Guidance

Country information note: medical treatment and healthcare, Ghana (accessible)

Updated 9 July 2024

Version 2.0

August 2022

Preface

Purpose

This note provides country of origin information (COI) for decision makers handling cases where a person claims that to remove them from the UK would be a breach of Articles 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition.

It is not intended to be an exhaustive survey of healthcare in Ghana.

For general guidance on considering cases where a person claims that to remove them from the UK would be a breach of Article 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition, see the instruction on Human rights claims on medical grounds.

Country of origin information

The country information in this note has been carefully selected in accordance with the general principles of COI research as set out in the Common EU [European Union] Guidelines for Processing Country of Origin Information (COI), dated April 2008, and the Austrian Centre for Country of Origin and Asylum Research and Documentation’s (ACCORD), Researching Country Origin Information – Training Manual, 2013. Namely, taking into account the COI’s relevance, reliability, accuracy, balance, currency, transparency and traceability.

The structure and content of the country information section follows a terms of reference which sets out the general and specific topics relevant to this note.

All information included in the note was published or made publicly available on or before the ‘cut-off’ date(s) in the country information section. Any event taking place or report/article published after these date(s) is not included.

All information is publicly accessible or can be made publicly available, and is from generally reliable sources. Sources and the information they provide are carefully considered before inclusion. Factors relevant to the assessment of the reliability of sources and information include:

• the motivation, purpose, knowledge and experience of the source

• how the information was obtained, including specific methodologies used

• the currency and detail of information, and

• whether the COI is consistent with and/or corroborated by other sources.

Multiple sourcing is used to ensure that the information is accurate, balanced and corroborated, so that a comprehensive and up-to-date picture at the time of publication is provided of the issues relevant to this note.

Information is compared and contrasted, whenever possible, to provide a range of views and opinions. The inclusion of a source, however, is not an endorsement of it or any view(s) expressed.

Each piece of information is referenced in a brief footnote; full details of all sources cited and consulted in compiling the note are listed alphabetically in the Bibliography.

Feedback

Our goal is to continuously improve our material. Therefore, if you would like to comment on this note, please email the Country Policy and Information Team.

Independent Advisory Group on Country Information

The Independent Advisory Group on Country Information (IAGCI) was set up in March 2009 by the Independent Chief Inspector of Borders and Immigration to support him in reviewing the efficiency, effectiveness and consistency of approach of COI produced by the Home Office.

The IAGCI welcomes feedback on the Home Office’s COI material. It is not the function of the IAGCI to endorse any Home Office material, procedures or policy. The IAGCI may be contacted at:

Independent Advisory Group on Country Information
Independent Chief Inspector of Borders and Immigration
5th Floor
Globe House
89 Eccleston Square
London
SW1V 1PN

Email: [email protected]

Information about the IAGCI’s work and a list of the documents which have been reviewed by the IAGCI can be found on the Independent Chief Inspector’s pages of the gov.uk website.

Healthcare context

Section 1 updated: 5 August 2022

1. Sources and prices

1.1 MedCOI

1.1.1 This note makes use of medical country of origin information (COI) compiled by Project MedCOI, which was set up and operated by the immigration authorities in Belgium and the Netherlands until 31 December 2020, and since then by the European Asylum Support Office (EASO) (now the European Union Agency for Asylum (EUAA)).

1.1.2 The EUAA MedCOI sector website explains how the project did and currently operates:

‘The EUAA provides access to medical country of origin information (MedCOI). This information supports the national migration and asylum authorities in Europe to reach accurate and fair decisions in international protection and other migration procedures. More precisely, MedCOI is a service for first instance migration authorities of EU+ countries, providing responses to requests for information about the availability and accessibility of medical interventions in countries of origin.

‘EUAA MedCOI relies on a worldwide network of medical experts that provides up-to-date medical information in countries of origin. Based on this information and combined with desk research, the EUAA MedCOI Sector produces responses to individual requests from EU+ countries, general medical country reports, and maintains a portal with a specific database where the information can be found…The database is only accessible to trained personnel in EUAA and the EU+ countries’ relevant administrations…

‘The portal also allows for the continuous exchange of information between countries, and between countries and EUAA. The database is only accessible to trained personnel in EUAA and the EU+ countries’ relevant administrations. Completion of the MedCOI training modules (specific training on the use of the MedCOI database and on MedCOI methodologies) is a necessary requirement to be granted access.

‘The high quality and medical accuracy of the information is guaranteed by specifically trained medical advisors and research experts who also provide guidance to the users of the portal.

‘The MedCOI Sector at EUAA has incorporated all services that were previously delivered by project teams in Belgium and the Netherlands in an ERF/AMIF funded project until 31/12/2020 (MedCOI4).’^{[footnote 1]}

1.1.3 The UK Home Office ceased to be able to make requests to or access the MedCOI database on 31 December 2020.

1.1.4 The UK Home Office has, however, retained copies of all MedCOI documents referred to in this note obtained prior to 31 December 2020 should they be required in individual cases.

1.2 Costs and currency

1.2.1 This note includes the cost for various medications and treatments. These prices have been converted into British pounds whenever possible. The exchange rate as of 5 August 2022 was £1 = 10.34 Ghana Cedis^{[footnote 2]}.

Section 2 updated: 4 August 2022

2. Healthcare system

2.1 Organisation and provision

2.1.1 The United States Department of Commerce (USDOC) Ghana - Country Commercial Guide stated:

‘The Government of Ghana continues to expand access to healthcare coverage and the scope of benefits it makes available to its citizens. Ghana’s 2021 census results report 68.6 % of the population is covered by either the National Health Insurance Scheme (NHIS) or private health insurance schemes…

‘The healthcare sector in Ghana is organized at three different levels: national, regional, and district. Health interventions are packaged for each level and are delivered at the respective clinics and hospitals.

‘Healthcare is variable throughout Ghana. Urban centers are well served, and are where most hospitals, clinics, and pharmacies in the country can be found. Rural areas often have no modern healthcare services. Patients in these areas either rely on traditional African medicine or travel great distances for healthcare. Most healthcare is provided by the government and is largely administered by the Ministry of Health and the Ghana Health Services. The healthcare system has five levels of providers: 1) health posts, the first level of primary care in rural areas; 2) health centers and clinics; 3) district hospitals; 4) regional hospitals; and 5) tertiary hospitals…

‘Ghana has very limited local production of pharmaceuticals and even less manufacturing of medical equipment and devices. The country relies on imports for approximately 85 percent of its total healthcare consumption.’^{[footnote 3]}

2.1.2 A MedCOI response providing general information on the healthcare system in Ghana stated:

‘The public healthcare system in Ghana has a referral level structure composed of a national level (tertiary care), regional level (secondary care) and primary care delivered at district level (hospitals), sub-district level (health centres) and community level (Community Health 1 Planning Services –CHPS)…Each level should deliver a specific package of services.’^{[footnote 4]}

2.1.3 The Foreign, Commonwealth and Development Office (FCDO) travel advice, aimed at British travellers, stated: ‘Medical facilities are poor outside towns.’^{[footnote 5]}

2.1.4 Boateng, Ernest, Davies, Oliver, Fage, John and Maier in the Encyclopaedia Britannica, updated September 2021, stated:

‘There are hospitals and clinics provided by the government and by various Christian missions in most parts of the country. Supplementary services consist of health centres, dispensaries, and dressing stations (first-aid centres). Considerable progress has been made in the quantity and quality of health facilities and medical personnel, but rapid population growth continues to impose great pressures on the available facilities. In addition to the large number of doctors in the public service, many private practitioners operate their own clinics and hospitals. Registered doctors and dentists are supported by a paramedical staff of nurses, midwives, and pharmacists, as well as by auxiliaries.’^{[footnote 6]}

2.2 The Ghana Health Service

2.2.1 The Ghanaian Ministry of Health website stated:

‘The Ghana Health Service (GHS) is a Ghanaian government body established in 1996 as part of the Health Sector Reform of Ghana. The Health Service is under the Ministry of Health. The Health service primarily administrates the health services provided by the government and in implementing government policies on healthcare…

‘GHS Mandate and Objectivity

‘GHS to provide and prudently manage comprehensive and accessible health service with special emphasis on primary health care at Ghana regional, district and sub-district levels in accordance with approved national policies. The objects of the Service are to:

• Implement approved national policies for health delivery in Ghana

• Increase access to good quality health services, and

• Manage prudently resources available for the provision of the health services.

‘GHS Functions

‘For the purposes of achieving its objectives the GHS performs the following functions amongst others:

‘Provide comprehensive health services at all levels in Ghana directly and by contracting out to other Ghana agencies^{[footnote 7]}.

2.3 National health insurance scheme (NHIS)

2.3.1 D Opoku, A K Edusei, P Agyei-Baffour, G Teddy, K Polin, W Quentin, in the Ghana: health system review 2021, stated: ‘One key characteristics of the health system of Ghana is the introduction and reform of the national health insurance scheme (NHIS) in 2003 and 2012 respectively. About 40% of the population are enrolled and 60% enrolled are exempted from premium payments…Enrolment in in the NHIS contributes to better access to health care and improved financial protection.’^{[footnote 8]}

2.3.2 A MedCOI response providing general information on the healthcare system in Ghana stated:

‘The National Health Insurance Scheme (NHIS) is a social intervention program introduced by government to provide financial access to quality health care for residents in Ghana…There are two kind of NHIS subscribers: the informal and exempt groups…Only the informal group pays premium. The annual premium is at most GHS 30, or USD 6 [£4.97^{[footnote 9]}]. Members of the exempt group do not pay premium…and include:

• chronic mental health patients - Chronic TB patients

• some HIV patients

• children under 18 years

• people over 70 years old

• indigenous population, classified as such by the Minister for Social Welfare

• pregnant women

• other categories of people determined by the Minister responsible for Social Welfare

• pensioners of Social Security and National Insurance Trust (SSNIT)

• SSNIT contributors, i.e. formal sector employees and the self-employed who contribute to the SSNIT…

‘21 million people out of the 30 million Ghanaian population are registered with the NHIS. 11 million of them are active users and around 1.4 million of people belong to the group exempt of fee premium…People enrolled under the NHIS are entitled to a NHIS member card, which allow them to access NHIS benefits…Benefits include outpatient and inpatient treatment, medication included in the NHIS medicines list, dental treatment, optical aids and emergency care. The NHIS also determines the diseases not included in its coverage.’^{[footnote 10]}

2.4 Facilities and personnel

2.4.1 The Aetna (international private medical insurance company)^{[footnote 11]} website stated:

‘The majority of hospitals in Ghana can be considered “general”, focusing on general medicine. This means they don’t offer a full range of diagnostics, testing or treatments. ….

‘There are around 1,300 private facilities which usually provide a better quality of treatment and have more modern equipment than public institutions. There are around 1,800 public hospitals. These facilities can be overcrowded and lack the quality those from developed countries have come to expect. While both public and private institutions are generally located in urban areas, major medical facilities are often outside densely populated urban areas.

‘Medical facilities run by religious institutions (usually Christian or Muslim) number more than 200 and they are found predominantly in rural areas.’^{[footnote 12]}

2.4.2 The Aetna website also stated: ‘As well as government-funded hospitals and clinics, religious groups play an important role in providing the population with much needed medical assistance through the health care centres they have set up.’^{[footnote 13]} The Aetna website added: ‘There are more than 550 pharmacies in Ghana, with most in the major cities and towns — some of which are open 24 hours.’^{[footnote 14]}

2.4.3 For a list of hospitals, see Ghana Hospitals. The Foreign, Commonwealth and Development Office also provides a list of medical facilities, updated 22 February 2021, that may be able to assist British nationals while in Ghana. The US Embassy also provides a list of medical practitioners and facilities who/which may be able to assist US citizens in Ghana.

2.5 Private medical insurance

2.5.1 A number of private medical insurance companies operate in Ghana, such as Glico Healthcare^{[footnote 15]}, Liberty Health^{[footnote 16]}, and Acacia Health Insurance Limited^{[footnote 17]}.

2.6 Paediatric healthcare

2.6.1 The Nyaha Medical Centre in Accra stated on its website that it has a paediatrics clinic and a team of paediatric specialists, who can diagnose and treat medical disorders and diseases in children^{[footnote 18]}.

