Introduction
In Ghana, hypertension and diabetes have become significant public
health problems. Evidence from cross-sectional studies conducted in
urban areas reveals prevalence levels of hypertension that ranges
between 28% and 40% (Amoah, 2003; Cappucio et al ., 2004;
Agyemang, 2006; Hill et al ., 2007). In rural areas, prevalence
figures that go as high as 35% have been recorded (Cook-Huyne et
al ., 2012). According to the Ministry of Health (MOH) and Ghana Health
Service (GHS), between 1990 and 2010, newly diagnosed cases of
ambulatory hypertension in public and mission health facilities in Ghana
(excluding teaching hospitals) increased more than ten times from 60,000
cases to about 700,000 cases (MOH/GHS, 2014). As the third most common
newly-diagnosed outpatient disease among adults in Ghana, hypertension
has ranked in the top five outpatient diseases for more than fifteen
years (MOH/GHS, 2014). Hypertension has therefore been declared as an
epidemic in Ghana and stakeholders have called for urgent action (Bosu,
2010).
Similarly, the prevalence of diabetes has increased from 2.0% in the
early 1960s (Dodu & De Heer, 1964) to 6.4% in the early 2000s (Amoah
et al ., 2002). In the urban areas, a prevalence range of 6.0% to
9.5% has been recorded (Hill et al ., 2007; Owiredu et
al ., 2009). In 2012, the Ghana News Agency reported that about four
million people may be affected with Type I and type II diabetes mellitus
in Ghana; a figure which represented about 20% of the Ghanaian
population at the time (Ghana News Agency, 2012). In health facilities,
reported newly diagnosed cases of diabetes increased five-fold from
25,000 cases to about 120,000 cases between 2005 and 2009 (MOH, 2012).
Diabetes affects the active population group in Ghana as 58% of cases
of diabetes were persons between the ages of 20 and 59 years in 2011
(MOH, 2012).
Despite this alarming trend, policy-makers have paid more attention to
managing communicable diseases with interest in managing hypertension
and diabetes only emerging recently. Aikins (2007), for example,
questioned the logic behind making HIV/AIDS with a national prevalence
of 3.2% a Millennium Development Goal target while hypertension, with a
prevalence of 28.7% remained neglected.
Evidence is limited in Ghana as epidemiological studies and health
services research on hypertension and diabetes have been in the form of
cross-sectional surveys of isolated populations and pockets. Both
planning and implementation of policies, therefore, are likely to have
limited impact in the absence of epidemiological data based on a
nationally representative sample. Besides, as Robles (2004) has argued,
the impact of health policies and their formulation, with respect to
non-communicable diseases (NCDs) such as hypertension and diabetes, are
influenced by the process by which such policies are made, implemented,
and how various stakeholders respond to the challenges. This may also be
a limitation in Ghana. The aim of this paper is to conduct a case study
at national and district levels to generate empirical data on the
management of hypertension and diabetes in Ghana.
This goal will be achieved by meeting the following two objectives:
first, examine how policies for managing hypertension and diabetes are
made and implemented in Ghana; second, examine the response to the
challenge of diabetes and hypertension from the perspective of key
stakeholders in the Ghanaian health sector.
The rest of the paper is organized as follows: section two explains the
conceptual underpinnings of the study (health policy, policy formulation
and policy implementation); section three provides a brief explanation
of the context of policy-making in Ghana; section four describes the
methods for the study; section five presents the results of the study;
section six discusses the results in the light of existing literature;
and, section seven concludes and draws out policy lessons from the
study.