The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana.

Mawuli Komla Kushitor,Sandra Boatemaa,Mark G Shrime

doi:10.1371/journal.pone.0194677

Abstract

Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services.

Highlights

Africa, is experiencing a double burden of diseases [1]. This is characterised by the increasing prevalence of chronic non-communicable diseases (NCD) and the battle to deal with infectious diseases [2,3]
While several studies have linked the poor control of NCDs to limited NCD care, we provide empirical evidence to show the inequalities in the allocation of health resources for the management of NCDs
This study shows limited resources available for people living with diabetes and hypertension within the formal health care system, a task shifting approach can potentially widen the reach of basic hypertension and diabetes management to the remotest areas in Ghana

Summary

Introduction

Africa, is experiencing a double burden of diseases [1]. This is characterised by the increasing prevalence of chronic non-communicable diseases (NCD) and the battle to deal with infectious diseases [2,3]. The burden of NCDs disproportionately affects populations in low and middle income countries (LMIC) where health systems are weak [4]. In LMICs, especially in sub Saharan Africa (SSA), hypertension is increasing rapidly because of rapid population growth, increased life expectancy and lifestyle factors [5,6,7]. In Ghana, the prevalence of NCDs such as obesity, hypertension, diabetes and heart diseases have been rising [8,9,10]. The Ghana Ministry of Health (MoH) 2010 annual report indicated that hypertension is the second leading cause of outpatient morbidity in adults 45 years and above [12]

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Results

Discussion

Conclusion