National Tuberculosis Control Programme
Tuberculosis control in Ghana started in the pre-independence era when the colonial government recognized the need to combat the disease due to the threat to the larger society. In July 1954, the Ghana Society for the Prevention of Tuberculosis was established to support and supplement government’s efforts. In the early 1960's, the Government of Ghana sponsored nurses to train in Israel in the area of TB Management who were then known as TB nurses. Mobile X-Ray vans were used to carry out mass screening for TB. However, the post-independence story until the early 90's was marked by unpredictable funding efforts for tuberculosis control.
Considering the rising number of TB cases in every region and the poor situation of TB control in the country, consensus was reached at the Regional Directors conference held at Ho in 1992 on the need for a TB control program. A TB Control Programme document was drafted for Ghana, which for the first time in decades received dedicated funding from DANIDA. The funding was short lived, but during this period, NTP was lifted from a state of neglect and many of its problems were addressed. The Central TB Unit was strengthened, diagnosis, case definitions, and treatment protocols were standardized, availability of drugs was improved; and health staff could be trained.
Programme implementation started in 1994 with training sessions in three regions. In the same year, Ghana adopted and implemented the WHO DOTS (Directly Observed Treatment Short course) strategy. By the end of 1998, TB services had been integrated into primary health care, and by 2005, Ghana achieved 100% DOTS coverage. In 2005, Ghana adopted the WHO interim policy on TB/HIV (national TB/HIV co-infection rate: 14.7%). The NTP is now implementing the new Stop TB Strategy of WHO.
Achievements and challenges
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 DOTS services. TB interventions were scaled up, the treatment success rate increased from 50% in 2000 to 84% in 2012. However, progress has been too slow. 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. Other key challenges include unacceptable TB death rates and low antiretroviral therapy (ART) coverage among TB/HIV patients.
The way forward
Top priorities under the Ghana Health Sector TB Strategic Plan 2015-2020 include:
- To early screen, detect and enroll into treatment all forms of notified new cases from 15,606 (2013) to 37,956 by 2020, while increasing the proportion of bacteriologically confirmed pulmonary TB from 51% (2013) to 60% by 2020.
- To early detect and enroll into treatment at least 85% of confirmed MDR-TB cases among new and previously treated cases by 2020.
- To attain higher treatment success for all forms of TB from 84% in 2012 to at least 91% by 2020.
- To reduce death rates of TB/HIV co-infected cases from 20% (2012) to 10% and uptake of ART coverage among co-infected from 5.7% (2013) to 37% by 2020.
There is a shift from passive TB case finding to active case finding using superior screening algorithms and diagnostic tools. An award-winning, evidence-based WHO set of guidelines, piloted in Ghana, has guided prioritization of the proposed interventions in this plan. The total funding need for this 6-year TB Strategic Plan 2015-2020 is close to 360 million USD. Through the Global Fund-financing mechanism, 6% of the total funding needs in the next 3 years will be provided. The Government of Ghana will provide at least 30% of the annual budgetary needs of this plan.