2.6.2 See also Child cancer, Paediatric heart surgery, and UNICEF Ghana country section.

2.7 Emergency healthcare

2.7.1 The Aetna website stated: ‘Emergency services and hospitals are available within cities, but few exist outside urban areas where traditional African medicine remains the main option for most of the rural population who cannot afford to travel long distances for care and/or treatment.’^{[footnote 19]}

Medical conditions

Section 3 updated: 31 May 2022

Official – sensitive: Start of section

The information in this section has been removed as it is restricted for internal Home Office use.

Official – sensitive: End of section

3. COVID-19

3.1.1 Up to date figures on COVID cases and deaths are available on the African Union dashboard.

3.1.2 Our World in Data provides a range of health information including information related to the Covid-19 pandemic.

3.1.3 See also the Institute of Statistical, Social and Economic Research (University of Ghana) Policy Brief, The Impact of Covid-19 on the Health Sector in Ghana, published in September 2020.

Section 4 updated: 5 August 2022

4. Cancer

4.1 General

4.1.1 The Global Health Dynamics Cancer Control website stated:

‘Access to specialist oncological care is limited to major teaching hospitals and some private hospitals in the cities and big towns. These centres are inaccessible by virtue of distance and the situation is made worse by poor public transportation systems and expensive accommodation in the cities…

‘On average, 1,200 new cancer cases are referred to the [National Centre for Radiotherapy, Accra] facility every year with about 70% requiring radiation treatment, however, less than 50% of these patients complete their treatment…’^{[footnote 20]}

4.1.2 An article on The Conversation website (independent online source of news analysis and informed comment written by academic experts)^{[footnote 21]}, Ghana needs a better policy to guide care for cancer patients regarding care for cancer patients, dated 3 March 2020, stated: ‘…patients with cancers…who seek services at oncology departments and palliative care units have to pay for treatment. In some cases, such services are inadequate or not within their means.’^{[footnote 22]}

4.2 Breast cancer

4.2.1 A 2021 academic study, Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region, published by the British Medical Journal (BMJ), stated:

‘Thirty-three out of the 34 hospitals (97%) in the Eastern Region [of Ghana] were surveyed…

‘A total of 350 healthcare workers involved with breast cancer care were reported across the 33 hospitals. Of these healthcare workers, 182 (56.2%) were MDs [medical doctors] and 32 (97.0%) of the hospitals employed at least 1 MD…

‘Breast cancer screening was mainly performed via CBE [clinical breast examination], and this was always available at 27 (81.8%) of the hospitals. None of the surveyed facilities had a mammogram machine…

‘For the pathological diagnosis of breast cancer, excisional biopsy was offered at 18 hospitals (54.5%). Five of these sites also performed fine needle aspiration and core needle biopsy and one additional hospital offered core needle biopsy only…

‘Thirteen hospitals (39.4%) provided surgery for the treatment of breast cancer. Six of these hospitals reported performing both mastectomy and wide local excision, and the other seven provided wide local excision only. Four of the hospitals that performed both mastectomy and wide local excision also performed axillary surgery, but no facilities performed sentinel lymph node biopsy.

‘Two hospitals (6.1%) offered chemotherapy for breast cancer. One of them offered cyclophosphamide, doxorubicin and fluorouracil and the other provided cyclophosphamide, methotrexate and fluorouracil chemotherapy. One of these hospitals (3.0%) offered endocrine therapy with tamoxifen. Radiotherapy was not available in any of the surveyed hospitals. Palliative care was available at 10 hospitals (30.3%).’^{[footnote 23]}

4.2.2 A Ghanaian National Health Insurance Scheme article on the anti-breast cancer drug herceptin and its addition to Ghana’s NHIS Medicine list, dated 10 August 2020, stated: ‘…the National Health Insurance Authority (NHIA) has added a Specialist Anti-Breast Cancer Drug…Herceptin is the brand name of a medicine called Trastuzumab + recombinant human hyaluronidase which is used to treat Breast Cancer, Esophageal Cancer and Stomach Cancer. From July 2019 to July 2020, 230 Ghanaian patients, including a 25 year old, have accessed this innovative treatment…under the NHIS.’^{[footnote 24]}

4.3 Prostate cancer

4.3.1 A MedCOI response, dated 1 October 2020, stated that PSA testing (test for prostate cancer) was available at the Korle Bu Teaching Hospital, Accra, (public facility)^{[footnote 25]}. A Korle Bu Teaching Hospital article on Radiation Therapy Treatment for Prostate Cancer, dated 7 September 2020, stated:

‘The National Nuclear Medicine and Radiotherapy Centre (NNMRC) of the Hospital has begun the treatment of prostate cancers with a new intervention called Intensity-Modulated Radiation Therapy (IMRT).

‘Intensity-Modulated Radiation Therapy (IMRT) is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor…the Head of the Centre, Dr Joel Yarney said, other than robust surgery, the Centre has all that it needs to manage prostate cancer in Ghana…

‘The Centre…has a new linear accelerator currently, it is the only Radiotherapy Centre that has the ability to treat prostate cancer with radiation therapy in Ghana.

‘…treatments for prostate cancer includes radical prostatectomy, brachytherapy and external beam radiation therapy, which can all be done in Ghana.’^{[footnote 26]}

4.4 Liver cancer

4.4.1 A Korle Bu Teaching Hospital article regarding liver cancer surgery, dated 27 November 2018, stated:

‘With about 120 successful liver, pancreas and bile duct cancer surgeries performed, the Korle Bu Teaching Hospital is poised and ready to assist all such patients who would have travelled outside Ghana for treatment to do so here at an affordable price.

‘In an interview with the Hospital, Dr. Asare Offei, the head of the team, said he was happy with their breakthrough.

‘Dr. Offei said patients who would have died from liver, pancreas and bile duct cancers or from the cost of travelling abroad for treatment can now do so in the Hospital at a relatively cheaper price.’^{[footnote 27]}

4.5 Radiotherapy

4.5.1 Radiotherapy is available at the Sweden Ghana Cancer Centre in East Legon Hills (a district of the Greater Accra Region), as noted in its website:

‘Our radiotherapy machine in our facilities is the Linear Accelerator (Linac) Elekta Synergy Platform 80 Leaf Multi-Leaf Collimator (MLC). The Linac allows for Image Guided Radiotherapy, that is imaging of soft tissue at the same time of treatment to allow efficient verification of tumour and critical structure position for safe dose placement. The accuracy and reliability of this equipment allows us to give personalized patient care throughout the entire radiotherapy treatment process.’^{[footnote 28]}

4.5.2 An undated article on the Global Health Dynamics Cancer Control website stated:

‘Ghana is fortunate to be amongst the few countries with radiotherapy facilities…Ghana can boast of three installed radiation therapy machines which include two conventional simulators, two modern Cobalt 60 teletherapy machines in the two national treatment centres; one in capital Accra located in the south of the country and the other in Kumasi in the Ashanti region located in the middle of the country and a private treatment facility in the capital Accra has a CT simulator and a linear accelerator…

‘The National Radiotherapy Centre in Accra has a high dose rate Cobalt 60 brachytherapy machine and also provides permanent brachytherapy with radioiodine for the management of prostate cancer and capsules for management of cancer of the thyroid. The facility in Kumasi provides low dose rate cesium brachytherapy services for cervical cancer management but expects to install a new high dose rate brachytherapy equipment by the end of the year.’^{[footnote 29]}

4.6 Chemotherapy

4.6.1 Sweden Ghana Cancer Centre in East Legon Hills, as noted in its website: ‘…has eight Codan Argus volumetric infusion pumps. Codan Argus pumps have a good reputation in specialist applications such as oncology. They are suitable for administering large volumes of medication in all sorts of therapeutic fields, and we use them for chemotherapy infusion.’^{[footnote 30]}

4.6.2 A MedCOI response, dated 3 October 2019, stated that the chemotherapy drugs – bortezomib (subject to supply problems), and cyclophosphamide, were available^{[footnote 31]}.

4.7 Child cancer

4.7.1 The World Child Cancer website, in an undated entry, stated:

‘Ghana has two main childhood cancer treatment centres; Korle Bu Teaching Hospital (KBTH) and Komfo Anokye Teaching Hospital (KATH). There are other five Shared Care Centres across the country, with plans for expansion to other regions, so that children can be treated locally without having to travel long distances. Access to healthcare services is limited for much of the population, so there remains a large number of children who are currently not diagnosed.’^{[footnote 32]}

Section 5 updated: 8 July 2022

5. Cardiovascular disease

5.1 Cardiology and high blood pressure

5.1.1 A series of MedCOI responses stated that the following drugs were available in Ghana in 2019/2020 to treat high blood pressure – the facility and location are provided in brackets:

• lisonopril (Add Pharma, Accra) (private facility)^{[footnote 33]}

• metoprolol (Add Pharma, Accra)^{[footnote 34]}

• doxazosin (Add Pharma, Accra)^{[footnote 35]}

• prazosin (Add Pharma, Accra)^{[footnote 36]}

• perindopril (Add Pharma, Accra)^{[footnote 37]}

• enalapril (Add Pharma, Accra)^{[footnote 38]}

• ramipril (Add Pharma, Accra)^{[footnote 39]}

• amlodipine (Add Pharma, Accra)^{[footnote 40]}

• felodopine (Add Pharma, Accra)^{[footnote 41]}

• isradipine (subject to supply problems) (Add Pharma, Accra)^{[footnote 42]}

• chlortalidone (Healthlink Hospital, Accra) (private facility)^{[footnote 43]}

• torasemide (Add Pharma, Accra)^{[footnote 44]}

• spironolactone (Add Pharma, Accra)^{[footnote 45]}

• amiloride (Add Pharma, Accra)^{[footnote 46]}

• eplerenone (Healthlink Hospital, Accra)^{[footnote 47]}

• nebivolol (Add Pharma, Accra)^{[footnote 48]}

• furosemide (Add Pharma, Accra)^{[footnote 49]}

• methyldopa (Korle Bu Teaching Hospital, Accra) (public facility)^{[footnote 50]}

• carvedilol (Lister Hospital, Accra)^{[footnote 51]}

• propranolol (Divine Favour Hospital, Agona) (private facility)^{[footnote 52]}

• bumetanide (Lister Hospital, Accra) (private facility)^{[footnote 53]}

• triamterene (Lister Hospital, Accra)^{[footnote 54]}

• eplerenone (Lister Hospital, Accra)^{[footnote 55]}

• hydrochlorothiazide (Lister Hospital, Accra)^{[footnote 56]}

• nicardipine (Add Pharma, Accra)^{[footnote 57]}

• nifedipine (Add Pharma, Accra)^{[footnote 58]}

• dilitiazem (Add Pharma, Accra)^{[footnote 59]}

• captopril (Add Pharma, Accra)^{[footnote 60]}

• terazosin (Add Pharma, Accra)^{[footnote 61]}

• fosinopril (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 62]}

• atenolol (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 63]}

• bisoprolol (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 64]}

• barnidipine (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 65]}

• lercanidipine (Add Pharma, Accra)^{[footnote 66]}.

5.1.2 A series of MedCOI responses stated that the following drugs were available in Ghana in 2019/2020 to prevent blood clotting:

• clopidogrel (Add Pharma, Accra) (private facility)^{[footnote 67]}

• prasugel (Add Pharma, Accra)^{[footnote 68]}

• ticagrelor (Add Pharma, Accra)^{[footnote 69]}

• apixaban (Add Pharma, Accra)^{[footnote 70]}

• enoxaparin (Add Pharma, Accra)^{[footnote 71]}

• heparin (Add Pharma, Accra)^{[footnote 72]}

• nadroparin (subject to supply problems) (Add Pharma, Accra)^{[footnote 73]}

• Aspirin (Add Pharma, Accra)^{[footnote 74]}

• carbasalate calcium (Equity Pharmacy, Accra) (private facility)^{[footnote 75]}

• warfarin (Lister Hospital, Accra)^{[footnote 76]}

• acenocoumarol (Lister Hospital, Accra )^{[footnote 77]}

• phenprocoumon (Lister Hospital, Accra)^{[footnote 78]}.

