Ghana
Nephrology
MedCOI

July 2024

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

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

3

EUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements......................................................................................................................... 1
Disclaimer ........................................................................................................................................ 5
Glossary and abbreviations ........................................................................................................... 6
Introduction ..................................................................................................................................... 7
Methodology ......................................................................................................................................... 7
Terms of reference ..................................................................................................................... 7
Collecting information................................................................................................................ 7
Quality control .............................................................................................................................. 7
Sources ................................................................................................................................................... 8
1.

Prevalence of kidney diseases and renal failure (RF) .................................................... 92.

Access to treatment ........................................................................................................... 92.1. Insurance and national programmes .................................................................................... 112.2. Non-governmental Organisations (NGOs) ........................................................................... 11

3.

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

4.

Cost of medication ............................................................................................................14

Annex 1: Bibliography ................................................................................................................... 17
Annex 2: Terms of Reference (ToR) .............................................................................................194

GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

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

5

EUROPEAN UNION AGENCY FOR ASYLUMGlossary and abbreviations
Term

Definition

AKI

Acute Kidney Injury

CHPS

Community Health Planning and Services

CKD

Chronic Kidney Disease

ESRD

End-Stage Renal Disease

EUR

Euro

FDA

Food and Drugs Authority

GFR

Glomerular Filtration Rate

HD

Haemodialysis

KATH

Komfo Anokye Teaching Hospital

KBTH

Korle Bu Teaching HospitalNGO

Non-Government Organisation

NHIS

National Health Insurance Scheme

PHC

Primary Healthcare

PTH

Parathyroid Hormone

RF

Renal Failure

RRT

Renal Replacement Therapy

USD

United States Dollar
6

GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

Introduction
Methodology
The purpose of the report is to provide information on access to kidney diseases 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 9 November
2023, peer review occurred between 10 November – 22 December 2023, and additional
information was added to the report as a result of the quality review process during the review
implementation up until 27 March 2024. The report was internally reviewed subsequently.

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

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

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

7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 Annex 1: Bibliography.
Key informant interviews were carried out in September 2023. Interviews were conducted
mainly with officers who work within organisations of Ghana’s healthcare system. A complete
anonymised list of interviewees can be found in the Annex 1: Bibliography.

8

GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

1.

Prevalence of kidney diseases and renal
failure (RF)

Nephrology is a medical speciality that focuses on the study of the kidneys, specifically normal
kidney function (renal physiology) and kidney disease (renal pathology), the preservation of
kidney health and the treatment of kidney diseases. This report looks at the situation of carefor kidney diseases and renal failure in Ghana.
There is scant data on the spectrum of renal diseases in Ghana. 4 The prevalence of renal
diseases in different regions of Ghana varies depending on the study and the population
being studied. The breakdown of renal disease types found in a 13-year retrospective study
conducted at the nephrology unit of Komfo Anokye Teaching Hospital (KATH), Kumasi,
showed that 70.76 % of the 1 426 participants had chronic kidney disease ((CKD) or renal
failure (RF)), 20.69 % had end-stage renal disease (ESRD), 5.05 % had acute kidney injury(AKI), and 3.51 % had nephrotic syndrome.5
A multicentre cross-sectional study found that the prevalence of CKD among patients withhypertension and diabetes was 28.5 %, for patients with only hypertension or diabetes theprevalence was found to be 26.3 % and 16.1 %, respectively. 6

2. Access to treatment
Ghana has a pluralistic health sector in terms of ownership (public and private), and in terms ofhealthcare models (orthodox, traditional and alternative medicine). 7 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. 8 The health system is organised inthree levels: the primary level, with a focus on primary healthcare (PHC) services, starts withthe community-based health and planning services (CHPS) compound, then the sub-district
health centre/clinic and ends up at the district hospital. The secondary and tertiary levels haveregional and teaching hospitals, respectively. 9

Okyere, P., et al., Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year
Retrospective Study, April 2020, url, p. 2
5
Okyere, P., et al., Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year
Retrospective Study, April 2020, url, p. 4
6
Tannor, E. K., et al., Prevalence and predictors of chronic kidney disease among Ghanaian patients withhypertension and diabetes mellitus: A multicenter cross-sectional study, October 2019, url, p. 1544
7
Ghana, MOH, National Health Policy: Ensuring healthy lives for all (revised edition), January 2020, url, p.23
8Ghana, MOH, Health Sector Medium Term Development Plan, 2022-2025, December, 2021, url, p. 11
9Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
4

