching hospitals, will go on 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 out of pocket by patients. Other public facilities will have instanceswhere staff request unofficial fees and charges for services rendered. 47
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. 48
Most of the medicines are available in the whole country. The private sector pharmacies
maintain a more complete stock of medicines than public facilities, and medicines are more
readily available in urban than in rural communities. 49
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. 50
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. 51
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. 52
In Table 3, ‘Pharmacy’ refers to the private sector and ‘Hospital’ refers to public sector.

Ghana, NHIS, Medicine List, February 2023, url
CNKII02, administrator at a private hospital, interview, July 2023, Accra
48
CNKII02, administrator at a private hospital, interview, July 2023, Accra
49
CNKII02, administrator at a private hospital, interview, July 2023, Accra
50
CNKII02, administrator at a private hospital, interview, July 2023, Accra
51
CNKII02, administrator at a private hospital, interview, July 2023, Accra
52
CNKII02, administrator at a private hospital, interview, July 2023, Accra
46
47

15

EUROPEAN UNION AGENCY FOR ASYLUM

Public facilities prices as listed in the NHIS medicines’ list. 53 No brand names are covered
under the medicines’ list. 54 Prices in private facilities and information on insurance andreimbursement are provided by interviewee CNKII02. 55
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.
Table 3: Medicines prices in public and private facilities
Generic Name

Brand nameStrengthof unit

Form

Numberof units inthecontainer

Price
per
box inGHS

Place(pharmacy,
hospital, …)

Carbamazepine

Tegretol®

200 mgtablet50

130Pharmacy

Carbamazepine

200 mgtablet50

47

Hospital

ClobazamUrbanol®

10 mgtablet100

627

Pharmacy

Clonazepam

Rivotril®

0.5 mgtablet100

452

Pharmacy

Gabapentine

Gabapentil

400 mgcapsule100

780

Pharmacy

Lamotrigine

Lamotrigine

50 mgtablet56

84

Pharmacy

Levetiracetam

Keppra®

250 mgtablet50

165

Pharmacy

Phenobarbital

Phenobar™

30 mg

tablet100

50

Pharmacy

Ghana, NHIS, Medicine List, February 2023, url
CNKII02, administrator at a private hospital, interview, July 2023, Accra
55
CNKII02, administrator at a private hospital, interview, July 2023, Accra
53

54

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GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

Brand nameStrengthof unit

Form

Numberof units inthecontainer

Price
per
box inGHS

Place(pharmacy,
hospital, …)

Phenobarbital

30 mg

tablet100

14

Hospital

Epanutin®

100 mgtablet100

100

Pharmacy

Phenytoin

100 mgtablet100

84

Hospital

Pregabaline

Lyrica®

75 mg

capsule30

175

Pharmacy

Valproic acid OR
valproate OR
Depakine®

Epilim®

200
mg/5 mlsyrup

300 ml97

Pharmacysyrup

300 ml165

Hospital

Generic Name

Phenytoin

Valproate

200
mg/5 ml

Diazepam (i.v.
injection for
epileptic attacks)

Diazepam

10 mg/ 2ml

Injection

10

9.13

HospitalMidazolam (i.m.
injection for
epileptic attacks)

Midazolam

5 mg/
5 ml

Injection

1

45.98

HospitalMidazolam (i.v.
injection for
epileptic attacks)

Dormicum

15 mg/
3 ml

Injection

5622

Hospital

Acetylsalicylic acid
(Aspirin®)

Aspar™

75 mg

tablet100

22

Pharmacy

Acetylsalicylic
acid (Aspirin®)

300 mgtablet100

16

Hospital

ApixabanEliquis™

2.5 mgtablet60

2 886

Pharmacy

Axaban- Denk

5 mg

tablet60

1 872

Hospital

Plavix™

75 mg

tablet28

618

Pharmacy

Clopidogrel

17

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand nameStrengthof unit

Form

Numberof units inthecontainer

Price
per
box inGHS

Place(pharmacy,
hospital, …)

Enoxaparin

Clexane™

40mg/0,4ml

injection

2

100

Pharmacy

injection

1

74.57

Hospital

Injection

10811.20

Pharmacy

Enoxaparin
Heparin

Heparin100
mg/ml
5 000 iu/
5 ml

Heparin

5 000 iu/
5 ml

injection

1

81.12

Hospital

Rivaroxaban

Xarelto™

20 mg

tablet14630

Pharmacy

Warfarin

Warfarin

5 mgtablet28

23.52

Hospital

Bromocriptine
mesilate

Parlodel®

1.5 mgtablet30

90

Pharmacy

Bromocriptine

2.5 mgtablet90

140.40

Hospital

Levodopa +benserazide

Madopar®

100/ 25mgtablet100

240

Pharmacy

Levodopa +carbidopa

Sinemet®

100/ 10mgtablet100

420

Pharmacy18

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

Annex 1: Bibliography
Oral sources, including anonymous sources
CNKII01, a consultant neurologist, interview, Accra, July 2023. The person wishes to remain
anonymous.
CNKII02, an administrator at a private hospital, interview, Accra, July 2023. The person wishes
to remain anonymous.

