Ghana
Cardiovascular Diseases
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: CARDIOVASCULAR DISEASES

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

3

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

Incidence and prevalence of cardiovascular diseases ................................................. 10
1.1. Hypertension .............................................................................................................................. 10
1.2. Myocardial infarction (MI) ......................................................................................................... 11
1.3. Heart failure (HF)......................................................................................................................... 11
1.4. Heart rhythm disorders ............................................................................................................. 112.

Access to treatment ..........................................................................................................122.1. Insurance and national programmes ....................................................................................132.2. Non-government organisations (NGOs) ...............................................................................14

3.

Cost of treatment ..............................................................................................................14

4.

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

Annex 1: Bibliography .................................................................................................................. 22
Annex 2: Terms of Reference (ToR) ............................................................................................ 25

4

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

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

AF

Atrial Fibrillation

AFL

Atrial Flutter

CABG

Coronary Artery Bypass Grafting

ComHIP

Community-Based Hypertension Improvement Project

CHPS

Community-Based Health Planning and Services

CK-MB

Creatine Kinase - Myoglobin Binding

CVD

Cardiovascular Disease

DHIMS

District Health Information Management System

ECG

Electrocardiogram

FDA

Food and Drugs Authority

GAR

Greater Accra Region

GHI

Ghana Heart Initiative

GHS

Ghanaian Cedi

GIZ

Deutsche Gesellschaft für Internationale Zusammenarbeit

HDL

High-Density Lipoprotein

6

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

TermDefinition

HHA

Healthy Heart Africa

HF

Heart Failure

ICD

Implantable Cardioverter Defibrillator

IHD

Ischaemic Heart Disease

KATH

Komfo Anokye Teaching Hospital

KBTH

Korle Bu Teaching Hospital

LDL

Low-Density Lipoprotein

MI

Myocardial Infarction

MOH

Ministry of HealthNGO

Non-Government Organisation

NHIS

National Health Insurance Scheme

PCI

Percutaneous Coronary Intervention

PHC

Primary Healthcare

PTCA

Percutaneous Transluminal Coronary Angioplasty

TEE

Transoesophageal Echocardiogram

USD

United States Dollar

7EUROPEAN UNION AGENCY FOR ASYLUM

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

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

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

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

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

8

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASESThe 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, and reports by non-governmental organisations. All sources that areused in this report are outlined in Annex 1: Bibliography.
Key informant interviews were carried out in September 2023. Interviews were conducted
mainly with officers who work within organisations of Ghana’s healthcare system. A complete
anonymised list of interviewees can be found in the Annex 1: Bibliography.

9EUROPEAN UNION AGENCY FOR ASYLUM

1.

Incidence and prevalence of
cardiovascular diseases

Cardiovascular diseases (CVDs) are increasingly emerging as a major health problem in subSaharan Africa (including Ghana), but the information on the epidemiology, clinicalcharacteristics and spectrum of the diseases is scanty. 4
In a retrospective study looking at trends in CVD admissions and outcomes over the period
January 2004 to December 2015, in central Ghana, the following observations were made:more women presented with CVD than men; there was an increase in the percentage of CVD
admissions from 4.6 % to 8.2 %; the top 3 causes of CVD admissions were heart failure (HF;
88.3 %), ischaemic heart disease (IHD; 7.2 %), and dysrhythmias (1.9 %). Of all HF admissions,
52 % were associated with hypertension; IHD prevalence rose by 250 % between 2005 and2015; and the fatality rate was 23 % with an increase in the percentage of all hospital deaths
that were cardiovascular in nature from 3.6 % to 7.3 %. Cardiac disease admissions andmortality have increased progressively over the past decade, with HF as the most common
cause of admission. Once rare, IHD is emerging as a significant contributor to the CVD burden
in sub-Saharan Africa.5

1.1.

