Ghana

The Republic of Ghana sits on West Africa's Gulf of Guinea with many ethno-linguistic groups comprising the country's 19 million people, approximately 36% of whom dwell in urban locations. Ghana's main economy derives from mining and agriculture based on its wealth of natural resources and its 70% forested and arable land. Ghana's 10+ years of substantial economic growth since the 1980s make it one of the most promising economic prospects in Africa.

Yet despite its economic growth, Ghana still suffers from health problems related to malaria. Malaria is hyper-endemic in Ghana, accounting for over 44% of all outpatient visits and 22% of its under-five mortality. One of the major causes of poverty and low productivity in Ghana, malaria cases reported in 2003 numbered between 7,100 to 7,700 cases per day in public health facilities, 2,700 of which were children under the age of five years. This probably represents a fraction of total cases, since a large number of cases are treated at home and go unreported.

As in many developing countries, the poor quality of antimalarial drugs presents an obstacle to disease control in Ghana and may also contribute to growing drug resistance. In 2002, Ghana adopted a new antimalarial drug policy based on the WHO-recommended and globally accepted Artemisinin Combination Therapy (ACT) as the first choice for the treatment of malaria when drug resistance to monotherapy is prevalent. Ghana chose the Artesunate + Amodiaquine combination because, among other factors, it could possibly be produced by local manufacturers.

Funded by the Global Fund for AIDS, TB, and Malaria, Ghana's Malaria Control Program began implementing the ACT program in January 2005; however, a number of adverse reactions were reported soon thereafter. In response, the government of Ghana set up systems for monitoring safety, quality, and efficacy to support the implementation process, and the University of Ghana Medical School began to monitor reports of any adverse events through their Pharmacovigilance Center.

In April 2004, the Ghanaian government appealed to USP DQI, through the USAID Malaria Action Coalition Initiative, to thoroughly assess the country's capacity for drug quality control and its ability to ensure safe use and good quality antimalarial drugs. The USP DQI assessment was limited to the central level; however, Ghana demonstrated a number of positive drug control factors in its favor, including a well-established drug policy, drug regulations in place, control of imports and distribution by the Food and Drug Board, and a structured drug registration program. Since that time, USP DQI has provided priority interventions to Ghana in the form of training and technical assistance. The government drug control laboratories have updated standard operating procedures, upgraded equipment, and begun monitoring drug quality and GMP compliance. Representatives from several local drug manufacturers also were trained in order to raise awareness about the quality of medicines and are working to improve their facilities and procedures in order to comply with the criteria necessary to become a WHO-pre-qualified manufacturer. Ghana has strengthened its central system and continues to dedicate its efforts to better address the health needs of its population.