Ghana Health: The Western African Coast Represents a Portal into the Future of Clinical Research

Jul 22, 2019 | Africa, Clinical Trials Africa, Ghana, Malaria

Recently, the Upper West Regional Hospital leadership fired their Medical Director and Finance Director due to what appeared to be corrupt practices involving misappropriation and misapplication of the hospital’s finances.

Apparently, the Ghana Health Service was investigating the duo at the Upper West Regional Hospital and had written a communication essentially articulating the need for the firing of the culprits due to a violation of the Public Financial Management Act 2016 (Act912), not to mention a breach of established policy and procedure associated with the Ghana Health Service. Poor management leads to a lack of accountability at best and outright theft as seems to be the case in this West African hospital, reports GhanaWeb.

Although the miscreants got away with the scheme for a while, the rule of Ghana law ultimately caught up with them.

Ghana the Country

With nearly 31 million people, this geographically small but culturally, economically and spiritually dynamic and diverse West African nation was the seat of pan African pre-colonial power with the Ashanti Empire. Under the rule of the British Empire, several hundred years later it was coined “The British Gold Coast” until the English were pushed out in 1957 not by violent revolution, but by a white paper articulating the rationale for independence. Perhaps this is the ultimate indicator as to the thoughtful, well-meaning and higher-order intelligence of the “Gold Coast” inhabitants in Ghana. English is the official language and dozens of indigenous languages are spoken not to mention French due to the surrounding ex-French colonies.

Ghana maintains over 100 ethnic groups with the largest being the Akan, Moshi-Dagbani, Ewe, and Ga. The Akan includes the Ashanti tribe which could trace its lineage back thousands of years. The country is known for expert craftwork.

With one of the wealthiest per-capita GDPs in Africa, Ghana is diversified and possesses a rich natural resource base. By 2011, it represented one of the fastest-growing economies in the world.

Ghana Health System

Since its independence from the British in 1957, Ghana has made great strides towards improving its healthcare facilities and associated services. Health in Ghana is managed by the Ghana Health Service, the health policy implementation agency of the Ghana Ministry of Health. The health system has evolved to include ten administrative regions across the country. Ghana has over 300 hospitals and its health system can be segmented into five levels including health posts (first primary care for rural areas), health centers and clinics, district hospitals, regional hospitals, and tertiary hospitals.

Ghana maintains a universal health care system apparently only designated for Ghanaian nationals, National Health Insurance Scheme (NHIS). Health care coverage is variable and undoubtedly some pockets have excellent coverage while other more rural areas may face greater access challenges.

Ghana Pharmaceutical Sector

The industry, valued at probably over $600 million at this point, appears to be in transition from domestically controlled market to one open to multinationals.  For example, by 2014 it was reported that industry was growing at a torrid 54% with $522 million in turnover. GhanaWeb reported that “indigenous pharmaceutical companies” were being ultimately pushed aside for multinational distribution with new international distributors such as Worldwide Healthcare Limited in the UK. Companies entering or already present with distribution contracts included Pfizer, GSK, AstraZeneca, Sanofi, Johnson & Johnson, Rush Pharma, and others.

Local Companies

The reports concerned the growing threat to domestic distributors including the following

Industry groups formed the Pharmaceutical Manufacturers Association of Ghana, which provides some rich information on the country’s pharma industry including its history. Prominent members are list here. It would appear that the country includes dozens of local pharmaceutical manufacturers and distributors.

Clinical Research in Ghana

Clinical trials in Ghana goes back to the 1970s when primarily intervention trials against onchocerciasis and childhood Burkitt’s lymphoma were conducted, giving way to a more diversified base of studies in the 1980s and 1990s involving therapeutic interventions against major communicable diseases for example. Post year 2000, a number of intervention trials targeting malaria saw some success including some vaccine development.

Over the past decades, academics George O. Adjei and Abdul M. Sulley researching Ghana’s clinical research say they found a consistent presence of reproductive health intervention and surgically-related clinical trials have been common. Less commonly, sponsors studied TB and neonatal-related interventions while trials against non-communicable diseases such as hypertension, cardiovascular diseases, and mental health disorders have been nearly non-existent.

