Ghana
Ghana is not among the World Health Organization’s (WHO’s) 22 high-burden
tuberculosis (TB) countries, yet the disease is a major health problem in the country.
With an estimated 47,632 new TB cases in 2007, Ghana ranks 19th in Africa for the
highest estimated number of new cases per year, according to WHO’s Global TB
Report 2009. Nine percent of the 7,786 TB patients registered in 2007 died before
completing TB treatment. Ghana’s National TB Control Program (NTCP), which is
based on DOTS (the internationally recommended strategy for TB control), was
established in 1994. DOTS was phased in over a number of years, with an initial
strategy to roll out DOTS to all public health facilities in all regions and districts, and
reached 100 percent coverage in 2000. However, the quality of DOTS in public health
facilities is still below expectations.
A recent study supported by the U.S. Government showed that some districts had not
incorporated DOTS into their routine activities. The case detection rate of sputum
smear-positive (SS+) TB has slowly declined over the past five years from 40 percent in
2003 to 36 percent in 2007, well below WHO’s target of 70 percent. The treatment
success rate has improved from 60 percent since 2002 to 76 percent in 2006; but this
is still below WHO’s target of 85 percent. The HIV/AIDS epidemic, a generalized
epidemic with a prevalence of 2.3 percent, is fueling TB incidence. According to
WHO, approximately 15.6 percent of new TB cases are HIV positive. Impact modeling
shows that HIV infection among TB patients could increase to 59 percent by 2009, and
an additional 30,000 new TB cases annually could be attributable to HIV/AIDS by 2015.
Though accurate data are limited, there is a growing concern about multidrug-resistant
(MDR) TB. WHO estimated that 1.9 percent of new TB cases were MDR in 2007.
There is currently no database on staff trained in DOTS, and the expansion of DOTS
has been limited because of competing demands on limited health resources. The key
challenges and gaps facing the NTCP in its efforts to expand and scale up existing
DOTS programs include implementation of activities aimed at increasing TB case
detection rate, TB-HIV/AIDS collaborative activities, and involvement of the private
health sector beyond Accra and Kumasi metropolises.
USAID Approach and Key Activities
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USAID’s approach in Ghana complements the priorities of the Government of Ghana,
WHO, and other partners. USAID, through the Tuberculosis Control Assistance
Program (TB CAP), provided technical assistance (TA) in the development of the
NTCP’s Strategic Plan for 2008–2012. In fiscal year 2008, USAID funds for TB
programming in Ghana totaled $595,000 per year. USAID supports TB activities
through its bilateral programs and TA provided by TB CAP. The Strategic Plan for
2008–2012 includes improved NTCP management capacity to implement quality DOTS
and improved quality assurance for sputum smear microscopy and supply chain
systems. In addition, under the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR), USAID provides support for strengthening TB screening and treatment of
HIV-infected patients in 25 selected health facilities and further supports people living
with HIV/AIDS (PLWHA) groups in early TB diagnosis and referrals. USAID assistance
also includes support for the following activities:
- Expanding and enhancing DOTS
- Increasing TB detection rate through the use of standard operating
procedures at health facilities and at the community level
- Improving management of TB-HIV/AIDS with improved data monitoring and
drug tracking and provision
- Training staff in the use of the logistics management information system (LMIS) for TB commodities
- Implementing community-based DOTS through activities conducted by support groups for PLWHA
- Involving health workers, relatives, and community volunteers in supervising TB patients to achieve cure and treatment
completion
- Addressing known financial constraints faced by TB patients, private clinics, hospitals, and laboratories using the “Enablers
Package,” a provision of food to assist TB patients in DOTS compliance
- Supporting operational research to uncover the reasons for low TB case detection
USAID Program Achievements
USAID’s assistance and support have helped address TB prevention and control through the following activities:
- Developed TB-HIV/AIDS policy and guidelines and expanded TB reporting tools to include HIV parameters
- Developed an operational plan for implementation of TB lab quality assurance
- Provided TA to implement quality DOTS and build capacity of the National Reference Laboratory to perform external
quality assurance
- Conducted studies to examine the reasons behind Ghana’s low case detection rates
- Increased functional TB microcopy sites from 211 to 240 and trained laboratory personnel from both the public and
private sectors on TB smear microscopy
- Achieved countrywide rollout of fixed-dose combination (FDC) treatment, with all new TB cases started on FDC
beginning in July 2007
- Engaged 111 out of 557 private health facilities through the public-private mix DOTS initiative, resulting in 97 of these
facilities supporting the diagnosis, treatment, and supervision of TB cases
- Supported the NTCP in the implementation of a LMIS for TB medicines
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
USAID support to the NTCP is provided through TB CAP, which is implemented by the Tuberculosis Coalition for Technical
Assistance (TBCTA). Management Sciences for Health coordinates the TBCTA in Ghana. USAID, in coordination with PEFPAR,
supported the NTCP in the development of a comprehensive TB-HIV/AIDS referral system and in care and support interventions.
Other key partners include the KNCV Tuberculosis Foundation, Quality Health Partners, the Strengthening HIV/AIDS Response
Partnership, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Ghana received Round 1 funding from the
Global Fund in 2002 for health system strengthening, which included support for TB programs; in 2006, Ghana received a Round 5
grant for $14.5 million for TB activities.
May 2009
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