9EUROPEAN UNION AGENCY FOR ASYLUM

Public and private facilities, at all levels of the health system, can provide care within limits set
by the Standard Treatment Guidelines 2017. 10 The primary level of care has limited capacity toidentify and make differential diagnoses of some of the nephrology conditions. This capacity ismostly at the district hospital level where they can make more definitive diagnoses,
commence basic care and continue to refer the client to the appropriate secondary or tertiary
facility for definitive case management. 11
Although there is no single central institute that specialises in the treatment of kidneydiseases / renal failure, the teaching hospitals have the most advanced nephrology careexpertise in country. There are no private specialist nephrology treatment centres, but there
are private health facilities that provide specialist nephrology consultations and care as part oftheir service package. Most of these facilities are in the regional capitals where they haveaccess to part-time services of physician specialists / nephrologists who work in therespective regional or teaching hospitals. There are treatment options for all nephrology
conditions observed in the country. 12
All patients can access care at the nearest point of service to them at any level of the healthsystem. Based on the severity of the condition and the capacity of the point of service tomanage the condition, care will be continued, or the patient will be referred to the next higher
level of care for further appropriate case management. Patients can however walk into any
emergency room in any secondary or tertiary facility and will be admitted for treatment if needbe. 13 Waiting times for outpatient services access are variable, and depend on the clinic andthe patient load for the day. Most clinics do not offer timed appointments; instead, theyschedule patients to come on a particular day. 14
Kidney transplantation is not readily available in Ghana and the predominantly available option
for renal replacement therapy is haemodialysis (HD). 15 As of 2022, there were 51 HD centres
located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning. Of thefunctioning centres most (n = 26, 65 %) are in the Greater Accra Region serving 17.7 % of the
population and 7 (17.5 %) in the Ashanti Region serving 17.5 % of the population in Ghana. The
rest of the 7 regions have 1 centre each. The private sector has twice as many HD centres as
the public sector and the mean cost of HD session is 53.9 ± 8.8 USD [49.07 ± 8.01 EUR] in
Ghana. The cost of HD remains prohibitive and mainly paid out of pocket limiting its
utilisation.16 The cost of dialysis is a limitation to effective treatment of renal failure. 17
Patients with renal diseases in Ghana face several challenges in accessing treatment,
including lack of awareness, limited access to renal replacement therapy (RRT), poor quality of

Ghana, MOH, GNDP, Standard Treatment Guidelines, Seventh Edition, 2017, url, pp. 392, 396
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
12
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
13
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
14
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
15
Boima, V., et al., Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana,
December 2020, url, p. 2
16
Tannor, E. K., et al., The geographical distribution of dialysis services in Ghana, The geographical distribution of
dialysis services in Ghana, January 2018, url, p. 2
17
Okyere, P., et al., Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year
Retrospective Study, April 2020, url, p. 4
10
11

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GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

life, low nephrology workforce, socioeconomic burden and the biggest being affordability oftreatment. 18
The social support system for patients with CKD in Ghana is mainly by their families,
community, workplace and religious groups. 19

2.1.

Insurance and national programmes

The public NHIS and private health insurance schemes cover both inpatient and outpatient
cost of care to different degrees, with the private schemes generally providing more coverthan the NHIS. 20 As of 2019, the NHIS had a membership of over 12 million Ghanaian 21 and it
is available for registration to all individuals living in Ghana. 22
The NHIS covers the consultation fees for all general and specialist clinic attendances, as well
as hospital admission (bed and feeding) are covered. A limited number of laboratory tests arecovered but the cost of specialised laboratory and diagnostic imaging investigations andtreatment are not covered by the NHIS and must be paid for by private insurance schemes orout of pocket. 23
The cost of HD remains prohibitive and is not covered by NHIA, but with some private insurer
providing cover. However, the cost of HD is mainly paid out of pocket, limiting its utilisation. 24

2.2.