Hypertension

The disease burden of hypertension in Ghana is considerable, with a high prevalence andincreasing incidence. 6 Hypertension is a significant public health concern in Ghana, and aleading cause of admissions and deaths in the country. 7 The prevalence of hypertension in thegeneral population of Ghana has been estimated to range from 19 % to 48 % in various
studies. 8 In one systematic review and metanalysis, it estimated the pooled prevalence ofhypertension in Ghana to be 30.3 %.9 This estimate is higher than the prevalence reported at
the beginning of the last decade, indicating a worsening epidemic of hypertension in the
country. 10

Owusu, I.K. and Acheamfuor-Akowuah, Pattern of Cardiovascular Diseases as Seen in an Out-Patient Cardiac
Clinic in Ghana. World Journal of Cardiovascular Diseases, January 2018, p. 1
5
Appiah, L. T., et al., Current trends in admissions and outcomes of cardiac diseases in Ghana, July 2017, p. 783
6
Atibila, F., et al., Prevalence of hypertension in Ghanaian society: a systematic review, meta‑analysis, and GRADE
assessment, August 2021, url, p. 2
7
Bosu, W. K. and Bosu, D. K., Prevalence, awareness, and control of hypertension in Ghana: A systematic review andmeta-analysis, March 2021, url, p. 1
8
Atibila, F., et al., Prevalence of hypertension in Ghanaian society: a systematic review, meta‑analysis, and GRADE
assessment, August 2021, url, p. 11
9
Atibila, F., et al., Prevalence of hypertension in Ghanaian society: a systematic review, meta‑analysis, and GRADE
assessment, August 2021, url, p. 7
10
Atibila, F., et al., Prevalence of hypertension in Ghanaian society: a systematic review, meta‑analysis, and GRADE
assessment, August 2021, url, p. 11
410

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASESIn another systemic review and metanalysis study, the pooled prevalence was 27 % for thecountry, with the coastal (28 %), and middle geo-ecological belts (29 %) experiencing twice theprevalence compared to the northern belt (13 %). The prevalence was similar by sex andurban-rural residence. The study found that only 35 % of persons with hypertension know theirstatus, 22 % are on treatment and 6 % had their blood pressure controlled. 11

1.2.

Myocardial infarction (MI)There is insufficient population-based data describing the prevalence and incidence of MI in
sub-Saharan Africa. 12 A systematic review of studies conducted in sub-Saharan Africa,
including Ghana, found that the prevalence of acute MI ranged from 0.1 % to 10.4 % among theincluded studies. 13

1.3.

Heart failure (HF)

HF has been found to account for 88.3 % of cardiovascular admissions to the medical ward of
Komfo Anokye Teaching Hospital (KATH) in Kumasi. 14
In a study at the teaching hospital, the commonest cardiovascular risk factors observed for HF
were hypertension (46.5 %), history of previous HF (40.7 %), excessive alcohol use (38.6 %)and family history of heart disease (29.3 %), predominantly hypertension (68.3 %). The major
underlying aetiology of HF was dilated cardiomyopathy (38.6 %), hypertensive heart disease(21.4 %), IHD (13.6 %) and valvular heart disease (12.9 %). These underlying aetiologies of HF
were more common in patients aged 40 years and above and those presenting with multiple
risk factors. 15

1.4.

Heart rhythm disorders

A systematic review of the spectrum of cardiac arrhythmias in sub-Saharan Africa, which
included some studies from Ghana, found that the prevalence of atrial fibrillation/atrial flutter(AF/AFL) was 16 % to 22 % in HF, 10 % to 28 % in rheumatic heart disease, and 3 % to 7 % in
cardiology admissions.16
A study conducted at the Emergency Department of Korle Bu Teaching Hospital (KBTH) in
Accra, Ghana, found that haemodynamically unstable tachyarrhythmias were the mostcommon arrhythmias found among the patients (66.7 %). Approximately 52 % of patients had
Bosu, W. K. and Bosu, D. K., Prevalence, awareness, and control of hypertension in Ghana: A systematic review
and meta-analysis, March 2021, url, p. 1
12Hertz, J. T., et al., Acute myocardial infarction in sub-Saharan Africa: The Need for Data, May 2014, url, p. 1
13Hertz, J. T., et al., Acute myocardial infarction in sub-Saharan Africa: The Need for Data, May 2014, url, p. 1
14
Appiah, L. T., et al., Current trends in admissions and outcomes of cardiac diseases in Ghana, July 2017, url,
p. 78315
Agyekum, F., et al., Contemporary aetiology of acute heart failure in a teaching hospital in Ghana, February 2023,
url, p. 1
16
Yuyun, M. F., et al. A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa, 2020, url,
p. 1
11

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EUROPEAN UNION AGENCY FOR ASYLUM

structural heart diseases, whereas 26.2 % had no apparent underlying cause or predisposing
factor. Cardioversion (52.4 %), commonly electrical (63.6 %), and transvenous pacemaker
implantation (23.8 %) were the common initial interventions. The majority of the patients(88.1 %) survived and were discharged home. 17