5.1.3 A series of MedCOI responses stated that the following drugs were available in Ghana in 2019/2020 to treat heart diseases:

• ivabradine (heart failure) (Lister Hospital, Accra)^{[footnote 79]}

• sotalol (heart rhythm disorders) (Lister Hospital, Accra)^{[footnote 80]}

• amiodarone (heart rhythm disorders) (Korle Bu Pharmacy, Accra)^{[footnote 81]}

• digoxin (heart rhythm disorders) (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 82]}

• ibutilide (heart rhythm disorders) (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 83]}

• atorvastatin (statin) (Add Pharma, Accra)^{[footnote 84]}

• rosuvastatin (statin) (Add Pharma, Accra)^{[footnote 85]}

• fluvastatin (statin) (Add Pharma, Accra)^{[footnote 86]}

• oravastatin (statin) (Korle Bu Teaching Hospital, Accra) (public facility)^{[footnote 87]}

• isosorbide dinitrate (angina pectoris) (Lister Hospital, Accra)^{[footnote 88]}

• isosorbide mononitrate (angina pectoris) (Add Pharma, Accra)^{[footnote 89]}

• nitroglycerin (angina pectoris) (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 90]}.

5.2 Heart diseases and heart surgery

5.2.1 The National Cardiothoracic Centre in Accra can, according to its website in an undated entry, provide the following services for people with cardiovascular conditions:

• holter monitoring

• electrocardiogram (ECG) tests

• cardiac health consultations

• diagnostic services^{[footnote 91]}.

5.2.2 A MedCOI response, dated 21 August 2020, stated that cardiologists were available in Ghana at Korle Bu Teaching Hospital (public facility)^{[footnote 92]}.

5.2.3 The Asafo-Boakye Specialist Hospital in Kumasi, stated in an undated entry on its website, that it has a cardiology clinic, which has treatment services including: ‘…medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology.’^{[footnote 93]}

5.3 Paediatric heart surgery

5.3.1 A Graphic online (Ghanaian online news and information portal) report on heart surgery, dated 21 October 2019, stated:

‘Doctors at the Komfo Anokye Teaching Hospital (KATH) in Kumasi have for the first time performed a successful heart surgery without opening the heart.

‘They successfully planted a pacemaker to help accelerate the heart-beat of the patient, a teenage girl who was suffering from a hole-in-heart.

‘It was the first time such a procedure was being used by local doctors in Ghana.’^{[footnote 94]}

5.3.2 See also Paediatric healthcare.

5.4 Brain aneurysm surgery

5.4.1 A Euracare Health article, Historic: Ghana performs first brain surgery without cutting skull at Euracare Advanced Diagnostics and Heart Centre, dated 8 April 2019, stated:

‘A seven-member team of Ghanaian doctors has performed the first-ever brain surgery in the country, without cutting the skull.

‘The minimally invasive brain surgery is the technique by which health workers safely remove brain and skull-base tumours through smaller and more precise openings that minimise collateral damage; that is, injury or other damage inflicted on an unintended target such as blood vessels and nerves…

‘The two-hour surgery was performed with modern equipment and computer software at the Euracare Advanced Diagnostic and Heart Centre, a private health facility in Accra.’^{[footnote 95]}

Section 6 updated: 5 May 2022

6. Dental treatment and conditions

6.1.1 The Bethel Dental Clinic in Accra, stated on an undated entry on its website, that it can provide the following dental care and treatment services:

• dental check-ups and cleaning

• oral cancer screening

• restorative dentistry

• dental implants

• cosmetic dentistry

• root canal surgery

• tooth extractions

• periodontal treatment

• temporomanibular joint disorder treatment^{[footnote 96]}.

6.1.2 The Korle Bu Teaching Hospital in Accra (public facility), noted on its website in an undated entry, that it can provide the following dental care dental surgery and treatment services:

• oral and maxillofacial surgery

• oral and maxillofacial pathology (oral diagnosis)

• restorative dentistry

• paedodontics

• orthodontics

• periodontology^{[footnote 97]}.

6.1.3 See also List of Dental Hospitals in Ghana - 2022 and Ghana Dental Association (GDA) (gdaonline.org)

Section 7 updated: 26 July 2022

7. Diabetes

7.1.1 A MedCOI response, dated 26 August 2020, stated that HbA1C tests could be carried out at the Korle Bu Teaching Hospital, Accra (public facility)^{[footnote 98]}. A MedCOI response, dated 1 June 2020, stated that blood-glucose self-testing strips and blood-glucose testing meters, were available at Komfo Ankokye Teaching Hospital, Kumasi (public facility)^{[footnote 99]}.

7.1.2 A MedCOI response of August 2020 stated that the following drugs, used in the treatment of diabetes, were available:

• insulin (Add Pharma, Accra) (private facility)

• empagliflozin (Add Pharma, Accra)

• gliclazide (Add Pharma, Accra)

• metformin (Add Pharma, Accra)

• canagliflozin (Add Pharma, Accra)

• dapagliflozin (Add Pharma, Accra)^{[footnote 100]}.

Section 8 updated: 12 April 2022

8. Ear, nose and throat conditions (ENT)

8.1.1 The Lucca Health Medical Centre in Accra, stated in an undated entry on its website, that it has ENT specialist doctors who can provide the following treatment services:

• ear diagnostic tests

• myringotomy

• tympanoplasty

• endoscopic sinus surgery

• functional endoscopic sinus surgery

• septoplasty

• tonsillectomy

• adenoidectomy

• treatment for head and neck injuries^{[footnote 101]}.

Section 9 updated: 23 May 2022

9. Endocrinological conditions, including thyroid diseases

9.1.1 The Korle Bu Teaching Hospital in Accra has an endocrine unit that can treat people with hormonal (endocrinological) conditions^{[footnote 102]} .

Section 10 updated: 8 July 2022

10. Epilepsy and neurological conditions

10.1.1 A MedCOI response, dated 1 October 2020, stated that neurosurgeons and neurologists were available at the Korle Bu Teaching Hospital, Accra (public facility)^{[footnote 103]}. The same MedCOI response stated that the following anti-epileptic drugs were available:

• levetiracetam

• lamotrigine

• valproic acid^{[footnote 104]}.

10.1.2 A series of MedCOI responses noted that the following drugs, used to treat neurological conditions, were available in 2019:

• betahistine dihydrochloride (Mokat Pharmacy, Accra) (private facility)^{[footnote 105]}

• piracetam (Add Pharma, Accra) (private facility)^{[footnote 106]}

• botulinum toxin type A (Add Pharma, Accra)^{[footnote 107]}

• amitriptyline (Korle Bu Teaching Hospital Pharmacy, Accra) (public facility)^{[footnote 108]}.

Section 11 updated: 8 July 2022

11. Eye conditions and diseases

11.1.1 The Dr Argawals Eye Hospital in Accra can provide the following services:

• glued intraocular lens

• pre descemets endothelial keratoplasty (partial thickness corneal transplant)

• oculoplasty (covers a variety of procedures that involve eyelids, eyebrows, orbits, tears ducts, and the face)

• pneumatic retinopexy (retinal detachment treatment)

• cataract surgery

• photorefractive keratectomy (PRK) (laser surgery to correct vision defects)

• pinhole pupilloplasty (procedure that narrows down the pupillary aperture, to treat irregular corneal astigmatism)

• paediatric ophthalmology

• cryopexy (treatment that uses intense cold therapy or freezing to treat certain retinal conditions)

• refractive surgery

• neuro-ophthalmology (specialty that concentrates on the neurological problems related to the eye)

• anti-vascular endothelial growth factor (VEGF) agents (anti-VEGF agents are a group of medications which block the activity of VEGF and mitigate the abnormal effects of VEGF)

• treatment for dry eyes

• retinal laser photocoagulation

• vitrectomy (surgical procedure where the vitreous humor gel is cleared to provide better access to the retina)

• scleral buckle (treatment for detached retinas)

• laser cataract surgery

• lasik laser surgery^{[footnote 109]}.

11.1.2 The Jachie Eye Hospital in Ashanti region, noted on an undated entry of its website, that it can provide treatment for the following eye conditions:

• refractive error

• glaucoma

• cataract

• uveitis

• conjunctivitis^{[footnote 110]}.

11.1.3 The Korle Bu Teaching Hospital in Accra, noted in an undated entry on its website, that it is able to provide:

• treatment for retinal conditions

• treatment for glaucoma and neuro-ophthalmological conditions

• treatment for oculoplastic conditions

• treatment for paediatric ophthalmological conditions

• arterior [anterior] segment treatment

• general ophthalmology treatment services^{[footnote 111]}.

11.1.4 The Afadjato Hospital for Eye and Special Surgery (Afadjato district) can provide the following eye healthcare services:

• cataract care

• comprehensive eye exams

• low vision service

• laser (refractive) eye surgery

• eye surgery

• glaucoma screening

• computerised visual field analysis

• eye examination (for medical reports)

• ultrasound scan assessment

• laser services for blindness prevention^{[footnote 112]}.

11.1.5 A MedCOI response, dated 29 October 2019, stated that the following drugs, used to treat glaucoma, were available:

• acetazolamide (Pharmacy Royale, Accra) (private facility)^{[footnote 113]}

• dorzolamide (Pharmacy Royale, Accra)^{[footnote 114]}

• brinzolamide (Grit Pharmacy, Accra) (private facility)^{[footnote 115]}.

Section 12 updated: 21 April 2022

12. Gastroenterological conditions

12.1.1 A series of MedCOI responses stated that the following gastroenterological drugs were available in 2019/2020:

• metoclopramide (used to treat motion sickness) (Add Pharma, Accra) (private facility)^{[footnote 116]}

• domperidone (used to treat motion sickness) (Add Pharma, Accra)^{[footnote 117]}

• esomeprazole (Healthlink Hospital, Accra) (private facility)^{[footnote 118]}

• lactulose (used to treat constipation) (Healthlink Hospital, Accra)^{[footnote 119]}

• bisacodyl (used to treat constipation) (Add Pharma, Accra)^{[footnote 120]}

• lacitol (used to treat constipation) (subject to supply problems) (Add Pharma, Accra)^{[footnote 121]}

• macrogol (used to treat constipation) (Healthlink Hospital, Accra)^{[footnote 122]}

• macrogol + electrolytes (used to treat constipation) (Healthlink Hospital, Accra)^{[footnote 123]}

• sodium bicarbonate (antiacid) (Healthlink Hospital, Accra)^{[footnote 124]}

• rabeprazole sodium (antiacid) (Healthlink Hospital, Accra)^{[footnote 125]}

• omeprazole (heartburn and indigestion) (Add Pharma, Accra)^{[footnote 126]}

• sodium chloride (Healthlink Hospital, Accra)^{[footnote 127]}

• loperamide (relieves diarrhoea). (Add Pharma, Accra)^{[footnote 128]}

• mesalazine (bowel disease) (Add Pharma, Accra)^{[footnote 129]}

• pantoprazole (antiacid) (Add Pharma, Accra)^{[footnote 130]}.

12.1.2 A MedCOI response, dated 2 June 2020, stated that colonoscopy, gastroenterologists, and gastroenterological surgery were available at the Korle Bu Teaching Hospital, public facility^{[footnote 131]}.

Section 13 updated: 11 April 2022

13. Gynaecological conditions

13.1.1 The website of the Korle Bu Teaching Hospital in Accra provided the following undated information:

‘The Obstetrics and Gynaecology department provides 275 beds for Obstetrics and 97 beds for Gynaecology. The department is divided into five units. A senior consultant heads each unit with other consultants and doctors equally distributed among the units…

‘During the course of providing antenatal care all patients with complications of pregnancy that cannot be safely managed on outpatient basis are admitted to the antenatal wards for further investigations and appropriate management…

‘The gynaecology unit has three wards that are used by the five obstetrics and gynaecology teams. Two of these wards are for patients who are admitted as emergency cases and the third is for patients admitted for elective surgery. Patients are seen on a daily basis at the out patients department…

‘Emergency cases are seen in the emergency room by the on call team. Patients are admitted from here to the emergency lying-in wards for surgery or for further investigations and treatment.’^{[footnote 132]}

Section 14 updated: 26 July 2022

14. Haematological conditions including sickle cell anaemia

14.1.1 A MedCOI response, dated 2 June 2020, stated that haematologists were available at the Korle Bu Teaching Hospital, Accra (public facility)^{[footnote 133]}.

