Background

WAHF The West African Health Foundation (WAHF) is a non-profit, non-governmental organization established in New York by a group of physicians concerned with the poor health and nutritional status of the people, particularly children and women, of the West African sub-region. The major causes of mortality and morbidity in this area could be prevented or reduced substantially through effective health and nutritional education at a fraction of the cost currently expended by the governments and individuals in managing these problems. The current lack of adequate, acceptable, compassionate, empathic, effective basic and advanced specialists health care for the people of Ghana in particular and West Africa in general is also of grave concern to WAHF.

In almost all of the countries of the sub-region the primary provider of health services is the government. In Ghana, there are 1,569 public and private health facilities of all categories (1977). These include 143 hospitals, 856 clinics, 387 health centers, 177 maternity homes, and 8 unclassified health units. The public sector is the largest provider of health services in the country accounting for 55% of the health facilities. The private for profit clinics account for 37% and the private not for profit clinics and hospitals account for the remaining 8%. The latter health services are provided mainly by the missionary hospitals comprising of the Catholic, Presbyterian, Seventh Day Adventist, and the Ahmadiya Mission.

Over the past two to three decades, the idea that preventive and primary level care are more successful and cost-effective on a population-wide basis has gained currency and general acceptance especially in the economically distressed countries of sub-Saharan Africa. Governments in these countries have discovered that Hospitals constitute a financial burden and drain on their fragile economies absorbing 40 to 60 per cent of the recurrent expenditure on health services.

Despite all these financial sacrifices, the Hospitals in these countries have had a limited and in some instances even a negative impact on the health of the population. In Ghana, the press has dubbed Hospitals, 'killing fields'. The reasons for the perilous state of the Hospitals are protean. Staffs are under-paid, under-employed, and demoralized; buildings and equipment are decrepit, services are poor and graft is rampant.

The Government expenditure on health as percentage of total general government expenditure for the year 2000 and 2002 in Ghana was estimated to be 7.9% and 9.0%, respectively (WHO). The average per capita government expenditure in the same years on health was 6 (six) US dollars. The out of pocket (private) expenditure on health as percentage of total expenditure on health for the year 2000 was 46.5%. The total health expenditure as percentage of GDP was 4.2% in the year 2001.

Given the tremendous pressure exerted on health resources, it is clear that Governments will find it increasingly difficult to meet the health aspirations of the population. West African Health Foundation is positioned to relieve some of these stresses on the health services and provide an invaluable addition or alternative to the over-burdened health systems in the sub-region. WAHF aspires to be a shinning star in innovative health care provision in the sub-region and a beacon of hope for the vast majority of the sick and afflicted.

top of page

Demographics

The population of West Africa is approximately 250 million of which Nigeria alone with a population of 118 million accounts for roughly half the people in the sub-region. Ghana's total population is estimated to be 19.7 million of which 50.4% are women (2000 population census). Togo that borders Ghana on the east has an estimated population of 4 million, Burkina Faso that borders Ghana on the north has an estimated population of 11 million, and Cote d'Ivoire that lies to the west of Ghana has an estimated population of 14 million. The total population of Ghana and its immediate neighboring countries is estimated to be 48 million.

The demographic profile of West African countries like all developing countries reveals that the population is made up of relatively young people with a median age of about 17 years (Ghana 2000 population census) and high total fertility rates. The total fertility rate in Ghana was 5.5 in 1991 and 4.3 in 2001. The annual population growth rate for Ghana from 1991 to 2001 was 2.4%. Approximately 48% of the Ghanaian population is less than 15 years old. Children 0-5 years constitute 20% and infants represent 3% of the total population. Only 4% of the population is over 65 years. Most of the inhabitants of the sub-region live in rural areas. In Ghana 32% of the total population resides in the urban areas (defined as communities with population over 5000) and the rest 58% in rural areas.

Morbidity/Morality

The average life expectancy at birth in Ghana for the total population as in most of the West African countries is 57.4 years; for males it is 55.8 years and for females it is 58.9 years. The morbidity pattern of the countries in the sub-region is also typical of that seen in all developing countries. Infections and infestation with parasitic organisms are common. Malaria, tuberculosis, respiratory, gastro-intestinal infections, HIV/AIDS and nutritional deficiencies are some of the causes of morbidity and mortality.

The World Health Organization (W.H.O) estimates that about 10 million infants and children die each year and approximately 585,000 women also die each year from complications of pregnancy. Ninety nine percent of these deaths occur in developing countries. The ministry of Health of Ghana reports similar dismal mortality rates. Complications of pregnancy, childbirth or unsafe abortion cause increase mortality in women of the sub-region.

