The state of play

Fragmentation, dislocation and under-funding characterise the current landscape for end of life care in Ghana, despite the country’s status as a continental leader in health insurance and strong government and societal support for health system development. Against this backdrop, small investments in end-of-life care can prove transformational.
The reality in Ghana looks like this:

• Acute shortage of specialised palliative care staff – who finance their own training.
• A brain drain as trained staff are pulled overseas attracted by better terms and conditions of service.
• Inadequate training capacity and a lack of a national palliative care policy.
• Poor infrastructure and weak coordination between services.
• Family caregivers and families usually provide home-based palliative and end-of-life care unsupported by health staff due to poor resource and geography.
• No patient pathway or choice of treatment, the patient comes last.
• Palliative referrals are too late, poorly planned and traumatic.
• No dedicated in-patient palliative ward in any of Ghana’s leading teaching institutes for children or adults.
• Opioid pain relief is often out of stock, difficult to access or prohibitively costly.
• Care and the dignity of care depend on the family and their knowledge.
• Too many die alone, in distress and without dignity – yet their courage and resolve shine through.

• Lack of provision for, or costing of, the delivery model for end-of-life care.
• Lack of strategic plan at the national/regional level for palliative and end-of-life care.
• Absence of meaningful public and demographic Health Data to guide decision-making and resource allocation.
• Poor integration across services.
• Collaboration is seen as a weakness, not a strength.