14.1.2 A MedCOI response, dated 28 May 2020, stated that there were haematologists available at the Korle Bu Teaching Hospital who could carry out full blood counts, blood transfusions, and deal with sickle cell disease crises. The same MedCOI response stated that folic acid (used to treat anaemia) was available in Ghana (Add Pharma, Accra) (private facility)^{[footnote 134]}.

14.1.3 A Novartis article on the expansion of the Africa Sickle Cell Disease (ASCD) program to Uganda and Tanzania, dated 18 June 2020, stated:

‘In Ghana, the [ASCD] program is already making progress with more than 2000 patients being treated with hydroxyurea in 11 treatment centers across the country. To date, Novartis has delivered more than 60 000 treatments of hydroxyurea in Ghana, helping ensure SCD patients have uninterrupted access to treatment during the global pandemic…Hydroxyurea is a commonly used medicine for patients with SCD in developed countries, and is approved for use in both adults and children.’^{[footnote 135]}

14.1.4 A MedCOI response from 2019 indicated that sickle cell disease can be treated in most hospitals in Ghana, including both government and private facilities^{[footnote 136]}.

Back to Contents

Section 15 updated: 23 June 2022

15. HIV/AIDS

15.1.1 The Joint United Nations Programme on HIV/AIDS (UNAIDS) website stated that in 2020, in Ghana, an estimated 350,000 people were living with HIV/AIDS. An estimated 19,000 people were receiving anti-retroviral (ARV) treatment in 2020^{[footnote 137]}.

15.1.2 A MedCOI response, dated 21 October 2020, stated that HIV/AIDS specialists were available at the Korle Bu Teaching Hospital, Accra (public facility). CD4 counts and viral load testing were also available at the Korle Bu Teaching Hospital^{[footnote 138]}.

15.1.3 A MedCOI response, dated 21 October 2020, stated that the following anti-retroviral drugs were available:

• dolutegravir (subject to supply problems) (Add Pharma, Accra) (private facility)

• emtricitabine (Korle Bu Teaching Hospital, Accra)

• tenofovir disoproxil (Korle Bu Teaching Hospital, Accra)

• truvada (Korle Bu Teaching Hospital, Accra)^{[footnote 139]}.

15.1.4 A John Snow Inc (JSI) report, HIV Treatment Restores One Woman’s Health in Ghana, dated 30 March 2022, stated:

‘The Care Continuum project works with institutions such as Ghana Health Service, Ghana AIDS Commission, the National AIDS/STI Control Program, and civil society organizations to strengthen Ghana’s ability to develop and manage HIV projects and reach epidemic control. The project works closely with local partners and the government to ensure comprehensive access to high-quality services for people living with HIV and to reduce stigma and discrimination against them in health settings.

‘Through Care Continuum and its partners, more than 4,000 people in Ahafo, 6,000 in Western North, and 19,000 in Western Regions are on treatment. Overall, the project and partners have helped more than 30,000 people get on HIV treatment.’^{[footnote 140]}

Section 16 updated: 26 July 2022

16. Homecare for the elderly

16.1.1 A Guardian article, ‘A lot of benign neglect’: how Ghana’s social changes are isolating older people​, dated 26 May 2020, stated:

‘Private care homes are slowly but steadily being introduced in the hope of revolutionising how this conservative society on the cusp of tradition and modernity cares for its senior citizens. Already, there are three care homes in operation and two more are under construction around Accra.

‘Founded by Judith Comfort Asomani in 2016, Comfort For The Aged is one of these. …

‘Today, there are seven residents aged between 70 and 89. The home can accommodate up to 10 people, says Mensah. Fees are on average around $250 (£202) a month depending on the type of care residents need. Apart from hypertension, some of the residents have Alzheimer’s or Parkinson’s disease, or are recovering from strokes.

‘The home has a structured daily routine, with nurses on hand to help with medication, hospital visits and other assisted living services such as grooming. …

‘There are no government-run care homes for older people and the cost of private care homes puts them out of reach for many Ghanaians struggling to look after ageing parents.’^{[footnote 141]}

16.1.2 The Comfort for the Aged NGO (located near Accra) provides the following care services for elderly persons:​

• 24-hour quality nursing care

• good interpersonal relationship and companionship

• indoor and outdoor activities

• quality and well-balanced meals

• visit by a medical doctor

• visit by religious leaders^{[footnote 142]}.

Section 17 updated: 12 May 2022

17. Kidney diseases

17.1.1 A MedCOI response, dated 14 August 2020, stated that kidney specialists, laboratory research of kidney function, monitoring of full blood count, and haemodialysis treatment was available at the Korle Bu Teaching Hospital (public facility)^{[footnote 143]}.

17.1.2 An article on the Korle Bu Teaching Hospital website regarding successful kidney transplantations, dated 11 December 2019, stated:

‘Korle Bu Teaching Hospital in collaboration with Transplant Links UK has performed Kidney transplantation for four patients with kidney failures…

‘The Transplant Links team have worked with the Korle Bu Hospital since 2008 and many patients have already benefited.

‘The First Sky Group fully funded the accommodation, feeding and airfare of the transplant team from UK. First Sky Group has since December 2016, donated 11 million and a brand-new Toyota Hilux pickup to the Renal Dialysis Unit. This donation has benefited thousands of patients receiving free dialysis every week.’^{[footnote 144]}

Section 18 updated: 12 May 2022

18. Liver diseases

18.1.1 A MedCOI response, dated 20 May 2020, stated that there were hepatologists at the Korle Bu Teaching Hospital, Accra (public facility), who can carry out laboratory research testing of liver function^{[footnote 145]}.

18.1.2 A MedCOI response, dated 18 September 2020, stated that ursodeoxycholic acid, used to treat liver and bile lithiasis, was available in Ghana (Healthlink Hospital, Accra, private facility)^{[footnote 146]}.

18.1.3 A Citi Newsroom report from November 2021, on the commencement of liver transplants at Korle-Bu Teaching Hospital, stated:

‘Authorities of the Korle-Bu Teaching Hospital have announced that the facility will begin liver transplant procedures this week.

‘… the hospital has had a hepatobiliary surgeon and liver cancer team in the past that have been providing treatment to patients suffering from liver, pancreatic, and bile duct cancers.’^{[footnote 147]}

18.1.4 A MedCOI response, dated 20 October 2020, stated that laboratory research liver function testing, DNA laboratory testing for hepatitis B, and laboratory research testing for hepatitis B antigens were available at the Korle Bu Teaching Hospital, Accra (public facility). Testing for liver fibrosis was also available at Korle Bu Teaching Hospital^{[footnote 148]}.

18.1.5 A MedCOI response, dated 20 October 2020, stated that the Healthlink Hospital, Accra (private facility), had these anti-hepatitis B drugs:

• tenofovir alafenamide

• entecavir^{[footnote 149]}.

Section 19 updated: 26 July 2022

19. Musculoskeletal conditions

19.1.1 The University of Ghana Medical Centre Ltd has a physiotherapy clinic that can treat people with musculoskeletal conditions. Its website explained:

‘Our specialist team is fully endowed with experienced and skilled physiotherapists who are dedicated to providing quality preventive, curative and rehabilitative care to both in and out-patients and the promotion of physical health within the community.

‘Our services include;

‘Musculoskeletal physiotherapy: Includes treatment of neck and back pain, joint and extremity pain, etc.

‘Neurorehabilitation: Includes stroke, Parkinson’s disease, Spinal cord injury and brain injury rehabilitation, etc

‘Post-Surgical rehabilitation: Includes Orthopaedic, Cardiothoracic, Neurosurgery, Burns and Plastics, etc

‘Post-Trauma rehabilitation

‘Paediatric physiotherapy

‘Sports physiotherapy

‘Geriatrics and Fall prevention.’^{[footnote 150]}

19.1.2 The Korle Bu Teaching Hospital stated, in an undated entry on its website, that it has a physiotherapy department that treats people with musculoskeletal conditions^{[footnote 151]}.

Section 20 updated: 5 August 2022

20. Mental healthcare

20.1 Mental healthcare services and personnel

20.1.1 The World Health Organisation Mental Health Atlas 2020 stated that there were 39 psychiatrists, 2,463 mental health nurses, 3 mental health hospitals, 260 psychiatric units in general hospitals, 1,016 non-hospital community outpatient facilities, 250 outpatient facilities attached to a hospital, and 10 community residential facilities in Ghana, in 2020^{[footnote 152]}.

20.1.2 The Ministry of Health, Ghana, Mental Health Policy 2019 - 2030, dated December 2018, provided a comprehensive description of the mental health services available in 2018:

‘Some NGOs are involved in mental health promotion, prevention and rehabilitation through education, facilitation of outreach services, capacity building, research and provision of sustainable livelihood empowerment. On account of inadequate spread and lack of accessibility to formal mental health services, a bigger proportion of patients are seen in the community by traditional and faith-based healers.

‘Services are delivered by a team of psychiatrists, other medical doctors, clinical psychologists, clinical psychiatric officers, physician assistants, psychiatric nurses, community psychiatric nurses, social workers, occupational therapists and other categories of staff. These services are provided within health facilities and in the communities. Outpatient clinics in the general hospitals are usually provided by doctors or physician assistants who often refer new cases of persons with mental health problems to the Mental Health Units.

‘There are three public psychiatric hospitals, two based in Accra and one in Cape Coast, and these have a total bed capacity of 1,322 but sometimes in-patient population of 1,500 depicting congestion on the wards. Two Teaching Hospitals (Korle Bu and Komfo Anokye) have psychiatric departments with 12 beds each where patients can be admitted for about two weeks. Three Regional Hospitals (Sunyani in Brong-Ahafo Region, Ho in the Volta Region and Koforidua in the Eastern Region) have psychiatric wings with 10 to 20 beds which also allow short term admission of up to two weeks. These have at least a psychiatric prescriber each.

‘Four other Regional Hospitals (Tamale in the Northern Region, Wa in the Upper West Region, Bolgatanga in the Upper East Region and Efia Nkwanta in the Western Region) have psychiatric units where patients can be detained for a few hours before they are admitted to the general wards or discharged home or referred…

‘There are four private psychiatric hospitals with a total bed capacity of forty supporting mental health care: two in Accra and two in Kumasi.’^{[footnote 153]}

20.1.3 A MedCOI response of 9 November 2020 stated:

‘According to the Mental Health Society of Ghana (MEHSOG), the psychiatric care in the country is insufficient [to meet demand]. There is a considerable shortage of qualified mental healthcare staff…

‘Sources differ regarding the number of psychiatrists in the country, it can be estimated between 12 to 32, although this includes some psychiatrists who are retired…The Agency for Food and Health Security (AHEFS) highlights that there are no mental health specialists in rural areas…There are only three specialised psychiatric hospitals in Ghana,…which are located in Central and Greater Accra Regions…Because of a lack of funding for the construction of new infrastructure, psychiatric units have been created within the existing health facilities at the three levels of the health pyramid for the delivery of mental health services…’^{[footnote 154]}

20.1.4 Quarshie, Emmanuel & Davies, Priscilla and Otoo, Pearl (Quarshie and others) in a September 2021 study paper - Setting Mental Health Priorities in Ghana: A 15-Year Contextual Analysis of the Presidential State of the Nation, stated:

‘Ghana has the most comprehensive mental health legislation within West Africa…however, the country’s mental health system faces many severe challenges, including infrastructural constraints, acute human resource (workforce) shortage, social services challenges, organisational, legal and judicial, research and information system and financial challenges, as well as considerable institutionalised stigma…In terms of access to mental healthcare by the public, only 2.8% of mentally ill persons are able to access treatment, with most mental health patients unable to receive professional care]…

‘Currently, mental healthcare and allied care activities in Ghana are regulated by the Mental Health Act, which was passed in 2012…The key evidence is that, compared to the physical/medical health sub-sector, the mental health sub-sector of the country remains under-served and under-resourced, and continues to be less prioritised on the national development agenda by government…’^{[footnote 155]}

20.1.5 Quarshie and others, also stated:

‘Thus far, there are only three mental hospitals in the country (namely, the Accra, Ankaful, and Pantang psychiatric hospitals), which are hugely under-resourced, overstretched, and severely congested…Of these three mental hospitals, two are located in Accra alone, the national capital in the south, and one is located in the Central Region of the country, also in the south. In all, there are 1322 beds within the three hospitals and 123 mental health outpatient care services across the country…Thus, apart from being incapable of serving the over 30 million people across the country, all three mental hospitals are located in urban areas within two southern regions, with none located in a rural community nor in any of the 14 other regions of the country.’^{[footnote 156]}

20.1.6 The online news website Ghanaian Times, in a report on mental health challenges from November 2021, stated:

‘In Ghana’s Mental Health Policy (2019-2030), formulated by the Ministry of Health and Mental Health Authority, the government has admitted that in spite of efforts to improve mental health care in the country, “there still remains serious challenges.”…The three mental hospitals in the country, Pantang, Accra and Ankaful Psychiatric hospitals, have a total of 1,322 beds (5.5 beds per 100,000 population). Two of these hospitals are located in Ghana’s capital city and the other in the Central Region, but all in the southern part of the country.

