Overview
The Republic of Ghana has a population of about 25 million people. It has a National Health insurance system which is funded by taxes and an annual premium paid by the individual in order to access the system. The health insurance is run by the National Health Insurance Authority under the act 852. There are private health insurance schemes and also those provided by companies for their employees. National Health Insurance (NHIS) can only be used in public hospitals and some Mission Hospitals.

What happens if you need to see a doctor?
Most health centers are run by medical doctors in the big cities and towns, however in the villages there are physician assistants and nurse prescribers who take care of patients. Most patients see the medical practitioner who would refer someone to a specialist if one is available. The cost of seeing the medical practitioner at the public hospitals is free under the NHIS. Medications which are not covered by the NHIS have to be paid for by the patient. This includes insulin in some health facilities for people with type 1 diabetes.

Who decides what medicines a doctor can prescribe?
The Food and Drugs Authority (FDA) is the National Regulatory Authority mandated by the public Health Act to regulate food, drugs, food supplements, herbal and homeopathic medicines, veterinary medicines, cosmetics, medical devices, household chemical substances, tobacco and tobacco products. The National Health Insurance Authority has a list of medicines from the FDA which are covered under the health insurance system and prescribers are encouraged to use this list. The Medical and Dental Council is the authority for medical doctors and also physician assistants.

Practically, what is it like to live with type 1 diabetes in the Ghana?
Insulin is on insurance and is meant to be prescribed freely to the type 1 diabetics in Ghana. Test strips, ketone meters, and other supplies have to be paid for out-of-pocket by the patient. Ideally, every type 1 diabetic should be referred to a specialist or endocrinologist for care. However, there are less than 15 endocrinologists in the whole country. Not all health centers have dieticians and patients have to rely on the doctor or nurse for food/nutrition advice. Patients are reviewed every 2-3 months and given refills of their insulin. Laboratory tests such as HbA1C are not available in most health care centers and if available must be paid by the patient. This is expensive and most cannot afford to have them done.

What about getting admitted to hospital?
Admission to the public hospital is covered under the health insurance, but glucose strips for glucose monitoring must be paid for by the patient in many hospitals.

How does diabetes care vary throughout the country?
Diabetes care greatly varies in various parts of the country; insulin is not always available. Some health care facilities have to sell insulin together with glucometers, strips and ketone strips. Insulin syringes also are bought by the type 1 diabetics after being prescribed by the doctors. Annual reviews such as eye and foot examinations are not routinely done though doctors are encouraged to refer their patients for this care. Knowledge of diabetes management in children, adolescents and young adults still needs to be increased and knowledge of medical personnel should be improved and updated to provide the optimum care for type 1 diabetics in Ghana. There are only 4 facilities in Ghana that solely manage young type 1 diabetics in clinics, all of them are in the southern sector of the country.

Thanks so much to Dr. Nana Ama Barnes and Diabetes Youth Care for sharing this information with us.