Expat guide to health care in Ghana

With its economy growing at seven percent (2018-2019), Ghana is an increasingly popular expat destination in West Africa.

While Ghana was the first country in Sub-Saharan Africa to reduce poverty by half — with more than 245,000 Ghanaians lifted out of poverty each year — its health care system is still not comparable to that of developed nations (ranked 135^th out of 191 for overall health system performance by the WHO). This means that private medical insurance is a must for expats to access higher quality private facilities and/or fly for treatment.

This page will detail the state of Ghana’s health care system, its quality and how it works.

An introduction to the health care system in Ghana

Ghana is one of the most advanced countries in Africa in terms of health care, thanks to the launch of the public insurance system that replaced the existing ‘cash and carry’ health system in 2003. The ‘cash and carry’ scheme required patients to pay for their treatment up front which meant that a large proportion of the population could not access care. The Ghanaian government subsequently set up the National Health Insurance Scheme (NHIS) which focused on local needs: treatments for malaria, diarrhoea, respiratory diseases, diabetes and hypertension among others. While one study found that “on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick” another found that costs (out-of-pocket expenses) remain ‘catastrophic’ for a large proportion of insured households. Premiums are set at flexible rates so low-income and self-employed people can access care, but there are up to six-month waiting lists for these groups. The former study concluded: “that the government's objective to increase access to the formal health care sector through health insurance has at least partially been achieved”.

The government has increased its expenditure for health care more than threefold within the past 10 years, but the health care infrastructure remains limited by the standards of developed nations, especially outside the large conurbations such as the capital, Accra. Public hospitals remain overcrowded and underfunded.

Case filled with emergency drugs such as morphine and adrenaline photographed in an ER in Accra, Ghana, 2018

As well as government-funded hospitals and clinics, religious groups play an important role in providing the population with much needed medical assistance through the health care centres they have set up.

Emergency services and hospitals are available within cities, but few exist outside urban areas where traditional African medicine remains the main option for most of the rural population who cannot afford to travel long distances for care and/or treatment. Al Jazeera also reported that many locals believe that the prescription drugs they are given are substandard and even ineffective. The same report includes the statistic that there is one doctor to 15,259 patients.

Expats living in Ghana usually use private facilities, which offer a considerably higher standard of treatment and modern medical facilities.

Public health care in Ghana

The government’s mission statement for the health service includes:

• Management and administration of the overall health resources within the service
• Promoting healthy mode of living and good health habits
• Establishing effective mechanism for disease surveillance, prevention and control

These will be delivered through directly managed services as well as third-party agencies. Even with the new NHIS, the standard and availability of public health care in Ghana varies, one study finding that “the average perception of health care quality among the respondents was relatively low” and that the uninsured perceived the quality of health care to be better than those who were insured”.

Expats can access NHIS services for a relatively small fee. The latest figures (2005) show a 20-minute doctor visit costing no more than USD$11.

Those insured by the public NHIS should be aware that not all medical facilities accept the NHIS card and insurance. Many treatments are also not covered by public insurance.

You can find a list of medical centres on the Ghana Hospitals website, which includes the type of services and specialisations they provide. The site also includes whether they are accredited by the NHIS and whether they accept health insurance.

Hospital room in West Africa

Private health care in Ghana

Private health care in Ghana is an absolute must for those who want to access quality care, treatments and reduce waiting times and ensure medication quality. It will also help you deal with emergency situations. Private hospitals in Ghana generally provide a better standard of treatment with more modern equipment than public hospitals and, while the standard of facilities at private hospitals in Ghana still varies, those in areas with big expat communities are well equipped, comfortable and medical staff usually speak fluent English. One study stated that patients found service quality better in private hospitals.

Emergency evacuation is often required for patients requiring serious medical attention, so most expats invest in international health insurance that includes emergency evacuation.

Read how an emergency airlift saved the life of one expat living in Mozambique.

Private health care means access to quality facilities such as Euracare in Accra and the Nyaho Clinic who cater specifically to expats and tourists.

Hospitals

The majority of hospitals in Ghana can be considered ‘general’, focusing on general medicine. This means they don’t offer a full range of diagnostics, testing or treatments. Specialist treatment will usually involve travel to certain hospitals which are often in other countries — which well-off Ghanaians and expats usually opt for. For example, ghanahospitals.org states there are only 14 eye clinics in Ghana, 17 with ultrasound scanning facilities and only eight diagnostic centres and some services are not provided in every hospital. For example, only nine hospitals provide surgery services, five of which actually specialise in the field.