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). 18 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. 19 The health system is organised inthree levels: the primary level, with a focus on primary healthcare (PHC) services, includes thecommunity-based health planning and services (CHPS) compound, the sub-district healthcentre/clinic and the district hospital. The secondary and tertiary levels have regional andteaching hospitals, respectively. 20
Public and private facilities, at all levels of the health system, can provide care within limits set
by the Standard Treatment Guidelines 2017. 21 The primary level of care has the capacity toidentify and make differential diagnosis of some of the conditions. This capacity is mostly at
the district hospital level where they can make more definitive diagnosis, commence basiccare and continue to refer the client to the appropriate secondary or tertiary facility fordefinitive case management. All patients can access care at the nearest point of service tothem at any level of the health system. Based on the severity of the condition and the capacityof the point of service to manage the condition, care will be continued, or the patient will bereferred to the next higher level of care for further case management. Patients can however
walk into any emergency room in any secondary or tertiary facility and will be attended to. 22
Cardiac care can be received at several places in Ghana, including specialised hospitals andclinics, primary care centres, and CHPS programmes. Specialised hospitals and clinics, such
as KBTH, KATH, and the National Cardiothoracic Centre provide specialised care for HF
patients in Ghana. 23 These hospitals have specialised teams of cardiologists, cardiac surgeons
and other healthcare professionals who are trained to diagnose and treat HF and other CVDs.
Primary care centres and CHPS programmes also provide general preventive and primarycare in rural areas, but they may not have the specialised resources and expertise to manage

Doku, A., et al., Outcome of life-threatening arrhythmias among patients presenting in an emergency setting at a
tertiary hospital in Accra-Ghana, August 2022, url, p. 1
18
Ghana, MOH, National Health Policy: Ensuring healthy lives for all (Revised Edition), January 2020, url, p. 23
19
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
20
Ghana, MOH, Health Sector Medium Term Development Plan 2022-2025, December 2021, url, p. 11
21
Ghana, MOH, GNDP, Standard Treatment Guidelines, Seventh Edition, 2017, url, pp. 134,146,156
22
CCdKII101, Consultant Cardiologist, Interview, September 2023
23
CCdKII101, Consultant Cardiologist, Interview, September 2023
17

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GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

complex cardiac conditions. 24 The Ghana Heart Initiative (GHI) is an ongoing national
programme since 2018, aimed at improving CVD care and reducing the death rates of CVDs. 25
A study looking at the capacity of the healthcare system in Ghana to manage CVDs found thata total of 83 % of the newly diagnosed hypertensives were put on treatment, 56.3 %,continued treatment during the study period and less than 10 % had their blood pressure
controlled at the end of the study (in March 2020). Challenges to access treatment were foundto include suboptimal health worker knowledge in CVD management, lack of equipment for
prompt CVD emergency diagnosis, poor management and monitoring of CVD care across alllevels of healthcare, lack of standardised protocol on CVD management, and limited numberof indicators on CVD in the National Database for CVD monitoring. 26 Other barriers to accessto treatment include poor patient knowledge and understanding of hypertension, inadequate
understating of the medication and poor adherence to medication; human resource
constraints; and the health system not adequately focused on hypertension. 27
The most significant challenge faced by the cardiothoracic surgery programme in Ghana isfunding of patient care, expanding the existing infrastructure and improving on the standard ofcare. The cost of heart surgery is beyond the reach of more than 90 % of the patients. This has
directly and indirectly affected the growth of the cardiothoracic programme. 28

2.1.

Insurance and national programmes

The public National Health Insurance Scheme (NHIS) and private health insurance schemes
cover both inpatient and outpatient cost of care to different degrees, with the private schemes
generally providing more cover than the NHIS. 29 The NHIS covers the consultation fees for all
general and specialist clinic attendances, as well as hospital admission (bed and food), arecovered. A limited number of laboratory tests (mostly routine general laboratory tests such as
Full blood Counts, Routine Urine and Stool tests, Liver Function Tests and Random/Fastingblood sugars) are covered but the cost of specialised laboratory and diagnostic imaging
investigations and treatment for CVDs are not covered by the NHIS and may be paid for by
private insurance schemes or out of pocket.30
As of 2019, the NHIS had a membership of over 12 million Ghanaians. 31 The NHIS is available
for registration to all individuals living in Ghana. 32