Generally, Adjei and Sulley report that clinical research in Ghana has followed a somewhat predictable trajectory of following global health initiatives and external funding exigencies. Today there are pressing needs for clinical research as care options, especially with non-communicable disease-causing morbidity and mortality.

Drugs and Device Authorities

Drugs and devices are regulated by the Food and Drug Administration Ghana. FDA Ghana runs a number of divisions including the Clinical Trials Department. This group oversees all investigative clinical trial work in Ghana. TrialSite News sought to review listed clinical trials and found the link to the webserver was broken.

Clinical Trials

TrialSite News research ran a search of clinical trials activity in Ghana. A grand total of 120 studies have been run there historically, at least that is what has been recorded in U.S. government site Clinicaltrials.gov.

Industry-Sponsored Studies Active

A total of five (5) studies were reported in Clincialtrials.gov. Two of the studies are sponsored by GSK and focus on malaria vaccine research, which has raised great hope (malaria is a killer) but also some questions as recently reported in the New York Times.  A third is sponsored by AstraZeneca and focuses on pediatric patients with Sickle Cell disease while a fourth is sponsored by Swiss-based Novartis and centers on an antimalarial drug called cipargamin. A fifth active, industry-sponsored study is scheduled to have concluded the end of last year. Sponsored again by the UK’s GSK, it was an epidemiology study planned to run in parallel with two other studies with a focus on longitudinal estimates of malaria parasite prevalence in the human population as well as record malaria control measure usage in the areas where the other two malaria trials occurred.

Academic Center, Government and NGO Studies Active

We found a total of eighteen active clinical trials; however, there could be more. A few examples are provided below.

One study focuses on first-time stroke survivors and represents a partnership between Kwame Nkrumah University of Science and Technology and the Medical University of South Carolina.

Another study represents a partnership between the Ghana Health Services and Noguchi Memorial Institute for Medical Research. This study centers on the control of lymphatic filariasis (LF).

An international WHO research effort studying Buruli Ulcer and a comparison of drugs (SR8 and CR8) is sponsored by the Netherlands’ University Medical Center of Groningen and involves multiple research centers in Ghana including:

Note that Buruli Ulcer is a chronic, debilitating, necrotizing disease of the skin and soft tissue. It is an emerging infectious disease and is the third most common mycobacterial disease of the immunocompetent host, after tuberculosis and leprosy. It is most common in West and Central Africa with occurrence clusters in Japan and Australia.

Large Hypertension Study Brings Localized Digital Engagement App to Ghana Study

In a Johns Hopkins led effort, Komfo Anokye Teaching Hospital, Kumasi South Hospital, Manhyia Government Hospital, and Suntreso Government Hospital is conducting a pilot cluster randomized control trial to test the feasibility of a multilevel, nurse-led, mobile health enhanced intervention in patients with uncontrolled hypertension in Ghana.

The study includes two arms, including an Enhanced Usual Care Group that will utilize a culturally-tested and locally attuned mobile health platform called “Akoma Pa app” made by Medtronic Labs. This “localized app” will be utilized to improve study communication between the Community Health Officer and the participant. The study sponsor’s sought to use this digital app platform to enhance shared decision making, clinical decision support, participatory communication, knowledge treatment adherence (medication and lifestyle modification), and self-monitoring of hypertension.

The team, led by Johns Hopkins and supported by the Ghana research sites will test the feasibility of the Akoma pa app in addressing patient-level and provider-level barriers to hypertension control.

Conclusion

TrialSite News focuses on clinical research worldwide with an emphasis on transparency at the research site level. We seek to cover clinical research information in a simplified, streamlined and straightforward way so more and more people and can track and understand clinical research. It is an important business that will shape our healthcare now and well into the future. This journey started with some news of localized corruption in Ghana’s regional hospital and meandered through Ghana’s health system to clinical research activity. An English speaking country with a friendly and dynamic outlook, Ghana has hosted at least 120 clinical trials and has dozens of prominent academic medical centers prominently engaged with international clinical trial sponsors.

The continent of Africa has over 1.2 billion people representing a young, dynamic and growing economy. Although clinical research in Africa hasn’t always had the greatest brand (for a variety of complex reasons), research will continue to grow and thrive. Research institutions will become accredited and increasingly structure multi-year research programs with commercial, academic and government sponsors.

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