‘Mental health services in the country are inadequate and there is the urgent need to do something about the situation to boost health service delivery.’^{[footnote 157]}

20.1.7 A Ghana Insider (online Ghana information and news portal) report on Psychiatric Hospitals in Ghana stated:

‘Ankaful Hospital…has beds for 500 patients who are admitted from central, western and Ashanti regions…The hospital allows people from all over Ghana to be admitted there for treatment…

‘The Hospital has eleven (11) wards but only seven (7) are operational…

‘Accra Psychiatry…has a 600-bed capacity. The services they render at the hospital are:

The OPD [Offender Personality Disorder] services

Clinical Psychology Services

Electro Convulsive Therapy

24hr Pharmacy

Social Work Services

Community Psychiatry Nursing

Rehab Alcoholicanous (Rehab for Alcohol Abuse)…

‘Pantang Hospital…is located near Pantang, which is a town about 1.6 kilometres off the Accra – Aburi road and 25 kilometres from Accra Central.

‘They offer the following services:

‘OPD services

‘Clinical Psychology Services

‘Electro Convulsive Therapy

‘24hr Pharmacy

‘Laboratory Services

‘Special School for the mentally challenged

‘Social Work Services

‘Community Psychiatry Nursing

‘In-Service Training Unit

‘Rehab for Alcohol Abuse.

‘Valley View Clinic…was founded in 1988 with the intent to treat patients with stress related illness in the community. It was established to help public institutions which treat psychological and psychiatric disorders and also to offer alternative solutions for such disorders…

‘There are specialized nurses that attend to any psychological or psychiatric emergencies.

‘The specific psychological or psychiatric consultation areas consist of general medicines, stress related illness, psychological medicine, substance abuse and other related disorders.

‘The clinic has three Units which are: Main Unit, Stress and VIP Wards,

‘They consult in the following areas:

1. Personal Problems

2. Individual Therapy

3. Marital Therapy. Couples

4. Family Therapy

5. Sexual Problems

6. Learning Disabilities and Academic Problems

7. Stress/Depression Management

8. Drug and Substance Abuse

9. Psychological Assessment

10. Anxiety Disorder including

11. Phobic, Obsessive [sic], Panic disorders

12. Post Traumatic Disorders

13. Schizophrenic disorder and related illnesses

14. Bipolar Disorders and related illnesses

15. Organic Related Psychosis Dementia and Seizures (Epilepsy) etc.

16. Attention Deficiency Hyperactive Disorders (ADHD).’^{[footnote 158]}

20.1.8 A MedCOI response, dated 8 December 2020, stated that psychiatrists were available at Pantang Psychiatric Hospital, Accra (public facility)^{[footnote 159]}. The hospital provided for forced admittance and long-term clinical treatment, and homecare psychiatric treatment by a psychiatric nurse^{[footnote 160]}.

20.2 Cost of treatment

20.2.1 A MedCOI response, dated 3 December 2020, stated that the cost of outpatient and ongoing psychiatric treatment at the Korle Bu Teaching Hospital (public facility) in Accra in 2020 was 80 Ghanaian Cedis (£8.40)^{[footnote 161]}. The cost of long-term clinical psychiatric treatment at the Korle Bu Teaching Hospital was 80 Ghanaian Cedis. The cost of short-term clinical psychiatric treatment at the Korle Bu Teaching Hospital was 80 Ghanaian Cedis. The cost of inpatient psychiatric treatment at the Korle Bu Teaching Hospital in 2020 was 80 Ghanaian Cedis^{[footnote 162]}.

20.2.2 No information about the cost of treatment in other facilities was available in the sources consulted (see Bibliography).

20.3 Medicines/drugs

20.3.1 A series of MedCOI responses stated that the following psychiatric drugs were available in 2019/2020:

• bromperidol decanoate depot injection (subject to supply problems) (Mokat Chemist, Accra) (private facility)^{[footnote 163]}

• zuclopenthixol decanoate depot injection (subject to supply problems) (Mokat Chemist, Accra)^{[footnote 164]}

• penfluriodol (subject to supply problems) (Mokat Chemist, Accra)^{[footnote 165]}

• olanzapine (Add Pharma, Accra) (private facility,)^{[footnote 166]}

• aripiprazole (Add Pharma, Accra)^{[footnote 167]}

• paliperidone (East Cantonment Pharmacy, Accra) (private facility) and (Mokat Chemist, Accra) (private facility)^{[footnote 168]}

• amisulpride (Healthlink Hospital, Accra) (private facility)^{[footnote 169]}

• haloperidol (Healthlink Hospital, Accra)^{[footnote 170]}

• clozapine (Healthlink Hospital, Accra)^{[footnote 171]}

• quetiapine (Healthlink Hospital, Accra)^{[footnote 172]}

• fluphenazine decanoate depot injection (Komfo Anokye Teaching Hospital, Kumasi, public facility)^{[footnote 173]}

• haloperidol decanoate depot injection (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 174]}

• perphanazine decanoaote depot injection (subject to supply problems) (Asofo-Boakye Specialist Hospital, Kumasi) (public facility)^{[footnote 175]}

• flupentixol (subject to supply problems) (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 176]}

• resperidone (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 177]}

• diazepam (anxiolytic) (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 178]}

• valproic acid (bipolar disorder) (subject to supply problems) (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 179]}

• lithium carbonate (bipolar disorder) (Komfo Anokye Teaching Hospital, Kumasi)^{[footnote 180]}

• paroxetine (subject to supply problems) (Equity Pharma, Accra) (private facility)^{[footnote 181]}

• sertraline (Equity Pharma, Accra)^{[footnote 182]}

• mirtazapine (Lister Hospital Pharmacy, Accra) (public facility)^{[footnote 183]}

• oxazepam (Lister Hospital Pharmacy, Accra)^{[footnote 184]}.

Section 21 updated: 5 August 2022

21. Palliative care

21.1.1 The International Association for Hospice and Palliative Care (IAHPC) Global Directory of Palliative Care Institutions and Organisations provided details of four NGOs/hospitals that provide palliative and hospice care. These palliative/hospice care providers were the Ghana Palliative Care Association (NGO)(Accra), Komfo Anokye Teaching Hospital (Kumasi), Perfect Hands Clinic (Tema), and Ripples Health Care (Accra)^{[footnote 185]}.

Section 22 updated: 26 July 2022

22. Tuberculosis (TB) and other lung diseases

22.1.1 The Country Coordinating Mechanism Ghana (part of the Global Fund to fight HIV/AIDS, TB, and malaria) website stated:

‘Ghana has made mixed progress since 2000 in the fight against TB. Currently, more than 1,600 public and private healthcare facilities all over Ghana provide [Directly Observed Treatment Short course] DOTS services…Case notification appears to be stagnant at around 60/100,000 person population in the last five years. Less than one third of the estimated drug resistant TB cases are detected and enrolled in treatment, making it one of the weakest links in the program.’^{[footnote 186]}

22.1.2 Gyimah, F T., Dako-Gyeke, P, Perspectives on TB patients’ care and support: a qualitative study conducted in Accra Metropolis, Ghana, published in 2019, stated:

‘…DOTS has been implemented by the National Tuberculosis control Program (NTP) of Ghana towards the enhancement of TB case detection, supervision of drug intake as well as monitoring the treatment process. DOTS regimens involve the intake of fixed-dose combination tablets. The treatment is divided into two folds including Intensive phase (for newly diagnosed patients) and the Continuous phase (patients who undergo the intensive phase)…patients enrolled in TB treatment, face challenges due to the mode of delivery of DOTS, which requires a frequent visit to the facility.’^{[footnote 187]}

22.1.3 A MedCOI response, dated 6 February 2019, stated that the following drugs - used to treat chronic obstructive pulmonary disease - were available at the Korle Bu Pharmacy, Accra (public facility):

• salbutamol

• beclometason + formoterol

• formoterol

• formoterol + budesonide

• ipratropium

• tiotropium^{[footnote 188]}.

22.1.4 A series of MedCOI responses from 2019 stated that the following anti-asthmatic drugs were available:

• fluticasone propionate (Korle Bu Pharmacy, Accra) (public facility)^{[footnote 189]}

• beclomethasone (Korle Bu Pharmacy, Accra)^{[footnote 190]}

• budesonide (Korle Bu Pharmacy, Accra)^{[footnote 191]}

• terbutaline (Lister Hospital, Accra) (private facility)^{[footnote 192]}

• ipatropium (Lister Hospital, Accra)^{[footnote 193]}.

Section 23 updated: 8 July 2022

23. Availability of painkiller medication

23.1.1 MedCOI responses stated that the following painkiller drugs were available in Ghana in 2019/2020:

• Aspirin (Add Pharma, Accra) (private facility)^{[footnote 194]}

• ibuprofen (Add Pharma, Accra)^{[footnote 195]}

• rizatriptan benzoate (Add Pharma, Accra)^{[footnote 196]}

• gabapentin (Add Pharma, Accra)^{[footnote 197]}

• pregabalin (Add Pharma, Accra)^{[footnote 198]}

• oxycodone (Add Pharma, Accra)^{[footnote 199]}

• tramadol (Add Pharma, Accra)^{[footnote 200]}

• paracetamol (Healthlink Hospital, Accra) (private facility)^{[footnote 201]}

• naproxen (Healthlink Hospital, Accra)^{[footnote 202]}

• sumatriptan (Add Pharma, Accra)^{[footnote 203]}

• diclofenac (Korle Bu Teaching Hospital Pharmacy, Accra)^{[footnote 204]}.

Section 24 updated: 8 July 2022

24. Availability of antibiotic medication

24.1.1 MedCOI responses stated that the following antibiotics were available in Ghana, in 2019/2020:

• penicillin (Add Pharma, Accra) (private facility)^{[footnote 205]}

• amoxicillin (Add Pharma, Accra)^{[footnote 206]}

• phenoxymethylpenicillin (Add Pharma, Accra)^{[footnote 207]}

• flucloxacillin (Add Pharma, Accra)^{[footnote 208]}

• metronidazole (Korle Bu Teaching Hospital Pharmacy, Accra) (public facility)^{[footnote 209]}

• clindamycin (Korle Bu Teaching Hospital Pharmacy, Accra) (public facility)^{[footnote 210]}

• clotrimoxazole (Korle Bu Teaching Hospital Pharmacy, Accra) (public facility)^{[footnote 211]}.

Annex A: List of available medication according to MedCOI

The list of drugs below has been compiled from MedCOI responses produced between 2018 and 2020 and researched by medical practitioners working in Ghana. The information is limited to the availability of the medication, usually at a particular clinic/health institute, and does not provide information on accessibility. That a particular medication was identified as being available at one facility does not mean that it was only available at that clinic/health centre.

