How Ghana's Health System Sabotages Its Own Success Against NCDs – And Why the Solution Isn't Simple.

For too long, discussions around Ghana's escalating burden of non-communicable diseases (NCDs) like hypertension and diabetes have revolved around alarming statistics or the promise of digital health solutions. While these factors are important, they barely scratch the surface of the real challenge: Ghana’s health system, by its very design, undermines the very outcomes it claims to pursue.

Despite pilot programs, digital tools, and health innovations that show promise, effective models for prevention and long-term care routinely fail to scale. The real issue lies not in the absence of solutions but in a system that is structurally and financially misaligned to support them.

Sabotage by Design: How the System Works Against Itself

At the root of this self-sabotage is the fee-for-service model that dominates Ghana’s healthcare financing. Health providers are reimbursed based on the number of services they deliver, not the quality of outcomes achieved. This creates a powerful disincentive for prevention, early detection, and follow-up care all of which are essential for managing NCDs.

Even more troubling, this isn’t just a financial issue. It’s a multi-layered systemic failure that touches every aspect of how care is planned, delivered, and sustained:

• No institutional pathway to scale: Promising pilot projects often die in silos. There's no national mechanism to absorb, fund, or replicate what works at the local level.

• Reactive budgeting: Health budgets prioritize curative services and infrastructure, not prevention or population health. Public health education and community screening remain underfunded.

• Data blindness: Fragmented and unreliable health data systems mean decision-makers can’t track outcomes across the population, reward success, or even understand the true scale of the NCD burden.

• Outdated provider training: Medical and nursing education continues to emphasize acute care, with limited focus on chronic disease management, lifestyle counseling, or prevention.

• Broken referrals: The system lacks functional bidirectional referral pathways. Patients screened for NCDs are rarely linked effectively to care or followed up consistently.

In effect, the health system rewards treatment over prevention, volume over value, and fragmentation over continuity. This is not an accidental oversight. It is a deeply entrenched structure that makes long-term success against NCDs nearly impossible.

Value-based care offers a compelling alternative, one that rewards outcomes over activity. Economic evaluations and cost-effectiveness analyses have shown that preventive approaches, longitudinal management, and robust linkage to care are not only clinically effective but also highly cost-effective in the long run.

But transitioning to VBC in Ghana isn’t as simple as flipping a policy switch.

Ghana faces resource scarcity, with chronic shortages of trained staff, essential medicines, and infrastructure. Data systems are fragmented, making outcome-based tracking difficult. Patients face barriers too—from low health literacy and cultural beliefs to out-of-pocket costs that deter follow-up. And at the governance level, long-term reforms require political stability, regulatory capacity, and resistance to inertia.

Even if a VBC model is introduced, it will fail without addressing these interconnected limitations.

The real insight is not in discovering new prevalence rates for diabetes or hypertension. It’s in understanding that the system itself is the bottleneck. Solving this requires more than innovation; it requires transformation.

To create a future where preventive NCD care thrives in Ghana, we must:

• Shift reimbursement toward outcomes, not activity

• Invest in foundational infrastructure, human resources, and reliable digital systems

• Empower communities through health literacy and lower access barriers

• Build political and institutional capacity for health system reform

• Retrain providers to lead with prevention, not just cure

Only by restructuring the very incentives, operations, and culture of our health system can Ghana move from fragmented pilot projects to sustainable nationwide solutions.

It’s Time to Stop Rewarding the Wrong Outcomes

Until Ghana stops rewarding volume over value, we will continue to treat NCDs at their worst instead of preventing them at their root. The tools for change already exist but the system must first stop sabotaging them.