CCdKII101, Consultant Cardiologist, Interview, September 2023
Ghanaian Society of Cardiology, Launch Of Ghana Heart Initiative (GHI) Project, August 2019, url ; GIZ, Ghana
Heart Initiative, Ghana: For Strong Hearts, 2021, url;
26
Doku, A., et al., A multilevel and multicenter assessment of health care system capacity to manage cardiovasculardiseases in Africa: a baseline study of the Ghana Heart Initiative, August 2023, url, p. 1
27
Laar, A. K., et al., Health system challenges to hypertension and related non-communicable diseases prevention
and treatment: perspectives from Ghanaian stakeholders, 2019, , pp. 5-11
28
Tettey, M., et al., Cardiothoracic surgical experience in Ghana, October 2016, , p. S70
29
CCdKII101, Consultant Cardiologist, Interview, September 2023
30
CCdKII101 Consultant Cardiologist, Interview, September 2023, Accra
31
NHIS, NHIS active membership soars, July 2020, url
32
CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra
24

25

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EUROPEAN UNION AGENCY FOR ASYLUM

2.2.

Non-government organisations (NGOs)

There is the Community-Based Hypertension Improvement Project (ComHIP), supported by
Novartis, a comprehensive intervention aimed at scaling up hypertension treatment services
at the community level in Ghana. The programme aims to provide cost-effective andaccessible care to individuals with hypertension, which can help reduce the financial burden
on patients. 33
AstraZeneca is since 2019 supporting the Healthy Heart Africa (HHA) Programme expansion
into Ghana in partnership with the Ghana Health Service. The programme contributes to theprevention and control of CVDs in Ghana with emphasis on hypertension. The charity PATH in
Ghana is the HHA implementing partner. 34
There is also the GHI initiated in September 2018, and officially launched on 9 January 2019,
introduced an innovative health system intervention to strengthen early detection, andmanagement of hypertension and CVDs across health facilities in the Greater Accra Region(GAR). The initiative was implemented as a collaborative effort by Deutsche Gesellschaft fürInternationale Zusammenarbeit (GIZ) GmbH, the Ministry of Health (MOH) and the Ghana
Health Services. 35
The Arrhythmia Alliance Hearts of Ghana Mission performs heart surgeries and supports
pacing and angiography. It also performs surgeries on those who would not otherwise be able
to afford it. 36

3.

Cost of treatment

The cost of treatment in the public sector is primarily regulated by the NHIS. The NHIS tariffs
are expected to be the official fees and charges in public facilities. This is often not adhered tobecause the public insurance 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 outof pocket by patients. Other public facilities will have instances where staff request for
unofficial fees and charges for services rendered. 37
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

Novartis Foundation, Community-based Hypertension Improvement Project (ComHIP), 2023, url
AstraZeneca, Healthy Heart Africa, Strengthening health systems, 2023, url
35
Singh, K., et al., Evaluation of the Ghana Heart Initiative - Design and Rationale of a Pragmatic Mixed-Methods
Study from Diverse Perspectives: A Study Protocol, May 2023, p. 4
36
Dunning, J., et al., The Edwards Every Heartbeat Matters, Arrhythmia Alliance Hearts of Ghana Mission, May
2022, url
37
CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra
33

34

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GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

and charges may be revised at any time, and the revisions are primarily influenced by foreignexchange rates and market forces. 38
In Table 1 and Table 2, the prices in public facilities prices are based on NHIS prices, 39 while
the prices for the private sector, as well as reimbursement and insurance information areprovided by interviewee CCdKII102, an administrator at a private hospital. 40
Concerning the coverage and reimbursement of the treatment prices in the tables 1 and 2
below, the following principles apply to all listed treatments, unless explained otherwise:
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 cardiology specialist consultations in public tertiary and private health facilities
Specialist

Publicoutpatient
treatment
price in GHS

Public inpatient treatment
price in GHS

Privateoutpatient
treatment pricein GHS

Privateinpatienttreatment
price in GHS

Cardiologist

147

128 (cost of admission, notincluding consultation fee)

280 to 400

600 to 1 000

Cardiacsurgeon147

128 (cost of admission, notincluding consultation fee)

280 to 400

600 to 1 000

CCdKII102, Administrator of a Private Hospital, Interview, September 2023, Accra
Ghana, NHIS, Tariffs for Tertiary Hospitals, February 2023
40
CCdKII102, Administrator of a Private Hospital, Interview, September 2023, Accra
38