There are around 1,300 private facilities which usually provide a better quality of treatment and have more modern equipment than public institutions. There are around 1,800 public hospitals. These facilities can be overcrowded and lack the quality those from developed countries have come to expect. While both public and private institutions are generally located in urban areas, major medical facilities are often outside densely populated urban areas.

Medical facilities run by religious institutions (usually Christian or Muslim) number more than 200 and they are found predominantly in rural areas.

Hospital room in West Ghana

Prescriptions, drugs and pharmacies

There are more than 550 pharmacies in Ghana, with most in the major cities and towns — some of which are open 24 hours.

There are serious concerns about some pharmacies selling fake and/or low-quality drugs and medication, so ensure that you purchase any medication from a pharmacy attached to a reputable medical facility.

Only certain pharmacies are licensed to dispense prescription drugs and you should check that any medication you take has been approved by the Ghanaian Pharmacy Council.

Expats suffering from chronic ailments or needing prescription medication should try to bring a supply of the medication with them to Ghana, as well as copies of the prescription and generic names of the drugs. But again, check that your drugs are legal in Ghana. For example, there are restrictions around sleeping pills, medication for ADHD and strong painkillers for which you will need a medical certificate. It is wise to create a list of the generic drug names to ensure you can access any you need. Your doctor or international private medical insurance provider will be able to help you with this.

Antimalarial medicine is available throughout the country, but it is advisable to buy medication in your home country to ensure access and effectiveness. If purchasing in-country, look for Atovaquone-proguanil, doxycycline and mefloquine to avoid the undesirable side effects of lower quality drugs.

Health hazards and vaccinations

There are numerous health hazards in Ghana and it is recommended to get your immunisations renewed, including:

• Routine jabs
  • Measles mumps and rubella (MMR)
  • Diphtheria tetanus and pertussis
  • Varicella (chickenpox)
  • Polio
  • Annual flu
• Yellow fever (you must have this to acquire a visa to Ghana)
• Hepatitis A and B
• Typhoid
• Polio
• Meningitis
• Rabies

Health hazards include:

• HIV/Aids
• Malaria
• Meningitis (in certain areas known as ‘the meningitis belt’)

Mental health care in Ghana

A mental health policy (1996) and plan (2007-2011) existed but emergency and disaster plans for mental health did not exist until 2012 when the Mental Health Act 846 2012 was passed. At this time, mental health had a ring-fenced budget of 1.4 percent of total governmental health expenditure (compared to around 10 percent in the UK). Until 2013, mental disorders were not covered by social insurance schemes and there was no national or regional mental health body to provide advice to the government on mental health policies and legislation.

A 2015 study found that “Mental health patients and their families suffer from stigma and discrimination from the individual, family, work, employment, education to the health level”. In 2018, the BBC even reported that one ‘prayer camp’ chained and even caged patients with mental health problems (illegal since 2012). But mental health awareness is growing around the world and Ghana has a number of organisations whose mission is to tackle mental health stigma as well as those directly affected, for example the Mental Health Society Of Ghana.

Larger cities have therapists and mental health facilities including psychologists, therapists and psychiatrists. There are lists of mental health practitioners online, but you may prefer to ask your international health insurer to recommend someone to ensure you receive quality treatment. Aetna International’s Employee Assistance Services include mental health counselling by phone or video.

Travel for treatment

While there is an increasing number of quality private facilities in Ghana, many richer Ghanaians and expats still prefer to fly abroad for treatment — especially specialist procedures. Reports say that many African countries want to reduce the flow of outbound medical tourism, mostly to India, and become local medical tourism destinations themselves.

For example, Ghana’s Ministry of Health has initiated a policy to make Ghana a health tourism destination in Africa by creating specialised health centres of excellence for the treatment of complicated diseases. A number of teaching hospitals are planned to take a leading role with the private sector providing support. The government claims that the program has already had a positive effect as fewer Ghanaian medical professionals are leaving and many medical experts returning home to work in such facilities.

Read more about flying for treatment.

Expat health insurance in Ghana

As indicated previously, health insurance is a must for expats who want to ensure they have access to quality care, including emergency medical attention and even evacuation.

Many expats will have health insurance provided for them by their employer as part of their employment package, especially when part of a long- or short-term international assignment.

There are many local private health insurance companies, but many expats prefer to choose international health insurance providers such as Aetna International which often offer more comprehensive cover and more cover options. As well as giving access to quality care in-country, international private medical insurers allow patients to travel for treatment. For example, Aetna International has a global network of centres of excellence that allows us to fly members to nearby countries to access quality care. For example, we airlifted one patient from Mozambique to South Africa for life-saving surgery after local surgeons left her with an “open stomach wound covered with gauze”.

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