Institutional capacity for non-communicable disease care in Ghana's primary health care system: a multi-method study

The burden of non-communicable diseases (NCDs), including hypertension, diabetes, and mental health conditions, is escalating in Ghana. Robust primary health care policies and effective health systems can prevent illness and complications and improve quality of life for ambulatory care-sensitive conditions like hypertension, diabetes and mental health. Understanding the capacity of Ghana's PHC system to manage NCDs is critical for designing effective policies. However, published evidence on this is limited. In this study we evaluated Ghana's primary health care system capacity to manage these NCDs effectively.

A multi-method approach combined a desk review of national policy documents with a cross-sectional survey of 207 PHC facilities in the Greater Accra and Eastern Regions. The desk reviews analyzed policy goals, resource allocation, and training provisions for NCD care. The survey, conducted between October 2023 and February 2024, used the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to evaluate service availability and readiness for hypertension, diabetes, and mental health services across domains such as staff, guidelines, equipment, diagnostics, and medications. Multivariable logistic regression using Stata 18 assessed readiness determinants, adjusting for facility type, managing authority, location (urban/rural), and region, with standard errors clustered at the district level. Ethical approval was obtained from the Ghana Health Service and the London School of Hygiene and Tropical Medicine.

A total of 13 national policy documents were reviewed, highlighting strong frameworks for resource allocation, workforce training, and NCD care integration into PHC, but revealing gaps in rural resource distribution and lower-tier workforce training. Service availability was highest for hypertension (39%), followed by mental health (38%) and diabetes (35%). District hospitals exhibited the most comprehensive availability (100% for hypertension and diabetes, 79% for mental health), while Community-based Health Planning and Services (CHPS) compounds had the lowest (4.2%). Readiness followed similar trends, with district hospitals scoring 77%-82%, and CHPS compounds 30%-36%. Medication availability was critically low, ranging from 1.6% for diabetes to 3.9% for mental health. Logistic regression identified private and urban facilities as having higher readiness than public and rural counterparts.

Significant disparities exist in the readiness of PHC facilities in the Greater Accra and Eastern Regions of Ghana to manage NCDs. Targeted interventions to strengthen CHPS compounds, address rural gaps, and improve medication availability are essential for achieving equitable NCD care delivery.