Empty
Capstone
mailcapstone@umcutrecht.nl

Profile Logout

Needs analysis for NCD training in Ghana and The Gambia


Ghana : NCDs account for 43% all-cause mortality in Ghana, with major NCDs such as heart disease, stroke, diabetes, cancer, and respiratory disease being common in health facilities. The likelihood of premature death between 30 and 70 years due to the major NCDs in Ghana is estimated to be 21%, higher than the global average of 18% (WHO, 2018). There is also a significant unmet need for diagnoses and treatment of NCDs and an imbalance in the allocation of health care resources at health care facilities in Ghana (Kushitor & Boatemaa, 2018).

The fight against NCDs in Ghana has been impeded by several issues. These include a lack of high-quality evidence-based data to (i) deliver comprehensive NCD care, (ii) inform priority setting to advance and prevent NCDs, and (iii) align strategy implementation. Additionally, there is a fragmented response to the growing burden by partners working in the NCD space and a lack of funding and human resources to fully monitor and coordinate activities being undertaken by stakeholders and partners in the country. The fight is further impeded by an unstructured screening programme for early detection and subsequent treatment. Staff shortages at health care facilities also remain a significant challenge, both in the public and private sector. Some private sector healthcare workers work part-time the public sector to take advantage of training opportunities; However, the majority of healthcare workers have no formal training or knowledge of taking care of people living with NCDs



According to a stakeholder consultation undertaken by the applicants in November 2022 among purposively sampled health policymakers and implementing officials (n=15) at the national and sub-national levels in Ghana, lack of trained human resources (1.1 doctors and 9.8 nurses per 10,000 Ghanaians), conflicting priorities with curative services, and inadequate training and capacity building services for NCD care were reported as major barriers.




The Gambia: According to The Gambia’s Ministry of Health (2022), the latest WHO NCD profile indicated that NCDs account for 34% of total annual mortality in The Gambia, with cardiovascular diseases (CVD) accounting for the highest proportion of NCD-related mortality, followed by cancers, chronic respiratory diseases, diabetes and other NCDs accounting for 14%, 4%, 2%, 1% and 12% respectively. In 2021, there were 8 hospitals operating in The Gambia, including one specialised, one teaching, and four private. There were four district hospitals and six major health centres. A total number of 40 minor health centres are distributed across the regions. Currently, the public health sector’s health workforce index for skilled health human resources nationally stands at 1.53/1000 population against WHO’s recommendation of 4.45/1000 population.

As for the individual cadres, the medical doctors to patient ratio is 0.09, nurse midwives 0.27, general nurses 0.45, public health practitioners 0.13, pharmacists 0.05 and laboratory personnel 0.08/1000 population, respectively. Of all medical doctors in The Gambia, 65 (29%) are registered specialists able to provide specialised care for advanced stage of NCDs (Health Management Information System Unit, Directorate of Planning and Information, 2021). As part of a situational analysis undertaken by the applicants among purposively sampled health policymakers and implementing officials in November 2022, a key informant interview with the Ministry of Health (MOH) revealed the limited number of internal medicine specialists with a focus on NCDs (two cardiologists, five ophthalmologists, one specialist oncologist surgeon, one endocrinologist, one nephrologist and one haematologist, although no pulmonologist despite a high prevalence of respiratory tract diseases). Only five of the specialists named above are Gambians. This reaffirms the need for a robust public health education and promotion programme towards effective prevention and control of NCDs in the country.

The national NCD Strategic plan 2022-2027 for The Gambia highlights the importance of (i) strengthening national NCD capacity, leadership, governance, multi-sectoral action and partnerships to accelerate country response for the prevention and control of NCDs; (ii) strengthening health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage and to (iii) promoting and supporting national capacity for high-quality research and development for the prevention and control of NCDs.