Maternal Morbidity/Morality

The maternal mortality rate in Ghana (1997) was estimated to be 214 per 100,000 live births. Between 9% and 13% of maternal deaths in 1990- 91 were due to abortion complications, 17.7% to hemorrhage, 17.5% to hypertension, 9.5% to genital tract infections, 5.5% to obstructed labor and uterine rupture, 11% to sickle cell disease, 6.5% to anemia (Ministry of Health, Ghana).

The contributing factors cited for this unacceptably high mortality rate were; high parity, pregnancy at the extremes of life, short intervals between pregnancies, poverty, malnutrition, customs and beliefs, lack of antennal care, lack of access to good quality health care, lack of education of mothers and unhealthy living conditions. 16% of the total gynecologic admissions were due to abortion-related complications.

Infany Morbidity/Morality

The infant mortality rate in Ghana was reported to be 66 per 1000 live births in 1997 and that of children 0-5 years of age to be 132 per 1000 in the same year. The commonest causes of death are; birth asphyxia, neonatal tetanus, pre-maturity, pneumonia, sepsis, congenital abnormalities, malaria, diarrhea, measles and HIV/AIDS. Some of the preventable factors cited for the neonatal deaths include poor and ineffective obstetric care (45%) and antenatal care (23.5%).

The majority of children who do not die from these diseases are left with complications such as mental retardation, blindness and crippling conditions. Children are at a worse disadvantage due to the fact that they depend solely on adults, especially their mothers for survival and nurturing.

top of page

HIV/AIDS

By 1994, approximately 16,000 cases of AIDS were reported to the (W.H.O), although the actual number of cases in Ghana is probably two to three times that number. It is estimated that as of 1994 approximately 172,000 adults in Ghana were infected with HIV, a prevalence rate of 2.3% among sexually active adults. The estimated number of adults and children living with HIV/AIDS at the end of 2001 was 360,000 of which 330,000 were adults (15-49 years), 170,000 women (15-49 years) and 34,000 children (0-15 years). The adult HIV prevalence rate in 2001 is estimated to be 3.0%. As of June 2002 a cumulative total of about 600,000 HIV/AIDS cases had been reported (Ghana AIDS Commission). The estimated number of deaths (adults and children) due to AIDS in 2001 was 28,000 and the estimated number of orphans in the same year was 200,000 (UNAIDS).

The peak age group of HIV/AIDS cases is the 25-34 year age group, which accounts for nearly 45% as reported in 2002. The highest prevalence rates are found in the 25-29 year age group for females and 30-34 year age group for males. Nearly 90% of the reported HIV/AIDS cases are found in patients 15-49 years old. For children the majority of cases are in the 0-4 year age group and the mode of infection is through Mother-To-Child Transmission. Sixty-three percent (63%) of all reported cases of HIV/AIDS in Ghana currently are in females.

The average adult prevalence of HIV from sentinel surveillance in Ghana is known to have increased from 2.6% in 1994 to 3.6% in 2001. Sentinel surveillance for HIV among pregnant women in 1992 showed prevalence rate of 3.2% and 4.2% in the urban centers of Koforidua and Kumasi, respectively. Currently and according to the 2002 surveillance report the median prevalence rate is 3.4% and the mean is 3.8%.

The prevalence rates among Sexually Transmitted Disease (STD) patients and blood donors in the Southern sectors of Ghana are 24% and3.0% respectively. Recent evidence shows an increasing level of HIV among commercial sex workers from 25% in 1987 to 38% in 1991 (Ministry of Health, Ghana). The prevalence rates were quite high among commercial sex workers in the urban areas, estimated at 75.9% in the Accra-Tema metropolitan area and 86.0% in Kumasi.

Heterosexual sex remains the most predominant mode of transmission, accounting for 75-80% of all infections. Mother-To -Child transmission and transmission through blood and blood products account for 15% and 5% respectively. STD is known to facilitate the acquisition and transmission of HIV. The characteristics of HIV/AIDS as observed in Ghana are similar to that of the other African countries. The reported prevalence rate of HIV/AIDS in the other countries in the West African sub-region is between 5% and 11%.

Other Diseases

Hypertension, cardiac diseases, diabetes mellitus and their complications, metabolic syndrome, malaria, tuberculosis, accidents, sickle cell disease and cancers (particularly breast, liver, prostate) are the causes of morbidity and mortality in the adult population in the sub-region.