Non-governmental Organisations (NGOs)

The Kidney Health International is a non-governmental organisation (NGO) set up in 2016 in
Ghana. It organises educational programmes, free health screening exercises for
disadvantaged populations, and health talks for organised groups and on radio, television,
online media and social media. It also trains volunteers to continually educate the populace on
hypertension, diabetes, obesity, healthy lifestyle and CKD. 25
The Bridge of Life is an NGO founded by DaVita; 26 it provides kidney care services andsupport in Ghana. 27

CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
Tannor, E. K., et al., Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - asingle centre study, April 2019, url, p. 2
20
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
21
NHIS, NHIS active membership soars, July 2020, url
22
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
23
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
24
Tannor, E. K., et al., The geographical distribution of dialysis services in Ghana, The geographical distribution of
dialysis services in Ghana, January 2018, url, p. 2
25
Tannor, E. K., et al., WCN23-0162 Promoting ‘Kidney Health For All’ in Ghana – The Role of a Nephrology-Led
Non-Governmental Organization, March 2023, url, p. S465
26
DaVita Inc is a kidney care provider in the United States, url
27
Bridge of Life, About Us, 2023, url
18

19

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EUROPEAN UNION AGENCY FOR ASYLUM

3. 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 NHIS tariffs are below market prices, so facilities, mainly the teaching hospitals,
will go on to secure parliamentary approval for higher rates for fees and charges that the NHIS
tariffs are unable to fully cover. These additional fees and charges are paid out of pocket bypatients. Other public facilities will have instances where staff request for unofficial fees andcharges for services rendered. 28
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. 29
In Table 1 and Table 2, the prices for public facilities are as available in the NHIS tariffs for
tertiary hospitals (2023). 30 Information for the private sector prices, as well as insurance andreimbursement information, is provided by Interviewee CNpKII103. 31
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.

CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
CNpKII103, Administrator of a Private Hospital, Interview, September 2023
30
NHIS tariffs for tertiary hospitals (2023)”
31
CNpKII103, Administrator of a Private Hospital, Interview, September 2023, Accra
28

29

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GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

Table 1. Cost of nephrology specialist consultations in public tertiary and private health facilities
Specialist

Publicoutpatient
treatment
price in
GHS

Public inpatient treatment pricein GHS

Privateoutpatient
treatment pricein GHS

Private inpatient
treatment pricein GHSInternist

147

128 (cost of admission, notincluding consultation fee)

280 to 400

600 to 1 000

Nephrologist

147

128 (cost of admission, notincluding consultation fee)

280 to 400

600 to 1 100

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

Private treatment price in
GHS

Bacterial cultures

39

200 to 250

Kidney function overall index:
Glomerular Filtration Rate (GFR)

55

120 to 150

Electrolytes: sodium, calcium,
potassium, chloride, phosphate, andmagnesium

Sodium – 20

Sodium – 30 to 40

Calcium – 30

Calcium – 60 to 70

Potassium – 30

Potassium – 30 to 40

Chloride – 20

Chloride – 30 to 40

Phospate – 30

Phospate – 40 to 50

Magnesium – 30

Magnesium – 40 to 50

PTH – 90

PTH – 300 to 350

Phosphate – 30

Calcium – 60 to 70

Calcium – 30

Phospate – 40 to 50

PTH, calcium, phosphate13EUROPEAN UNION AGENCY FOR ASYLUM

Public treatment price in
GHS

Private treatment price in
GHS

Renal/ kidney function (creatinine,
ureum, proteinuria, sodium,
potassium levels)

47

120 to 150

Ultrasound of the kidney

92

300 to 400

Clinical admittance in nephrology
department (daily rates)

127

250 to 400

Surgical placement of an arterial
shunt for haemodialysis

Not found

1 000 to 1 400

Surgical placement of a shunt throughjugular vein for hemodialysis

Not found

1 700 to 2 000

Chronic haemodialysis; cost of one
session*400

800 to 1 200

Acute haemodialysis*

400/ session

800 to 1 200/ session*Treatments not covered by NHIS, but by some private insurances. They are mostly paid outof-pocket by the patients.

4. Cost of medication
The cost of medication in the public sector is regulated by the NHIS medicines’ list. 32 The
NHIS medicines’ list is expected to include official charges for medicines in public facilities.
This is often not adhered to because the insurance tariffs are below the market prices.
Facilities, mainly the teaching hospitals, will go on to secure parliamentary approval for higher
fees and charges to ensure they are able to recover the cost of services and medicines, which
the NHIS may not fully cover. These additional fees and charges are paid out of pocket bypatients. 33

32
33

NHIS, Medicine List, February 2023, url
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
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GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

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. 34
The cost of medication is generally higher in private as compared to public facilities and also
increases from primary to tertiary level of care. 35 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 as against ruralcommunities. 36
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. 37
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. 38
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 for them. 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. 39
In Table 3, ‘Pharmacy’ refers to the private sector and ‘Hospital’ refers to the public sector.
Public facilities prices are provided as listed in the NHIS medicines’ list. 40 Prices in private
facilities as well as information on insurance and reimbursement are provided by interviewee
CNpKII102. 41
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.

