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The CCM Ghana

The Country Coordinating Mechanism (CCM) of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria is a country-driven and multi-sectoral partnership of relevant stakeholders with health programs in the three disease areas. They comprise representatives from government, private, civil society, bilateral and multilateral agencies, academia, professional associations and people living with either of these diseases.

Since the Global Fund does not have offices in implementing countries, the CCM is central to the Global Fund's commitment to local ownership and participatory decision-making. As a country led body, the CCM is expected to engage a variety of actors in decision-making processes through a country dialogue in order to develop a national proposal based on priority needs and gaps identified in the three disease components. Additionally, the CCM is responsible for overseeing progress of program implementation. As part of this oversight role, the CCM appoints the Principal Recipients of the Global Fund grants through a fair and transparent selection process.

TB and poverty

Ghana’s first national survey on costs faced by TB patients and their households revealed that 64% of TB affected households face catastrophic costs, i.e. the TB related costs exceed 20% of their income.

This survey carried out with 691 TB clients from 25 districts across Ghana indicated that TB patients are over proportionally affected by poverty. While 24% of Ghanaians live under the poverty line (<1.90 USD / day), it is 46% of the TB patients. This means that almost half of the people living with TB are too poor to spare a small amount for their treatment. The catastrophic TB related costs drive even more TB patients into poverty. After TB treatment, 60% of the patients live under the poverty line.

Each TB episode adds on average 2,000 GHS to their cost and as much as 3,000 GHS in the case of drug resistant TB. The biggest cost drivers are income loss and additional expenditures for nutritious foods (each 34%), followed by medical cost (19%) and non-medical cost, incl. transport related to treatment (14%). More than half of the TB patients in the survey had to rely on savings, borrowing, or selling assets in order to cover the additional cost. Reports on delayed start of treatment and treatment interruptions, that might result into drug resistant TB, for financial constraints are not unusual.

Dr. Bonsu, Programme Manager of the National TB Programme, emphasized the importance of an enhanced TB care financing system within the Universal Health Coverage policy, the “free TB care” policy and additional relief measures to help TB patients reduce cost associated with treatment.