A

Abacavir (subject to supply problems)^{[footnote 212]}, acarbose^{[footnote 213]}, acenocoumarol^{[footnote 214]}, acetazolamide^{[footnote 215]}, adalimubab (subject to supply problems)^{[footnote 216]}, alendronate sodium^{[footnote 217]}, alfacalcidol^{[footnote 218]}, allopurinol^{[footnote 219]}, aluminium hydroxide^{[footnote 220]}, aluminium oxide^{[footnote 221]}, amiloride^{[footnote 222]}, amiodarone^{[footnote 223]}, amisulpride^{[footnote 224]}, amitriptyline^{[footnote 225]}, amlodipine^{[footnote 226]}, amoxicillin^{[footnote 227]}, amoxicillin + clavulanic acid^{[footnote 228]}, apixaban^{[footnote 229]}, atenolol^{[footnote 230]}, aripiprazole^{[footnote 231]}, aspirin^{[footnote 232]}, atazanavir^{[footnote 233]}, atenolol^{[footnote 234]}, atorvastatin^{[footnote 235]}, azathioprine^{[footnote 236]}

B

Barnidipine^{[footnote 237]}, beclometasone^{[footnote 238]}, beclometasone + formoterol^{[footnote 239]}, benzathine benzylpencillin^{[footnote 240]}, benzbromarone^{[footnote 241]}, betahistine dihydrochloride^{[footnote 242]}, betamethasone^{[footnote 243]}, bimatropost^{[footnote 244]}, bisacodyl^{[footnote 245]}, bisoprolol^{[footnote 246]}, botulinum toxin type A^{[footnote 247]}, brinzolamide^{[footnote 248]}, bromocriptine mesilate (subject to supply problems)^{[footnote 249]}, bromperidol (subject to supply problems)^{[footnote 250]}, bromperidol decanoate^{[footnote 251]}, bromperidol decanoate depot injection (subject to supply problems)^{[footnote 252]}, budesonide^{[footnote 253]}, bumetanide^{[footnote 254]}

C

Cabergoline^{[footnote 255]}, calcium^{[footnote 256]}, calcium carbonate^{[footnote 257]}, calcium gluconate (subject to supply problems)^{[footnote 258]}, calcium polystyrene sulphonate (subject to supply problems)^{[footnote 259]}, canagliflozin^{[footnote 260]}, candesartan^{[footnote 261]}, captopril^{[footnote 262]}, carbamazepine^{[footnote 263]}, carbasalate calcium^{[footnote 264]}, chloramphenicol eye drops^{[footnote 265]}, chloroquine phosphate (subject to supply problems)^{[footnote 266]}, chlortalidone^{[footnote 267]}, cimetidine^{[footnote 268]}, clindamycin^{[footnote 269]}, clonazepam^{[footnote 270]}, clopidogrel^{[footnote 271]}, clotiapine^{[footnote 272]}, clozapine^{[footnote 273]}, colecalciferol^{[footnote 274]}, colochicine^{[footnote 275]}, combivir^{[footnote 276]}, cortisone^{[footnote 277]}, cyclopentolate hydrochloride^{[footnote 278]}, cyclophosphamide^{[footnote 279]}, cyclosporine^{[footnote 280]}

D

Dapagliflozin^{[footnote 281]}, darbepoetin alfa^{[footnote 282]}, darunavir (subject to supply problems)^{[footnote 283]}, deforoxamine (subject to supply problems)^{[footnote 284]}, dexamethasone^{[footnote 285]}, dexamethasone eye drops^{[footnote 286]}, diazepam^{[footnote 287]}, diclofenac^{[footnote 288]}, dihydrotachysterol (subject to supply problems)^{[footnote 289]}, digoxin^{[footnote 290]}, dilitiazem^{[footnote 291]}, domperidone^{[footnote 292]}, dolutegravir (subject to supply problems)^{[footnote 293]}, dorzolamide^{[footnote 294]}, doxazosin^{[footnote 295]}, duloxetine (subject to supply problems)^{[footnote 296]}

E

Efavirenz^{[footnote 297]}, empagliflozin^{[footnote 298]}, emtricitabine^{[footnote 299]}, enalapril^{[footnote 300]}, enoxaparin^{[footnote 301]}, eplerenone^{[footnote 302]}, epoetin alfa^{[footnote 303]}, epoetin beta^{[footnote 304]}, entecavir^{[footnote 305]}, ergocalciferol^{[footnote 306]}, esomeprazole^{[footnote 307]}

F

Febuxostat^{[footnote 308]}, felodipine^{[footnote 309]}, ferrioxidesaccharate (subject to supply problems)^{[footnote 310]}, ferrous fumarate^{[footnote 311]}, ferrous gluconate^{[footnote 312]}, ferrous sulphate^{[footnote 313]}, flucloxacillin^{[footnote 314]}, flupentixol decanoate depot injection^{[footnote 315]}, fluphenazine decanoate depot injection^{[footnote 316]}, fluticasone^{[footnote 317]}, fluticasone propionate^{[footnote 318]}, fluvastatin^{[footnote 319]}, folic acid^{[footnote 320]}, formoterol^{[footnote 321]}, formoterol + budesonide^{[footnote 322]}, fosinopril^{[footnote 323]}, furosemide^{[footnote 324]}, fusidic acid^{[footnote 325]}

G

Gabapentin^{[footnote 326]}, gliclazide^{[footnote 327]}

H

Haloperidol^{[footnote 328]}, heparin^{[footnote 329]}, hydrochlorothiazide^{[footnote 330]}, hydrocortisone^{[footnote 331]}, hydroxychloroquine^{[footnote 332]}

I

Ibandronic acid^{[footnote 333]}, ibuprofen^{[footnote 334]}, ibutilide^{[footnote 335]}, idapamide^{[footnote 336]}, imatinib mesilate^{[footnote 337]}, infliximab (subject to supply problems)^{[footnote 338]}, insulin^{[footnote 339]}, ipratropium^{[footnote 340]}, irbesartan^{[footnote 341]}, iron^{[footnote 342]}, isradipine (subject to supply problems)^{[footnote 343]}

K

Kaletra^{[footnote 344]}

L

Lacitol (subject to supply problems)^{[footnote 345]}, lactulose^{[footnote 346]}, lamivudine (subject to supply problems)^{[footnote 347]}, lamotrigine^{[footnote 348]}, lanolin^{[footnote 349]}, lansoprazole^{[footnote 350]}, latonoprost^{[footnote 351]}, leflunomide (subject to supply problems)^{[footnote 352]}, lercanidipine^{[footnote 353]}, levetiracetam^{[footnote 354]}, lidocane^{[footnote 355]}, lithium carbonate^{[footnote 356]}, lisonopril^{[footnote 357]}, loperamide^{[footnote 358]}, lorazepam (subject to supply problems)^{[footnote 359]}, losartan^{[footnote 360]}

M

Macrogol^{[footnote 361]}, Macrogol + electrolytes^{[footnote 362]}, magnesium hydroxide^{[footnote 363]}, mesalazine^{[footnote 364]}, metamizole (subject to supply problems)^{[footnote 365]}, metformin^{[footnote 366]}, methotrexate^{[footnote 367]}, methyldopa^{[footnote 368]} methylprednisolone^{[footnote 369]}, metoclopramide^{[footnote 370]}, metoprolol^{[footnote 371]}, metronidazole^{[footnote 372]}, midazolam^{[footnote 373]}, mirabegron^{[footnote 374]}, mirtazapine^{[footnote 375]}, mometasone^{[footnote 376]}, morphine^{[footnote 377]}, moxifloxacin hydrochloride^{[footnote 378]}, mycophenolate mofetil^{[footnote 379]}

N

Nadoparin (subject to supply problems)^{[footnote 380]}, naproxen^{[footnote 381]}, nebivolol^{[footnote 382]}, nepafenac^{[footnote 383]}, nevirapine^{[footnote 384]}, nicardipine^{[footnote 385]}, nifedipine^{[footnote 386]}, nitroglycerin^{[footnote 387]}

O

Olanzapine^{[footnote 388]}, omeprazole^{[footnote 389]}, oxazepam^{[footnote 390]}, oxycodone^{[footnote 391]}

P

Paliperidone^{[footnote 392]}, pantoprazole^{[footnote 393]}, paracetamol^{[footnote 394]}, paroxetine (subject to supply problems)^{[footnote 395]}, penfluridol (subject to supply problems)^{[footnote 396]}, penicillin^{[footnote 397]}, perindopril^{[footnote 398]}, perphenazine decanoate depot injection^{[footnote 399]}, phenomethylpenicillin^{[footnote 400]}, piracetam^{[footnote 401]}, polyvidone eye drops (subject to supply problems)^{[footnote 402]}, potassium^{[footnote 403]}, potassium bicarbonate (subject to supply problems)^{[footnote 404]}, potassium citrate^{[footnote 405]}, prasugrel^{[footnote 406]}, prazosin^{[footnote 407]}, pravastatin^{[footnote 408]}, prednisolone^{[footnote 409]}, prednisolone eye drops^{[footnote 410]}, prednisone^{[footnote 411]}, pregabalin^{[footnote 412]}, prilocaine^{[footnote 413]}

Q

Quetiapine^{[footnote 414]}, quinagolide hydrochloride (subject to supply problems)^{[footnote 415]}

R

Rabeprazole sodium^{[footnote 416]}, raltegravir^{[footnote 417]}, ramipril^{[footnote 418]}, ranitidine^{[footnote 419]}, regorafenib^{[footnote 420]}, risperidone^{[footnote 421]}, ritonavir^{[footnote 422]}, rizatriptan benzoate^{[footnote 423]}, rouvastatin^{[footnote 424]}

S

Salbutamol^{[footnote 425]}, sevelamer^{[footnote 426]}, sildenafil^{[footnote 427]}, simvastatin^{[footnote 428]}, sodium bicarbonate^{[footnote 429]}, sodium chloride^{[footnote 430]}, solifenacin^{[footnote 431]}, sotalol^{[footnote 432]}, spironolactone^{[footnote 433]}, sulfasalazine^{[footnote 434]}, sunitinib malate^{[footnote 435]}

T

Tacrolimus^{[footnote 436]}, telmisartan^{[footnote 437]}, tenofovir disoproxil^{[footnote 438]}, tenofovir alafenamide^{[footnote 439]}, terazosin^{[footnote 440]}, terbutaline^{[footnote 441]}, testosterone^{[footnote 442]}, ticagrelor^{[footnote 443]}, timolol^{[footnote 444]}, tiotropium^{[footnote 445]}, tobramycin eye drops^{[footnote 446]}, tolterodine^{[footnote 447]}, torasemide^{[footnote 448]}, travapost (subject to supply problems)^{[footnote 449]}, tramadol^{[footnote 450]}, triamterene^{[footnote 451]}, Truvada^{[footnote 452]}

U

Ursodeoxycholic acid^{[footnote 453]}

V

Valproic acid^{[footnote 454]}, valsartan^{[footnote 455]}, verapamil^{[footnote 456]}, vitamin B complex^{[footnote 457]}, vitamin D^{[footnote 458]}

W

Warfarin^{[footnote 459]}

Z

Zidovudine (subject to supply problems)^{[footnote 460]}, zoledronic acid^{[footnote 461]}, zuclopenthixol decanoate^{[footnote 462]}, zuclopenthixol decanoate depot injection (subject to supply problems)^{[footnote 463]}

Terms of Reference

A ‘Terms of Reference’ (ToR) is a broad outline of what the CPIN seeks to cover. They form the basis for the country information section. The Home Office’s Country Policy and Information Team uses some standardised ToRs, depending on the subject, and these are then adapted depending on the country concerned.