CNpKII102, A Specialist Pharmacist, Interview, September 2023, Accra
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
36
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
37
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
38
CNpKII101, Consultant Nephrologist, Interview, September 2023, Accra
39
CNpKII103, Administrator of a Private Hospital, Interview, September 2023, Accra
40
Ghana, NHIS, Medicine List, February 2023, url
41
CNpKII102, Specialist Pharmacist, Interview, September 2023, Accra
34

35

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EUROPEAN UNION AGENCY FOR ASYLUM

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. Cost of medicines
Generic Name

Brand nameStrength of
unit

Form

Numberof unitsin thecontainerPrice
per boxin GHS

Place(pharmacy,
hospital,…)Epoetin alphaBinocrit®

5 000 iu/0.5 ml

injection
pen

1

213

Pharmacy

Epoetin beta

Recormon®

5 000 iu/
0.3 mls

ampoule1

157

Pharmacy

ampoule1

115

HospitalCalciumcarbonate

Calciumcarbonate

1gtablet60

522

Pharmacy

Magnesiumhydroxide +aluminiumhydroxide(combination)

Magnesiumhydroxide +aluminiumhydroxide

400 mg/
400 mgtablet100

24

HospitalCalcium
polystyrene
sulphonate

Calcium
polystyrenesul
phonate15 g

powder20

916

Pharmacy

Sodium(natrium)
polystyrene
sulphonate

Sodiumpolystyrene
sulphonate

15 g

powder1

816.3

Pharmacy

Sodiumbicarbonate (=sodiumhydrogencarbonate)

Sodiumbicarbonate

8.4 % (840 mg in
10 ml)

ampoule1

28.08

Hospital

Alfacalcidol

One-alpha®

0.5 mcg

capsule30

300

Pharmacy

16

GHANA TOPICAL MEDCOI REPORT: NEPHROLOGY

Annex 1: Bibliography
Oral sources, including anonymous sources
CNpKII101, A Consultant Nephrologist, Interview, Accra, September 2023. The person wishes
to remain anonymous.
CNpKII102, A Specialist Pharmacist, Interview, Accra, September 2023. The person wishes toremain anonymous.
CNpKII103, An Administrator of a Private Hospital, Interview, Accra, September 2023. The
person wishes to remain anonymous.

Public sources
Boima, V., Agyabeng, K., Ganu, V., Dey, D., Yorke, E., Amissah-Arthur, M. B., Wilson, A. A.,
Yawson, A. E., Mate-Kole, C. C. and Nonvignon, J., Willingness to pay for kidneytransplantation among chronic kidney disease patients in Ghana, in: PLoS ONE, Vol. 15, Issue
12, Article No. e0244437 [no pagination], December 2020,
https://doi.org/10.1371/journal.pone.0244437, accessed 5 December 2023
Bridge of Life, About Us, 2023, https://www.bridgeoflifeinternational.org/country/ghana/,
accessed 5 December 2023
Ghana, MOH (Ministry of Health), GNDP (Ghana National Drugs Programme), Standard
Treatment Guidelines, Seventh Edition, 2017, https://www.moh.gov.gh/wpcontent/uploads/2020/07/GHANA-STG-2017-1.pdf, accessed 5 December 2023
Ghana, MOH (Ministry of Health), Health Sector Medium Term Development Plan, 2022-2025,
December, 2021, https://www.globalfinancingfacility.org/sites/gff_new/files/Ghana-GFFInvestment-Case.pdf, accessed 5 December 2023
Ghana, MOH (Ministry of Health), National Health Policy: Ensuring healthy lives for all (revised
edition), January 2020, https://www.moh.gov.gh/wpcontent/uploads/2020/07/NHP_12.07.2020.pdf-13072020-FINAL.pdf, accessed 5 December
2023
Ghana, NHIS (National Health Insurance Scheme), Medicine List, February 2023,
https://nhis.gov.gh/medlist, accessed 5 December 2023
Ghana, NHIS (National Health Insurance Authority), Tariffs for Tertiary Hospitals, February
2023, accessed 5 December 2023, not available online

