Ghana

The Constitution of Ghana does not provide a justiciable right to health. However, under article 34, the right to good health care as a ‘basic human right’ is recognized as part of its Directive Principles of State Policy These principles of State Policy shall guide all citizens, Parliament, the President, the Judiciary, the Council of State, the Cabinet, among others, in applying or interpreting the Constitution or any other law and in taking and implementing any policy decisions. The President shall report to Parliament on the steps taken to ensure the realization of these policy objectives.

Article 35(6)(D) of the Constitution of Ghana establishes that the State must take appropriate measures to make democracy a reality by decentralizing the administrative and financial machinery of government to the regions and districts and by affording all possible opportunities to the people to participate in decision-making at every level in national life and in government.

Article 190 of the Constitution provides the scope of Public Services which includes the Health service, along with, among others, the civil service, the judicial service, the audit service, the education service, the prison service, the parliamentary service, the statistical service, the national fire service, the police service, the legal service. The parliament may by law prescribe other public services.

The Local Governance Act, 2016, provides for decentralised public service sectors including health (section 77 and first schedule). At the local level, departments for health are the Metropolitan Health Department (within the Metropolitan Assembly), the Municipal Health Department (within the Municipal Assembly) and the District Health Department (within the District Assembly) (section 78 and second schedule). The District Assembly shall be established for each district, municipality and metropolis and is the highest political authority in the District (section 3).

According to Article 14 of the Local Governance Act, 2016, the person who performs the duties of a Medical Officer or Sanitary Inspector in line with the Public Health Act, 2012, shall be the Health Officer of the District Assembly of the area to give effect to and enforce by-laws related to public health made by the District Assembly which is the highest political authority in the district.

The Health Professions Regulatory Bodies Act, 2013 establishes regulatory bodies overseeing health professions in Ghana, namely: the Allied Health Professions Council (Part One, Article 1), Medical and Dental Council (Part Two, Article 25), Nursing and Midwifery Council (Part Three, Article 53), Pharmacy Council (Part Four, Article 78), and Psychology Council (Part Five, Article 115). The primary responsibility of these health professions councils is to ensure the highest standards in the practice of professionals registered under this Act.

For each entity, the Act provides provisions for their functions; governing bodies of the councils; qualification requirements; registration procedures including the registration of foreign-trained practitioners; types of registers; inspection and sanction procedures, etc.

The Act outlines the licensing procedures for businesses involved in retailing restricted medicines (Article 93), selling over-the-counter medicines (Article 94), wholesaling restricted medicines (Article 95), and includes regulations on sales restrictions (Article 97) and prescription rules (Article 99). Furthermore, Article 104 establishes the procedure for the classification of medicines where the Minister of Health on the advice of the Food and Drugs Authority and the Pharmacy Council issues an executive instrument to classify medicines and conditions for their supply and dispensing

The National Health Insurance Act, 2012 is organized around 4 main parts. The first addresses the National Health Insurance Authority (including its establishment, its administrative and financial provisions). Part two addresses the national health insurance scheme (establishing its establishment, the National Health Insurance Fund, the National Health Insurance Levy). Part three addresses private health insurance schemes (including the provisions on Private Health Insurance Schemes, Private Commercial Health Insurance Schemes, Private mutual Health Insurance Schemes, and the General provisions applicable to operation of private health insurance schemes). Finally, part four deals with Adjudication and other provisions (e.g. offences, regulations, interpretations, repeals etc.).

Part One on the National Health Insurance Authority establishes the National Health Insurance Authority (Article 1). The objectives of the Authority are to attain Universal Health Insurance coverage in relation to persons resident in the country, and persons not resident in the country but who are on a visit to the country (Article 2). Its functions are broad and include, among others, managing the National Health Insurance Scheme, determining in consultation with the Minister the contributions to be made by its members, registering members, registering and supervising private health insurance schemes, issuing identity cards to members of the scheme, granting credentials to healthcare providers and facilities providing services as part of the scheme, managing the national health insurance fund, providing a decentralized system to receive complaints by members of the scheme and healthcare providers, receive and pay claims etc. (article 3). The authority is governed by a Board including, among others, representatives from different ministries (Health, Finance, Social Welfare), Insurance bodies, medical, dental and pharmacy professions, as well as two persons representing members of the scheme (article 4). Administrative and financial provisions are addressed from article 14 to article 25.