For this particular CPIN, the following topics were identified prior to drafting as relevant and on which research was undertaken:

• Healthcare system

• Overview of healthcare structure

• Financing of healthcare

• Health insurance schemes (costs of these/contributions)

• Details of non-government organisations that provide healthcare and assistance

• Emergency medical care

• Infrastructure and staffing

  • Number, location and type of medical facility (and specialism) – primary, secondary and tertiary

  • Number and location in absolute and as per head of population of nurses and doctors, including specialists

  • Provide links to medical, dental and other healthcare practitioners, and hospitals

• Impact of Covid-19

• Specific diseases/conditions

• Cancer treatment (oncology)

• Cardiology

• Diabetes

• Dental treatment and conditions

• Ear, nose and throat conditions

• Eye treatment (ophthalmology)

• Gastroenterological conditions

• Gynaecological conditions and obstetrics

• Haematology (blood diseases)

• Hepatitis

• HIV/AIDs

• Kidney diseases

• Liver transplants and liver conditions (hepatology)

• Lung diseases

• Musculoskeletal conditions

• Mental health and psychiatric care

• Neurological conditions

• Paediatrics

• Palliative care, nursing home care and geriatrics

• Sickle cell disease

• Annex of main drugs – an alphabetical list of commonly requested drugs, indicating availability

Bibliography

Sources cited

Aetna,

‘About Us’, no date. Last accessed: 4 August 2022

‘An introduction to the healthcare system in Ghana’, no date. Last accessed: 4 August 2022

Afadjato Hospital for Eye and Special Surgery, ‘Services’, no date. Last accessed: 28 April 2022

Asafo-Boakye Specialist Hospital, ‘Cardiology Clinic’, no date. Last accessed: 13 May 2022

Bethel Dental Clinic, ‘Our Services’, no date. Last accessed: 12 April 2022

Boateng; Ernest Amano; Davies, Oliver; Fage, John; and Maier, Donna, Encyclopaedia Britannica, ‘Ghana’ (Health and welfare), 30 September 2021. Last accessed: 14 June 2022

Business Ghana, ‘Acacia Health Insurance Limited’, no date. Last accessed: 4 April 2022

Citi Newsroom, ‘Korle-Bu to begin liver transplant procedures in new milestone’, 2 November 2021. Last accessed: 5 August 2022

Comfort for the Aged, ‘homepage’, no date. Last accessed: 4 May 2022

Conversation, The

‘Who we are’, no date. Last accessed: 14 June 2022

‘Ghana needs a better policy to guide care for cancer patients’, 3 March 2020. Last accessed: 23 June 2022

Dr Argawals Eye Hospital, ‘Treatments’, no date. Last accessed: 28 April 2022

Ghana Country Coordinating Mechanism, Ghana Global Fund to fight AIDS, Tuberculosis and Malaria, ‘National Tuberculosis Control Programme’, no date. Last accessed: 5 May 2022

Global Health Dynamics, Cancer Control, ‘Cancer Radiotherapy in Ghana’, no date. Last accessed: 5 August 2022

Gyimah, Faustina Twumwaa, Dako-Gyeke, Phyllis, Biomed Central, ‘Perspectives on TB patients’ care and support: a qualitative study conducted in Accra Metropolis, Ghana’, 5 March 2019. Last accessed: 5 May 2022

Euracare Health, ‘Historic: Ghana performs first brain surgery without cutting skull at Euracare Advanced Diagnostics and Heart Centre’, 8 April 2019. Last accessed: 11 April 2022

European Union Agency for Asylum, ‘MedCOI’. (restricted access). Copies of listed responses in the footnotes above available on request. Last accessed: December 2020

Foreign, Commonwealth and Development Office, ‘Foreign Travel advice – Ghana – Health’, updated on 18 July 2022. Last accessed: 5 August 2022

Ghana Health Service, ‘2014 Ghana Demographic and Health Survey’, October 2014. Last accessed: 14 June 2022

Ghana Insider, ‘Psychiatric Hospitals in Ghana – Complete List 2022’, no date. Last accessed: 27 April 2022

Ghana National Health Insurance Scheme, ‘NHIA adds Specialist Anti Breast Cancer Drug (Herceptin) to Ghana’s NHIS Medicine list’, 10 August 2020. Last accessed: 20 April 2022

Ghanaian Times, ‘Ghana: Tackling Ghana’s Mental Health Challenges in an Unequal World’, 2 November 2021. Last accessed: 27 April 2022

Glico Healthcare, ‘Who we are’, no date. Last accessed: 4 April 2022

Graphic online, ‘KATH: Ghanaian doctors perform heart surgery without opening patient’s heart’, 21 October 2019. Last accessed: 11 April 2022

Guardian, ‘“A lot of benign neglect”: how Ghana’s social changes are isolating older people​’, 26 May 2020. Last accessed: 4 May 2022

Institute for Health Metrics and Evaluation, ‘Ghana’, 2019. Last accessed: 14 June 2022

International Association for Hospice and Palliative Care, Global Directory of Palliative Care Institutions and Organisations, ‘Africa’, last update: 2 August 2022. Last accessed: 5 August 2022

Issaka, Adamu; Adjeso, Theophilus; Baba Yabasin, Iddrisu, Panafrican Medical Journal, ‘Flexible bronchoscopy in Ghana: initial experience in a tertiary hospital’, 22 March 2021, Last accessed: 5 May 2022

Jachie Eye Hospital, ‘About the Eye Hospital’, no date. Last accessed: 28 April 2022

John Snow Inc., ‘HIV Treatment Restores One Woman’s Health in Ghana’, 30 March 2022. Last accessed: 4 May 2022

Korle Bu Teaching Hospital (Accra),

‘Dental Department’, no date. Last accessed: 5 May 2022

‘Eye Centre’, no date. Last accessed: 28 April 2022

‘Korle Bu Begins Radiation Therapy Treatment for Prostate Cancer’, 7 September 2020. Last accessed: 8 April 2022

‘Obs & Gynaecology’, no date. Last accessed: 11 April 2022

‘We Now Undertake Liver Cancer Surgeries too’, 27 November 2018. Last accessed: 8 April 2022

‘Physiotherapy Department’, no date. Last accessed: 12 May 2022

‘korle Bu performs four successful kidney transplantations’, 11 December 2019. Last accessed: 12 May 2022

‘Medical Sub-BMC’, no date. Last accessed: 22 May 2022

Lancet, ‘Healthcare Access and Quality Index’, 27 August 2020. Last accessed: 14 June 2022

Liberty Health, ‘Our benefits’, no date. Last accessed: 4 April 2022

Lucca Health Medical Centre, ‘Services – Ear-Nose-Throat (ENT)’, no date. Last accessed: 12 April 2022

Moustafa, Moustafa; Eileen Mali, Meghan; Lopez-Verdugo, Fidel; Sanyang, Ousman; Nellermoe, Jonathan; Price, Raymond; Manortey, Stephen; Biritwum-Nyarko, Alberta; Ofei, Irina; Sorensen, Justin; Goldsmith, Alison; Brownson, Kirstyn; Kumah, Augustine; Sutherland, Edward, British Medical Journal, ‘Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region’, 2021. Last accessed: 4 April 2022

National Cardiothoracic Centre, ‘Our Services’, no date. Last accessed: 21 April 2022

Novartis, ‘Novartis expands Africa Sickle Cell Disease program to Uganda and Tanzania’, 18 June 2020. Last accessed: 12 May 2022

Nyaha Medical Centre, ‘Paediatrics Speciality Clinic at the Nyaho Medical Centre’, no date. Last accessed: 12 May 2022

Opoku D, Edusei A K, Agyei-Baffour P, Teddy G, Polin K, Quentin W, European Journal of Public Health, ‘Ghana: health system review,’ 20 October 2021, Volume 31, Issue Supplement 3. Last accessed: 1 April 2022

Quarshie, Emmanuel & Davies, Priscilla and Otoo, Pearl. ‘Setting Mental Health Priorities in Ghana: A 15-Year Contextual Analysis of the Presidential State of the Nation Address’, 2021. Last accessed: 14 June 2022

Republic of Ghana, Ministry of Health,

‘Mental Health Policy 2019-2030’, December 2018. Last accessed: 5 August 2022

‘Ghana Health Service’, no date. Last accessed: 1 April 2022

Sweden Ghana Cancer Centre, ‘Facilities’, no date. Last accessed: 8 April 2022

UNAIDS (Joint United Nations Programme on HIV/AIDS), ‘Country Factsheets - Ghana 2020’, no date. Last accessed: 23 June 2022

United States Department of Commerce, ‘Ghana Country Commercial Guide - Healthcare’, 22 July 2022. Last accessed: 4 August 2022

University of Ghana Medical Centre Ltd, ‘Physiotherapy Clinic’, no date. Last accessed: 12 May 2022

World Child Cancer, ‘Ghana - Background’, no date. Last accessed: 5 April 2022

World Health Organisation, Mental Health Atlas 2020, ‘Member State Profile – Ghana’, 2021. Last accessed: 24 June 2022

XE Currency Converter,

‘[Ghanaian Cedis to British Pounds’, 5 August 2022. Last accessed: 5 August 2022

‘USD to British Pounds’, 5 August 2022. Last accessed: 5 August 2022

Sources consulted but not cited

Global Futures, ‘The Limitations Of Ghana’s Rural Health Care Access: Case Study: GA East, Greater Accra’, no date. Last accessed: 31 May 2022

Macrotrends, ‘Ghana Healthcare Spending 2000-2022’, no date. Last accessed: 31 May 2022

Republic of Ghana, Ministry of Health, ‘Republic of Ghana’, no date. Last accessed: 30 May 2022

World Bank, Working Paper 210, ‘Private Health Sector Assessment in Ghana’, 2011. Last accessed: 31 May 2022

World Health Organisation, ‘Ghana’, no date. Last accessed: 30 May 2022

Version control

Clearance

Below is information on when this note was cleared:

• version 2

• valid from 8 August 2022

Official – sensitive: Start of section

The information in this section has been removed as it is restricted for internal Home Office use.