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EUROPEAN UNION AGENCY FOR ASYLUM

Ghana, NHIS (National Health Insurance Scheme), NHIS active membership soars, July 2020,
https://www.nhis.gov.gh/News/nhis-active-membership-soars5282#:~:text=Ghana's%20National%20Health%20Insurance%20Scheme,Accra%20region%20
with%201.7%20million, accessed 5 December 2023
KBTH (Korle Bu Teaching Hospital), Korle Bu Chalks a Milestone in Kidney Transplantation,
July 2023, https://kbth.gov.gh/korle-bu-chalks-a-milestone-in-kidney-transplantation/,
accessed 5 December 2023
Okyere, P., Okyere, I., Dadzie Ephraim, R. K., Attakorah, J., Osafo, C., Arhin, B., Bachelle, S. andAbaka-Yawson, A., Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian
Adults: A 13-Year Retrospective Study, in: International Journal of Nephrology, Article ID:
8967258 [no pagination], April 2020, https://doi.org/10.1155/2020/8967258, accessed 5
December 2023
Tannor, E. K., Awuku, Y. A., Boima, V. and Antwi, S., The geographical distribution of dialysis
services in Ghana, The geographical distribution of dialysis services in Ghana, in: Renal
Replacement Therapy, Vol. 4, Issue 3, [no pagination], January 2018,https://doi.org/10.1186/s41100-018-0143-1, accessed 5 December 2023
Tannor, E. K., Norman, B. R., Adusei, K. K., Sarfo, F. S., Davids, M. R. and Bedu-Addo, G., Qualityof life among patients with moderate to advanced chronic kidney disease in Ghana - a single
centre study, in: BMC Nephrology, Vol. 20, Issue 1, Page: 122 [no pagination], April 2019,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454740/, accessed 5 December 2023
Tannor, E. K., Sarfo, F. S., Mobula, L. M., Sarfo-Kantanka, O., Adu-Gyamfi, R. and Plange-Rhule,J., Prevalence and predictors of chronic kidney disease among Ghanaian patients withhypertension and diabetes mellitus: A multicenter cross-sectional study, in: The Journal of
Clinical Hypertension, Vol. 21, Issue 10, October 2019, pp. 1542-1550,
https://doi.org/10.1111/jch.13672, accessed 5 December 2023
Tannor, E. K., Tannor, A., Gatorwu, S. and Osei-Agyemang, C., WCN23-0162 Promoting ‘Kidney
Health For All’ in Ghana – The Role of a Nephrology-Led Non-Governmental Organization, in:Kidney International Reports, Vol. 8, Issue 3, March 2023, pp. S1-S473,
https://www.sciencedirect.com/science/article/pii/S2468024923010938, accessed 5
December 2023

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Annex 2: Terms of Reference (ToR)
Nephrology (kidney diseases; renal failure)
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
•
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•
•

•
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•
•

Briefly describe prevalence and incidence of kidney diseases and renal failure / typesof this disease (epidemiologic data).
How is the health care organized for nephrology 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 these diseases [public, private not for profit (e.g.,
hospitals run by the church), private for-profit sector]? Include links to facilities’
websites if possible.
How are the resources organized in general to treat patients with kidneydiseases/renal failure? Are there sufficient resources available to treat all patients?
Is there a particular type of kidney diseases/renal failure for which no (or only partial)
treatment exists in the country?
Is there a (national) institute specialised in treating kidney diseases/renal failure?
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
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•

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

•

the patient find help and/or specific information? Where can s/he receive follow-up
treatment? Are there waiting times for treatments (e.g., dialysis, kidney transplantation,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 or apublic or private institution? Is treatment covered by social protection or an additional /communal health insurance? If not, how can the patient gain access to a treatment?
Any occurrences of healthcare discrimination for people with this disease?

Insurance and national programmes (include if relevant•••

National coverage (state insurance).
Programmes funded by international donor programmes.
Include any insurance information that is specific for patients with this disease.

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

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

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

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

Do not delete any medicines from the tables. Instead, state that they are not available
or information could not be found if that is the case.

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•
•
•
•

•
•

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. Any medication without a found price was removed at the editorial
stage.

NGOs••

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

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