Public sources
Akpalu, A., Adjei, P., Nkromah, K., Poku, F. O. and Sarfo, F. S., Neurological disorders
encountered at an out-patient clinic in Ghana’s largest medical center: A 16-year review,
eNeurologicalSci, July 2021, https://doi.org/10.1016/j.ensci.2021.100361, article no. 100361,pp.
1-7, accessed 18 August 2023
Baatiema, L., Otim, M., Mnatzaganian, G., De-Graft Aikins, A., Coombes, J. and Somerset, S.,
Towards best practice in acute stroke care in Ghana: a survey of hospital services, BMC
Health Services Research, February 2017, https://doi.org/10.1186/s12913-017-2061-2, article no.
108, accessed 18 August 2023
BasicNeeds Ghana, 2020, https://basicneedsghana.org/, accessed 18 August 2023
Ghana, MOH (Ministry of Health MOH), Health Sector Medium Term Development Plan, 20222025, 1 December 2021, https://www.globalfinancingfacility.org/sites/gff_new/files/GhanaGFF-Investment-Case.pdf, accessed 18 August 2023
Ghana, MOH (Ministry of Health), GNDP (Ghana National Drugs Programme), Standard
Treatment Guidelines, Seventh Edition (7th), 2017, https://www.moh.gov.gh/wpcontent/uploads/2020/07/GHANA-STG-2017-1.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 Authority), Tariffs for Tertiary Hospitals, February
2023, accessed 22 August 2023, not available online
Ghana, NHIS (National Health Insurance Scheme), Medicine List, February 2023,
https://nhis.gov.gh/medlist, accessed 22 August 2023

19

EUROPEAN UNION AGENCY FOR ASYLUMInternational League Against Epilepsy (ILAE)-Africa, Ghana Epilepsy Society, 2020,
https://www.ilae.org/regions-and-countries/national-chapters/ghana, accessed 22 August2023
International Parkinson and Movement Disorder Society (MDS)-African Section, n.d,
https://www.movementdisorders.org/MDS-AS, accessed 22 August 2023
Sarfo, F. S., Akassi, J., Badu, E., Okorozo, A. B., Ovbiagele, B. and Akpalu, A., Profile ofneurological disorders in an adult neurology clinic in Kumasi, Ghana, eNeurologicalSci, Vol. 3,
June 2016, https://doi.org/10.1016/j.ensci.2016.03.003, pp. 69-74, accessed 18 August 2023
Sarfo, F. S., Mobula, L. M., Plange-Rhule, J., Ansong, D. and Ofori-Adjei, D., Incident stroke
among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study,
Journal of the Neurological Sciences, September 2018,https://doi.org/10.1016/j.jns.2018.09.018, pp. 17-24, accessed 18 August 2023
WHO (World Health Organization), Africa, Ghana, "Fight against Epilepsy" Initiative in Ghana,
WHO Programme on reducing the epilepsy treatment gap 2012–2016, 2018,https://www.afro.who.int/sites/default/files/2018-11/WHO-Epilepsy-Ghana_web.pdf , accessed
18 August 2023

20

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

Annex 2: Terms of Reference (ToR)
Neurology (epilepsy, cerebral vascular accident (CVA)/“stroke”, Parkinson’s disease
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 diseases Epilepsy, CVA andParkinson’s disease/ types of these diseases (epidemiologic data).
How is the health care organized for neurological diseases?
How are the 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 neurologicaldiseases? 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 neurological 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 neurological 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 thisdisease? 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?
21EUROPEAN UNION AGENCY FOR ASYLUM•

What is the ‘typical route’ for a patient with this disease (after being diagnosed withthe 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 neurological rehab. clinics 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? If not, how can the patient gain access toa treatment?

•

Any occurrences of healthcare discrimination for people with neurologicaldiseases: (e.g., access is denied because of having this disease)?

Insurance and national programmes•

National coverage (state insurance).

•

Programmes funded by international donor programmes.

•

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

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.

•

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.

22

GHANA TOPICAL MEDCOI REPORT: NEUROLOGY

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 the prices could
not be found 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 with neurologicaldiseases? 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 in case of NGOs providing care only to children for instance).

23

EUROPEAN UNION AGENCY FOR ASYLUM

24