Part two governs the National Health Insurance scheme. It provides for its establishment (which covers among other issues of membership, contribution, benefits, list and tariffs for medicines and services) (article 26 to article 38). This Part also provisions for the National Health Insurance Fund (including object, sources of money, reporting) (Articles 39-46). Lastly, this part provides for the National Health Insurance Levy charged at a 2.5% rate on each supply of goods and services as specified in the law (Articles 47-52).

The Public Health Act of 2012 is organized around 9 parts addressing a broad array of issues including communicable diseases (Part One), vaccination requirements (Part Two), quarantine (Part Three), vector control (Part Four), environmental sanitation (Part Five), tobacco control (part Six), Food and Drugs including the Food and Drugs Authority (part Seven), Clinical Trials (part Eight) and miscellaneous provisions e.g., Patient's Charter, International Health Regulation, public health emergency etc. (Part Nine).

Part Seven of the Act establishes the Food and Drugs Authority (article 80) that provides and enforces standards for the sale of food, herbal medicinal products, cosmetics, drugs, medical devices and household chemical substances (Article 81). Part Eight of the Act establishes the Clinical Trials Technical Advisory Committee operating under the Food and Drugs Authority (Article 150) to oversee the monitoring of clinical trials and advise the Authority on the quality of the protocols among other functions (Article 152).

Part Nine of the Act includes provisions for a Patient’s Charter, which delineates the rights and responsibilities of patients or clients within the healthcare system (Article 167; Sixth Schedule). It also provides for the declaration of a public health emergency (Article 169) and grants emergency powers to address public health crises effectively (Article 170).

Under section 21, public vaccinator shall vaccinate, free of charge, persons who present themselves or are presented for the purpose, or persons who are or become liable to be vaccinated

The Health Institutions and Facilities Act of 2011 is organized around 4 parts. Part One addresses the Health Facilities Regulatory Agency including the establishment of the Agency, the establishment of zonal health facilities committees, the licensing of facilities (sections 2 to 27). Part Two addresses Mortuaries and Funeral Facilities Agency, including the establishment of the Agency, the Zonal Mortuary and Funeral Facilities Committees, the registration of practitioners, the licensing of facilities and burial grounds (sections 28 to 59). Part three addresses the Ambulance Council including the establishment of the Council, the registration of practitioners, licensing, and regulation of ambulance services (sections 60 to 93). The last part provides for administrative and financial provisions.

Under part One of the Act, the Health Facilities Regulatory Agency is established; it is responsible for licensing and monitoring facilities that provide public and private health care services in Ghana (Articles 2 and 3). The functions of the Agency also include receiving and approving license applications, inspecting and licensing healthcare facilities, setting equipment and personnel standards, regulating practice activities, collaborating on professional standards, assessing health facilities, and promoting quality improvement in healthcare providers (Article 4). The Agency is governed by a Board whose composition is described under article 5. Part One of the Act also establishes Zonal Health Facilities Committees (Article 6) that are charged with processing and advising on the applications for licensing of facilities, monitoring and inspecting licensed facilities, receiving licensing fees, enforcing compliance, and reporting to the Board of the Health Facilities Regulatory Agency (Article 8). The Zonal Committee is composed of a maximum of five members with relevant qualifications, expertise and experience and at least one of the members must be a woman (Article 7). Facilities subject to licensing requirements are listed in the First Schedule of the Act and include medical and dental (clinics and hospital); eye care clinics; convalescent and nursing homes; geriatric homes; maternity homes; occupational therapy clinics; physiotherapy clinics; dental technology laboratory; clinical and bio-medical laboratory, medical assistant clinics; diagnostic-imaging technology clinics; pharmacies and chemical shops; osteopathy clinics; prosthetics and orthotics clinics. The Minister may add to this list (section 11 and first schedule).

Part Three of the Act establishes the Ambulance Council of Ghana (Article 60) entrusted with regulating the operation of ambulance services in the country in accordance with policy standards (Article 61). The Council's functions are defined by Article 62 and include setting and enforcing training and service standards, monitoring ambulance services and practitioners, registering and licensing practitioners, ensuring equitable ambulance distribution, advising on policy, regulating fees, and collaborating with relevant institutions.