Official – sensitive: End of section

Changes from last version of this note

Updated with new information

1. European Union Agency for Asylum, ‘MedCOI’ ↩

2. XE Currency Converter, ‘Ghanaian Cedis to British Pounds’, 5 August 2022 ↩

3. USDOC, ‘Ghana - Country Commercial Guide – Health’, 22 July 2022 ↩

4. MedCOI, BDA-20200929-GH-7317, 9 November 2020 ↩

5. FCDO, ‘Foreign Travel advice – Ghana – Health’, updated 18 July 2022 ↩

6. Boateng and others, Encyclopaedia Britannica, ‘Ghana’ (Health and welfare), 30 September 2021 ↩

7. Republic of Ghana, Ministry of Health, ‘Ghana Health Service’, no date ↩

8. Opoku and others, European Journal of Public Health, ‘Ghana: health system…,’ 20 October 2021 ↩

9. XE Currency Converter, ‘USD to British Pounds’, 5 August 2022 ↩

10. MedCOI, BDA-20201021-GH-7372, 3 December 2020 ↩

11. Aetna, ‘About Us’, no date ↩

12. Aetna, ‘An introduction to the healthcare system in Ghana’, no date ↩

13. Aetna, ‘An introduction to the healthcare system in Ghana’, no date ↩

14. Aetna, ‘An introduction to the healthcare system in Ghana’, no date ↩

15. Glico Healthcare, ‘Who we are’, no date ↩

16. Liberty Health, ‘Our benefits’, no date ↩

17. Business Ghana, ‘Acacia Health Insurance Limited’, no date ↩

18. Nyaha Medical Centre, ‘Paediatrics Speciality Clinic at the Nyaho Medical Centre’, no date ↩

19. Aetna, ‘An introduction to the healthcare system in Ghana’, no date ↩

20. Global Health Dynamics, Cancer Control, ‘Cancer Radiotherapy in Ghana’, no date ↩

21. The Conversation, ‘Who we are’, no date ↩

22. The Conversation, ‘Ghana needs a better policy to guide care for cancer…’, 3 March 2020 ↩

23. BMJ, ‘Surveying and mapping breast cancer services in Ghana…’, 2021 ↩

24. National Health Insurance Scheme, ‘NHIA adds Specialist Anti Breast Cancer…’, 10 August 2020 ↩

25. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

26. Korle Bu Teaching Hospital, ‘Korle Bu Begins Radiation Therapy Treatment…’, 7 September 2020 ↩

27. Korle Bu Teaching Hospital, ‘We Now Undertake Liver Cancer Surgeries too’, 27 November 2018 ↩

28. Sweden Ghana Cancer Centre, ‘Facilities’, no date ↩

29. Global Health Dynamics, Cancer Control, ‘Cancer Radiotherapy in Ghana’, no date ↩

30. Sweden Ghana Cancer Centre, ‘Facilities’, no date ↩

31. MedCOI, response to information request, BMA-12828, 3 October 2019 ↩

32. World Child Cancer, ‘Ghana Background’, no date ↩

33. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

34. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

35. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

36. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

37. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

38. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

39. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

40. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

41. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

42. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

43. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

44. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

45. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

46. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

47. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

48. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

49. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

50. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

51. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

52. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

53. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

54. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

55. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

56. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

57. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

58. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

59. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

60. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

61. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

62. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

63. MedCOI, response to information request, BMA-12748, 28 September 2019 ↩

64. MedCOI, response to information request, BMA-12748, 28 September 2019 ↩

65. MedCOI, response to information request, BMA-12748, 28 September 2019 ↩

66. MedCOI, response to information request, BMA-12176, 29 March 2019 ↩

67. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

68. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

69. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

70. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

71. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

72. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

73. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

74. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

75. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

76. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

77. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

78. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

79. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

80. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

81. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

82. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

83. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

84. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

85. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

86. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

87. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

88. MedCOI, response to information request, BMA-13349, 3 March 2020 ↩

89. MedCOI, response to information request, BMA-13349, 3 March 2020 ↩

90. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

91. National Cardiothoracic Centre, ‘Our Services’, no date ↩

92. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

93. Asafo-Boakye Specialist Hospital, ‘Cardiology Clinic’, no date ↩

94. Graphic online, ‘KATH: Ghanaian doctors perform heart surgery without…’, 21 October 2019 ↩

95. Euracare Health, ‘Historic: Ghana performs first brain surgery without cutting skull…’, 8 April 2019 ↩

96. Bethel Dental Clinic, ‘Our Services’, no date ↩

97. Korle Bu Teaching Hospital, ‘Dental Department’, no date ↩

98. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

99. MedCOI, response to information request, BMA-13643, 1 June 2020 ↩

100. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

101. Lucca Health Medical Centre, ‘Services – Ear-Nose-Throat (ENT)’, no date ↩

102. Korle Bu Teaching Hospital, ‘Medical Sub-BMC’, no date ↩

103. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

104. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

105. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

106. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

107. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

108. MedCOI, response to information request, BMA-12784, 3 October 2019 ↩

109. Dr Argawals Eye Hospital, ‘Treatments’, no date ↩

110. Jachie Eye Hospital, ‘About the Eye Hospital’, no date ↩

111. Korle Bu Teaching Hospital, ‘Eye Centre’, no date ↩

112. Afadjato Hospital for Eye and Special Surgery, ‘Services’, no date ↩

113. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

114. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

115. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

116. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

117. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

118. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

119. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

120. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

121. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

122. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

123. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

124. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

125. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

126. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

127. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

128. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

129. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

130. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

131. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

132. Korle Bu Teaching Hospital, ‘Obs & Gynaecology’, no date ↩

133. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

134. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

135. Novartis, ‘Novartis expands Africa Sickle Cell Disease program to Uganda…’, 18 June 2020 ↩

136. MedCOI, response to information request, BMA-12122, 9 March 2019 ↩

137. UNAIDS, ‘Country Factsheets - Ghana 2020’, no date ↩

138. MedCOI response to information request, BMA-14118, 21 October 2020 ↩

139. MedCOI response to information request, BMA-14118, 21 October 2020 ↩

140. JSI, ‘HIV Treatment Restores One Woman’s Health in Ghana’, 30 March 2022 ↩

141. The Guardian, ‘“A lot of benign neglect”: how Ghana’s social changes are…’, 26 May 2020 ↩

142. Comfort for the Aged, ‘homepage’, no date ↩

143. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

144. Korle Bu Teaching Hospital, ‘korle Bu performs four successful kidney…’, 11 December 2019 ↩

145. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

146. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

147. Citi Newsroom, ‘Korle-Bu to begin liver transplant procedures in new milestone’, 2 November 2021 ↩

148. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

149. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

150. University of Ghana Medical Centre Ltd, ‘Physiotherapy Clinic’, no date ↩

151. Korle Bu Teaching Hospital, ‘Physiotherapy Department’, no date ↩

152. World Health Organisation, Mental Health Atlas 2020, ‘Member State Profile – Ghana’, 2021 ↩

153. Republic of Ghana, Ministry of Health, ‘Mental Health Policy…’ (section 2.4.3), December 2018 ↩

154. MedCOI, BDA-20200929-GH-7317, 9 November 2020 ↩

155. Quarshie and others, ‘Setting Mental Health Priorities in Ghana..’ (pages 2-3), 10 September 2021 ↩

156. Quarshie and others, ‘Setting Mental Health Priorities in Ghana..’ (page 7), 10 September 2021 ↩

157. Ghanaian Times, ‘Ghana: Tackling Ghana’s Mental Health Challenges…’, 2 November 2021 ↩

158. Ghana Insider, ‘Psychiatric Hospitals in Ghana. Complete List 2022’, no date ↩

159. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

160. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

161. XE Currency Converter, ’Ghanaian Cedis to British Pounds’, 6 July 2022 ↩

162. MedCOI, response to information request, BDA-20201021-GH-7372, 3 December 2020 ↩

163. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

164. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

165. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

166. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

167. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

168. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

169. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

170. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

171. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

172. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

173. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

174. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

175. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

176. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

177. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

178. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

179. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

180. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

181. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

182. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

183. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

184. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

185. IAHPC, Global Directory of Palliative Care Institutions and Organisations, ‘Africa’, 2 August 2022 ↩

186. Country Coordinating Mechanism Ghana, ‘National Tuberculosis Control Programme’, no date ↩

187. Biomed Central, ‘Perspectives on TB patients’ care and support:..’, 5 March 2019 ↩

188. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

189. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

190. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

191. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

192. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

193. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

194. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

195. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

196. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

197. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

198. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

199. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

200. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

201. MedCOI, response to information request, BMA-13650, 20 May 2020 ↩

202. MedCOI, response to information request, BMA-13650, 20 May 2020 ↩

203. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

204. MedCOI, response to information request, BMA-12740, 3 September 2019 ↩

205. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

206. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

207. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

208. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

209. MedCOI, response to information request, BMA-12740, 1 September 2019 ↩

210. MedCOI, response to information request, BMA-12740, 1 September 2019 ↩

211. MedCOI, response to information request, BMA-12732, 3 September 2019 ↩

212. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

213. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

214. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

215. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

216. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

217. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

218. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

219. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

220. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

221. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

222. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

223. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

224. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

225. MedCOI, response to information request, BMA-12784, 3 October 2019 ↩

226. MedCOI, response to information request, BMA-,12176, 29 March 2019 ↩

227. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

228. MedCOI, response to information request, BMA-12122, 9 March 2019 ↩

229. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

230. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

231. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

232. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

233. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

234. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

235. MedCOI, response to information request, BMA-13908, 21 August 2020 ↩

236. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

237. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

238. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

239. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

240. MedCOI, response to information request, BMA-12122, 9 March 2019 ↩

241. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

242. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

243. MedCOI, response to information request, BMA-12176, 29 March 2019 ↩

244. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

245. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

246. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

247. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

248. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

249. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

250. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

251. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

252. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

253. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

254. MedCOI, response to information request, BMA-12459, 21 June 2019 ↩

255. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

256. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

257. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

258. MedCOI, response to information request, BMA-13429, 8 April 2020 ↩

259. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

260. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

261. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

262. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

263. MedCOI, response to information request, BMA-13223, 3 February 2020 ↩

264. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

265. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

266. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

267. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

268. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

269. MedCOI, response to information request, BMA-12740, 1 September 2019 ↩

270. MedCOI, response to information request, BMA-13223, 3 February 2020 ↩

271. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

272. MedCOI, response to information request, BMA-13922, 26 August 2020 ↩

273. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

274. MedCOI, response to information request, BMA-12122, 9 March 2019 ↩

275. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

276. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

277. MedCOI, response to information request, BMA-13329, 28 February 2020 ↩

278. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

279. MedCOI, response to information request, BMA-12828, 3 October 2019 ↩

280. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

281. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

282. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

283. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

284. MedCOI, response to information request, BMA-13429, 8 April 2020 ↩

285. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

286. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

287. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

288. MedCOI, response to information request, BMA-12122, 9 March 2019 ↩

289. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

290. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

291. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

292. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

293. MedCOI, response to information request, BMA-14118, 21 October 2020 ↩

294. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

295. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

296. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

297. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

298. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

299. MedCOI, response to information request, BMA-14118, 21 October 2020 ↩

300. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

301. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

302. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

303. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

304. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

305. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

306. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

307. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

308. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

309. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

310. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

311. MedCOI, response to information request, BMA-13429, 8 April 2020 ↩

312. MedCOI, response to information request, BMA-13455, 2 April 2020 ↩

313. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

314. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

315. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

316. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

317. MedCOI, response to information request, BMA-12176, 29 March 2019 ↩

318. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

319. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

320. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

321. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

322. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

323. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

324. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

325. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

326. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

327. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

328. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

329. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

330. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

331. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

332. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

333. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

334. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

335. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

336. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

337. MedCOI, response to information request, BMA-11934, 31 December 2018 ↩

338. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

339. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

340. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

341. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

342. MedCOI, response to information request, BMA-13455, 2 April 2020 ↩

343. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

344. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

345. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

346. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

347. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

348. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

349. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

350. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

351. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

352. MedCOI, response to information request, BMA-13455, 2 April 2020 ↩

353. MedCOI, response to information request, BMA-12176, 29 March 2019 ↩

354. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

355. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

356. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

357. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

358. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

359. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

360. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

361. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

362. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

363. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

364. MedCOI, response to information request, BMA-12860, 21 October 2019 ↩

365. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

366. MedCOI, response to information request, BMA-13898, 26 August 2020 ↩

367. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

368. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

369. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

370. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

371. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

372. MedCOI, response to information request, BMA-12740, 1 September 2019 ↩

373. MedCOI, response to information request, BMA-13684, 4 August 2020 ↩

374. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

375. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

376. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

377. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

378. MedCOI, response to information request, BMA-12998, 28 November 2020 ↩

379. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

380. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

381. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

382. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

383. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

384. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

385. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

386. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

387. MedCOI, response to information request, BMA-12811, 2 October 2019 ↩

388. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

389. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

390. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

391. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

392. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

393. MedCOI, response to information request, BMA-12436, 15 July 2019 ↩

394. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

395. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

396. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

397. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

398. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

399. MedCOI, response to information request, BMA-13909, 21 August 2020 ↩

400. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

401. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

402. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

403. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

404. MedCOI, response to information request, BMA-13455, 2 April 2020 ↩

405. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

406. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

407. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

408. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

409. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

410. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

411. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

412. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

413. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

414. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

415. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

416. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

417. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

418. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

419. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

420. MedCOI, response to information request, BMA-11934, 31 December 2018 ↩

421. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

422. MedCOI, response to information request, BMA-12168, 15 March 2019 ↩

423. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

424. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

425. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

426. MedCOI, response to information request, BMA-12998, 28 November 2019 ↩

427. MedCOI, response to information request, BMA-12991, 26 November 2019 ↩

428. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

429. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

430. MedCOI, response to information request, BMA-13605, 20 May 2020 ↩

431. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

432. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

433. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

434. MedCOI, response to information request, BMA-13329, 28 February 2020 ↩

435. MedCOI, response to information request, BMA-11934, 31 December 2018 ↩

436. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

437. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

438. MedCOI, response to information request, BMA-14118, 21 October 2020 ↩

439. MedCOI, response to information request, BMA-14063, 20 October 2020 ↩

440. MedCOI, response to information request, BMA-12816, 31 October 2019 ↩

441. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

442. MedCOI, response to information request, BMA-13333, 27 February 2020 ↩

443. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

444. MedCOI, response to information request, BMA-13402, 9 April 2020 ↩

445. MedCOI, response to information request, BMA-11944, 6 February 2019 ↩

446. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

447. MedCOI, response to information request, BMA-12888, 29 October 2019 ↩

448. MedCOI, response to information request, BMA-13868, 14 August 2020 ↩

449. MedCOI, response to information request, BMA-13349, 3 March 2020 ↩

450. MedCOI, response to information request, BMA-13650, 2 June 2020 ↩

451. MedCOI, response to information request, BMA-13794, 14 July 2020 ↩

452. MedCOI, response to information request, BMA-14118, 21 October 2020 ↩

453. MedCOI, response to information request, BMA-14000, 18 September 2020 ↩

454. MedCOI, response to information request, BMA-14056, 1 October 2020 ↩

455. MedCOI, response to information request, BMA-11935, 6 February 2019 ↩

456. MedCOI, response to information request, BMA-12483, 3 September 2019 ↩

457. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

458. MedCOI, response to information request, BMA-13642, 28 May 2020 ↩

459. MedCOI, response to information request, BMA-12898, 30 October 2019 ↩

460. MedCOI, response to information request, BMA-12256, 19 April 2019 ↩

461. MedCOI, response to information request, BMA-13651, 2 June 2020 ↩

462. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩

463. MedCOI, response to information request, BMA-14280, 8 December 2020 ↩