39

15

EUROPEAN UNION AGENCY FOR ASYLUMTable 2. Cost of cardiology laboratory, diagnostic imaging and specialist treatment interventions inpublic tertiary and private health facilities
Note: In the following table, as per market practices, the cost of some interventions is quoted in United States
dollar (USD) and the client is billed in the Ghanaian cedi (GHS) equivalent at the time of accessing the service. 41

41

Treatments

Public treatment pricePrivate treatment price

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

GHS 86

GHS 100 to 130

Laboratory research for
cardiac biomarker; creatine
kinase MB (CK-MB)

GHS 35

GHS 80 to 100

Laboratory research for
cardiac biomarker; troponin

GHS 180

GHS 120 to 150

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

GHS 39GHS 100 to 130

Angiography (= arteriography)

GHS 1 000

GHS 2 500 to 4 500

Cardiac stress test

GHS 400

GHS 550 to 950

ECG (electro cardiogram; cardiology)

GHS 112

GHS 150 to 250

Holter monitor/ ambulatory ECG device(cardiology)

GHS 400

GHS 500 to 950

Ultrasound of the heart (=echocardiography = echocardiogram =TTE)

GHS 400

GHS 450 to 600

Diagnostic imaging: transesophageal
echocardiogram (TEE)

GHS 600

Not found

CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra
16

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

Treatments

Public treatment pricePrivate treatment price

Clinical admittance in cardiology
department (daily rates)

GHS 128

GHS 375 to 500

Clinical admittance in cardiac surgery
department (daily rates)

GHS 128

GHS 375 to 500

Cardiac surgery; cardiac
catheterisation *USD 1 750

Not found

Cardiac surgery; coronary artery
bypass grafting (CABG), bypass

USD 10 000

Not found

Cardiac surgery; PTCA/PCI; coronary
angioplasty, incl. follow-up

USD 2 000

Not found

Cardiology, placement of pacemaker

USD 5 000

Not found

Cardiology, maintenance and follow up
of pacemaker

GHS 240

Not found

Cardiology, placement of ICD(Implantable Cardioverter Defibrillator)

USD 8 000

Not found

Cardiology, follow-up of ICD bycardiologist

GHS 240

Not found* This treatment is not covered by NHIS, but some private insurance schemes do. If no insurance, thenthe patient has to pay out-of-pocket.

4.

Cost of medication

The cost of medication in the public sector is regulated by the NHIS medicines list. 42 The NHIS
medicines’ list is expected to include the official charges for medicines in public facilities. This
is often not adhered to because the prices of NHIS’ medicines are below market prices, so
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

42

NHIS, Medicine List, February 2023, url
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EUROPEAN UNION AGENCY FOR ASYLUM

the NHIS may not fully cover. These additional fees and charges are paid out of pocket bypatients. 43
The cost of medicines in the private sector is not regulated, and different service providers set
different fees and charges that enable them to, at least, fully recover their costs. These fees
and charges may be revised at any time and the revisions are primarily influenced by foreignexchange rates. The cost of medication is generally higher in private as compared to public
facilities, and also increases from primary to tertiary level of care. 44
Most medicines are available countrywide. The private sector pharmacies maintain a more
complete stock of medicines than public facilities and medicines are more readily available inurban versus rural communities. 45
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 has gone through and passed therigorous testing and product source verification processes carried out by the FDA of Ghana.
However non-registered, as well as fake, medicines are also found in the country. Some of the
medicines are on the Essential Medicines List and the National Health Insurance Medicines
List. Their inclusion on the list encourages pharmacies and health facilities to stock them,
reducing situations when stocks run out. Public facilities prices as available in the NHIS
medicines’ list. 46
In situations where 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. 47
In Table 3, ‘Pharmacy’ refers to the private sector and ‘Hospital’ refers to the public sector.
Public facilities prices are as listed in the NHIS medicines’ list. 48 No brand names are covered
under the medicines’ list. 49 Prices in private facilities and information on insurance andreimbursement are provided by interviewee CCdKII103. 50
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.

CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra
CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra
45
CCdKII101, Consultant Cardiologist, Interview, September 2023, Accra, Accra
46
CCdKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
47
CCdKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
48
Ghana, NHIS, Medicine List, February 2023, url
49
CCdKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
50
CCdKII103, Pharmacist of a Private Hospital, Interview, September 2023, Accra
43

44

18

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

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 in both public and private sector
Generic Name

Brand nameStrengthof unit

Form

Numberof unitsin thecontainer

Price perbox in GHS

Place(pharmacy,
hospital,…)

Amlodipine

Norvasc™

10 mg

tablet28

784

Pharmacy

Amlodipine(Teva)

10 mg

tablet28

408.8

Hospital

Amlodipine +valsartan +hydrochloroth
iazideExforge HCT™

5 mg/
16 mg/
12.5 mgtablet28

406

Pharmacy

Atenolol

Gensis™

25 mg

tablet28

35.6

Pharmacy

Atenolol

50 mgtablet28

9.8

Hospital

Bisoprolol

Bisoprolol
Sandox®

20 mg

tablet28

35

Pharmacy

Candesartan

Atacand®

8 mg

tablet28

319

Pharmacy

Carvedilol

Dilatrend™

12.5 mgtablet28

327

Pharmacy

Carvedilol

12.5 mgtablet28

52.64

Hospital

Doxazosin

Doxazosin

2 mgtablet28

22.4

Pharmacy

Enalapril

Enalapril

5 mgtablet28

47.6

Pharmacy

Eplerenone

Epnone25 mg

tablet30

459

Hospital

Furosemide

Furosemide

20 mgtablet28

16.8

Pharmacy

20 mgtablet28

6.72

Hospital

Hydrochloroth
iazideHydrochlorot
hiazide25 mgtablet30

52

Pharmacy

Indapamide

Natrilix®

1.5 mgtablet30

69

Pharmacy

19

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand nameStrengthof unit

Form

Numberof unitsin thecontainer

Price perbox in GHS

Place(pharmacy,
hospital,…)Irbesartan

Approvil®

150 mgtablet28

257.6

Pharmacy

Lisinopril

Zestril®

10 mg

tablet28

299.6

Pharmacy

Lisinopril(vega)

10 mg

tablet117.60

Hospital

Lisinopril +hydrochlorothiazide(combination)

Zestoretil®

20 mg/
12.5 mgtablet28

574

Pharmacy

Losartan

Losartan

50 mg

tablet28

53.2

Pharmacy

100 mgtablet28

12.88

Hospital

Metoprolol

Metoprolol

100 mgtablet28

168

Pharmacy

Nifedipine

Adalat®

30 mg

tablet30

267.3

Pharmacy

Perindopril

Coversyl™

5 mgtablet28

468.6

Pharmacy

Propranolol

Propranolol

40 mgtablet28

22.3

Pharmacy

Spironolactone

Spironolactone

25 mgtablet100

80.8

Pharmacy

Telmisartan

Teletal40 mgtablet30

73.50

Hospital

Torasemide

Torasemide

5 mgtablet28

128.7

Pharmacy

Valsartan

Diovan™

160 mgtablet28

247.2

Pharmacy

Isosorbide
dinitrate

Isosorbide
dinitrate

10 mgtablet50

60

Pharmacy

Nitroglycerin

Nitroglycerin

600 mcg/
spray

aerosol1

81.2

Pharmacy

Acetylsalicylic
acid

Acetylsalicylic
acid

75 mg

tablet100

41

Pharmacy

Clopidogrel

Clopidogrel

75 mgtablet28

47

Pharmacy

Frelet

0.2 mlampoule1036

Hospital

Fragmin®

5 000 iu

ampoule10

109.9

Pharmacy

Dalteparin

20

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

Generic Name

Brand nameStrengthof unit

Form

Numberof unitsin thecontainer

Price perbox in GHS

Place(pharmacy,
hospital,…)Enoxaparin

Clexane™

40mg

injection

1

50

Pharmacy

Enoxaparin
sodium40 mg/
0.4ml

injection

2

74.57

Hospital

Heparin

Heparin

5 000 iu

ampoule1

121.3

Hospital

Dipyridamole

Dipyridamole

200 mgtablet28

528

Pharmacy

Prasugrel

Prasugrel

5 mg

tablet30

55

Pharmacy

Ticagrelor

Brilinta™

90 mg

tablet50

2 050

Pharmacy

21

EUROPEAN UNION AGENCY FOR ASYLUM

Annex 1: Bibliography
Oral sources, including anonymous sources
CCdKII101, A Consultant Cardiologist, Interview, Accra, September 2023. The person wishes toremain anonymous.
CCdKII102, An Administrator of a Private Hospital, Interview, Accra, September 2023. The
person wishes to remain anonymous.
CCdKII103, A Pharmacist of a Private Hospital, Interview, Accra, September 2023. The person
wishes to remain anonymous.

Public sources
Agyekum, F., Folson, A. A., Asare, B. Y. A., Doku, A., Kpodonu, J., Okine, R., Fokuoh, F. andAkamah, J. A., Contemporary aetiology of acute heart failure in a teaching hospital in Ghana,
in: BMC Cardiovascular Disorders, Vol. 23, Article No. 82 [no pagination], February 2023,
https://doi.org/10.1186/s12872-023-03103-3, accessed 5 December 2023
Appiah, L. T., Sarfo, F. S., Agyemang, C., Tweneboah, H. O., Appiah, N. A. B. A., Bedu‐Addo, G.,& Opare‐Sem, O., Current trends in admissions and outcomes of cardiac diseases in Ghana, in:Clinical Cardiology, Vol. 40, Issue 10, July 2017, pp. 783-788,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490361/, accessed 5 December 2023
AstraZeneca, Healthy Heart Africa, Strengthening health systems, 2023,
https://www.astrazeneca.com/sustainability/access-to-healthcare/healthy-heart-africa.html,
accessed 5 December 2023
Atibila, F., ten Hoor, G., Donkoh, E. T., Wahab, A. I. and Kok, G., Prevalence of hypertension in
Ghanaian society: a systematic review, meta‑analysis, and GRADE assessment, in: Systematic
Reviews, Vol. 10, Article No. 220 [no pagination], August 2021, https://doi.org/10.1186/s13643021-01770-x, accessed 5 December 2023
Bosu, W. K. and Bosu, D. K., Prevalence, awareness, and control of hypertension in Ghana: A
systematic review and meta-analysis, in: PLos ONE, Vol. 16, Issue 3, Article No. e0248137 [nopagination], March 2021,
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248137, accessed 5
December 2023
Doku, A., Tuglo, L. S., Chilunga, F., Edzeame, J., Peters, R. J. G. and Agyemang, C., A multileveland multicenter assessment of health care system capacity to manage cardiovasculardiseases in Africa: a baseline study of the Ghana Heart Initiative, in: BMC Cardiovascular
Disorders, Vol. 23, Article No. 421, August 2023, https://doi.org/10.1186/s12872-023-03430-5,
accessed 5 December 2023

22

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

Doku, A., Yeboah-Asiamah Asare, B., Osei, R., Owoo, C., Djagbletey, R., Akamah, J., Aniteye, E.
and Ahadzi, D., Outcome of life-threatening arrhythmias among patients presenting in an
emergency setting at a tertiary hospital in Accra-Ghana, in: BMC Cardiovascular Disorders,Vol. 22, Article No. 361 [no pagination], August 2022,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358854/, accessed 5 December 2023
Dunning, J., Arkley, J. and Akowuah, E., The Edwards Every Heartbeat Matters, Arrhythmia
Alliance Hearts of Ghana Mission 2022, CTSNet, May 2022,
https://www.ctsnet.org/article/edwards-every-heartbeat-matters-arrhythmia-alliance-heartsghana-mission-2022, 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, MOH, GNDP, Standard Treatment Guidelines, Seventh Edition, 2017,https://www.moh.gov.gh/wp-content/uploads/2020/07/GHANA-STG-2017-1.pdf, accessed 5
December 2023
Ghana, NHIS (National Health Insurance Authority), Tariffs for Tertiary Hospitals, February
2023, accessed 5 December 2023, not available online
Ghana, NHIS (National Health Insurance Scheme), Medicine List, February 2023,
https://nhis.gov.gh/medlist, accessed 5 December 2023
Ghanaian Society of Cardiology, Launch Of Ghana Heart Initiative (GHI) Project, August 2019,https://www.gsc-gh.org/launch-of-ghana-heart-initiative-ghi-project/, accessed 5 December
2023
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
GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit), Ghana Heart Initiative, Ghana:
For Strong Hearts, 2021, https://reporting.giz.de/2021/our-work-around-the-world/globalhealth/ghana-heart-initiative/, accessed 5 December 2023
Hertz, J. T., Reardon, J. M., Rodrigues, C. G., de Andrade, L., Limkakeng, A. T., Bloomfield, G. S.
and Lynch, C. A., Acute Myocardial Infarction in Sub-Saharan Africa: The Need for Data, in:PLos ONE, Vol. 9, Issue 5, Article No. e96688 [no pagination], May 2014,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016044/, accessed 5 December 2023

23

EUROPEAN UNION AGENCY FOR ASYLUM

Laar, A. K., Adler, A. J., Kotoh, A. M., Legido-Quigley, H., Lange, I. L., Perel, P. and Lamptey, P.,
Health system challenges to hypertension and related non-communicable diseases
prevention and treatment: perspectives from Ghanaian stakeholders, in: BMC Health Services
Research, Vol. 19, Article No. 693 [no pagination], 2019, https://doi.org/10.1186/s12913-0194571-6, accessed 5 December 2023
Owusu, I. K. and Acheamfour-Akowuah, E., Pattern of Cardiovascular Diseases as Seen in an
Out-Patient Cardiac Clinic in Ghana. World Journal of Cardiovascular Diseases, in: World
Journal of Cardiovascular Diseases, Vol. 8, Issue 1, January 2018, pp. 70-84,
https://doi.org/10.4236/wjcd.2018.81008, accessed 5 December 2023
Singh, K., Otchi, E., Shah-Rohlfs, R., Udofia, E., Louis, V. R., Adomako, I., Hagan-Seneadza, N.
A., Herzhauser, N., Owusu, A. B., Tetteh, J., DeGraft-Amoah, D., Kallson, E., Winkler, V. F.,
Yawson, A. E. and De Allegri, M., Evaluation of the Ghana Heart Initiative - Design andRationale of a Pragmatic Mixed-Methods Study from Diverse Perspectives: A Study Protocol,
in: Research Square [Preprint], Version 1 [no pagination], May 2023,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246241/pdf/nihpp-rs2893313v1.pdf, accessed
5 December 2023
Tettey, M., Tamatey, M. and Edwin, F., in: Cardiothoracic surgical experience in Ghana, in:
Cardiovascular Diagnosis and Therapy, Vol. 6, Supplement 1, October 2016, pp. S64-S73,
https://cdt.amegroups.org/article/view/11332/12794, accessed 5 December 2023
Yuyun, M. F., Bonny, A., Ng, G. A., Sliwa, K., Kengne, A. P., Chin, A., Mocumbi, A. O., Ngantcha,
M., Ajijola, O. A. and Bukhman, G., A Systematic Review of the Spectrum of Cardiac
Arrhythmias in Sub-Saharan Africa, in: Global Heart, Vol. 15, Issue 1, Article No. 37 [nopagination], 2020, https://doi.org/10.5334/gh.808, accessed 5 December 2023

24

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

Annex 2: Terms of Reference (ToR)
Cardiovascular diseases; hypertension, myocardial
infarction, heart failure and heart rhythm disorders
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 cardiovascular diseases (hypertension,
myocardial infarction, heart failure and heart rhythm disorders)/ types of these
diseases (epidemiologic data).
How is the health care organized for cardiovascular diseases?
How are cardiovascular diseases treated – at specific centres, in primary health care
centres, secondary care / hospitals, tertiary care etc.?
Which kinds of facilities can treat cardiovascular 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 cardiovasculardiseases? Are there sufficient resources available to treat all patients?
Is there a particular type of cardiovascular diseases for which no (or only partial)
treatment exists in the country?
Is there a (national) institute specialised in treating cardiovascular 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 cardiovascular 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
cardiovascular 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?

25

EUROPEAN UNION AGENCY FOR ASYLUM

•

•
•
•

•

What is the ‘typical route’ for a patient with cardiovascular diseases (after being
diagnosed with the disease)? In other words: for any necessary treatment, where canthe patient find help and/or specific information? Where can s/he receive follow-up
treatment? Are there waiting times for treatments (e.g., surgery, investigations, 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 cardiovascular diseases?

Insurance and national programmes•••

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

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

•
•
•
•

Do not delete any treatments from the tables. Instead state that they are not available
or information could not be found if that is the case.
In the table, indicate the price for inpatient and outpatient treatments in public andprivate facilities 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:26

GHANA TOPICAL MEDCOI REPORT: CARDIOVASCULAR DISEASES

•
•
•
•
•

•
•

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.
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 them
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 cardiovasculardiseases? 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).

27

EUROPEAN UNION AGENCY FOR ASYLUM

28