1. The Public Health Snapshot (Executive Summary)
Ghana is currently navigating a profound “epidemiological transition,” a shift in which the national health burden is shifting rapidly from infectious diseases to non-communicable diseases (NCDs). Within this new reality, stroke has surged from the 5th to the 2nd leading cause of death in the country. This crisis is frequently mischaracterized as an inevitability of biology; however, the data reveal a far more harrowing systemic reality. Cardiovascular diseases (CVDs) now account for 19% of all NCD-related deaths in Ghana, and the average 28-day mortality rate for stroke stands at a staggering 41.1%.
These outcomes are not driven by biological determinism, but by late diagnosis and structural barriers—such as the high cost of care and limited rural infrastructure. To address this, we must adopt a Systems-Based Lifespan Protection framework:
- Institutionalised Prevention: Moving beyond individual lifestyle advice to state-supported screening and the implementation of the WHO/ISH risk prediction charts.
- Infrastructure Equity: Standardising care across all levels, ensuring that specialized services are not confined to urban teaching hospitals.
- Economic Safeguards: Expanding insurance coverage to include chronic NCD management and medications to prevent the poverty reinforcement cycle.
- Data-Driven Policy: Utilizing evidence-based data to replace fragmented, reactive health responses.
2. Ghana’s Shifting Health Landscape: The Dual Burden
The transition from communicable to non-communicable diseases is a present and escalating reality. According to the Institute for Health Metrics and Evaluation, disease trends from 1990 to 2019 show NCDs commanding the health landscape. Stroke admissions at major facilities like Komfo Anokye Teaching Hospital (KATH) saw a 260% increase over three decades, rising from 5.32 per 1000 admissions in 1983 to 13.85 per 1000 in 2010. This rise is inextricably linked to rapid urbanisation and lifestyle transitions, which have escalated the prevalence of hypertension and diabetes.
| Historical Landscape (1990) | Modern Landscape (Current) |
| Stroke ranked 5th commonest cause of death | Stroke ranked 2nd commonest cause of death |
| Ischaemic heart disease ranked 7th | Ischaemic heart disease ranked 5th |
| Primary burden: Infectious diseases | Primary burden: Non-communicable diseases (NCDs) |
| Fragmented NCD policy | 2022 National NCD Policy & Strategy implemented |
3. Deconstructing the “Silent Killers”
Hypertension and diabetes function as systemic risks that provide no outward warning until a catastrophic event occurs. Hypertension acts as an asymptomatic driver of vascular damage, while diabetes initiates a “complication cascade” that weakens circulatory integrity.
The 2024 Focused Update to the National Guidelines emphasises that the precursors to the atherosclerotic process—specifically elevated low-density lipoprotein (LDL) and other atherogenic lipoproteins—are causally related to cardiovascular events. To demonstrate high-level guideline awareness, it is critical to note that the update recommends newer therapeutic categories such as siRNA (e.g., Inclisiran), which reduces hepatic proprotein convertase subtilisin/kexin 9 (PCSK9) synthesis.
“Invisible risk accumulates silently within system gaps.”
limited access to tools such as-By the time a patient presents with symptoms, the underlying damage is often advanced. This reflects a failure of the screening system and a lack of access to tools like the new version of the WHO/ISH risk prediction chart, rather than a patient’s lack of concern.
4. The Anatomy of Stroke in the Ghanaian Context
Understanding stroke in Ghana requires distinguishing between its two primary forms. Ischaemic stroke occurs when blood supply to the brain is interrupted, while haemorrhagic stroke results from the rupture of a blood vessel. Nationally, there has been a notable shift: while haemorrhagic stroke was historically responsible for 61% of autopsy findings at Korle-Bu in earlier studies, there is now a rising trend in ischaemic stroke.
This shift presents a survival paradox. While ischaemic stroke generally offers better immediate survival rates than haemorrhagic stroke, it significantly increases the long-term disability burden. The “Productivity Loss” is immense: nearly 48% of stroke survivors in Ghana are within the working-age population. When a breadwinner survives but is left with chronic disability, the medical event transforms into a multi-generational poverty trap.
5. Structural Drivers of Late Diagnosis
Patients in Ghana often present at hospitals far too late for optimal intervention. This is not individual negligence but a result of “infrastructure exposure.” Systemic barriers prevent early management:
- Limited Routine Screening: Unstructured screening programmes mean many are unaware of their hypertension until a stroke occurs.
- Cost Barriers: A 2017 study found that 76.3% of patients cited economic barriers as the primary reason for treatment nonadherence.
- Logistical Constraints: High transportation costs and long distances to specialised facilities discourage follow-ups.
- Systemic Education Gaps: What is often labelled as “cultural normalisation” or “spiritual belief” is actually a vacuum created by a lack of accessible, context-specific community health education. In the absence of system-led education, patients naturally turn to the only available explanatory models.
6. Rural–Urban Inequities: The Geography of Survival
Survival often depends on geography. Urban centres like Accra benefit from specialised units at Korle-Bu Teaching Hospital (KBTH), yet rural areas face ambulance response gaps and referral delays. The Ghana Health Service (GHS) guidelines define five Levels of Care, yet the capability is unevenly distributed:
- Level 0: General recommendations for all levels.
- Level 1: Health centres/CHPS without a doctor.
- Level 2: Facilities with a doctor.
- Level 3: Facilities with a physician specialist or family physician.
- Level 4: Tertiary facilities with cardiologists and sophisticated equipment.
Progress is being made, such as the Ho Teaching Hospital inaugurating a specialised stroke ward in March 2025, but until Level 1 and 2 facilities are equipped with basic screening and stabilization protocols, rural-urban disparities will continue to determine mortality.
7. The Economic Ripple Effect: Households Under Strain
Stroke creates a “Poverty Reinforcement Cycle.” Families face immediate income loss combined with high out-of-pocket expenses. Research by Atibila et al. estimates the total patient cost for stroke care at GH₵ 4647.40, with medications and treatment accounting for the vast majority.
The financial burden is staggering when viewed over a lifetime; the estimated cost of managing complications from hypertension can reach GH₵ 869,106.00. This burden is heavily gendered, as caregiving duties frequently fall upon women, limiting the family’s earning potential and entrenching the cycle of debt and limited opportunity.
8. NHIS and the Policy Gap: Opportunities for Reform
The National Health Insurance Scheme (NHIS), established in 2003, was a landmark achievement, yet current coverage often excludes the specialised treatments and medications required for chronic NCD management. This forces patients toward out-of-pocket expenses they cannot sustain.
The proposed 2025 Ghana Medical Trust Fund represents a vital structural solution. By specifically targeting chronic diseases like hypertension, stroke, and cancer, this fund could provide the financial protection necessary to ensure that life-saving medications and interventions are accessible to all Ghanaians, regardless of their economic standing.
9. From Personal Choice to Policy Decision: Building Prevention Infrastructure
Protecting the Ghanaian lifespan requires moving beyond individual choices to systems-level accountability. The Ministry of Health and GHS have launched several initiatives aimed at building this infrastructure:
- The “Akomacare” App: A tool to assist clinicians in delivering evidence-based management at various levels of care.
- National CVD Support and Call Centre: Set up in 2021 to provide top-side technical support for cardiovascular care nationwide.
- 2022 NCD Strategy: A policy aligned with global strategies to integrate NCD services into primary health care through the WHO PEN (Package of Essential Noncommunicable Disease Interventions).
10. Ghana as a Regional Case Study
Ghana is positioned as a model for West Africa, but the system faces acute internal pressures. Leadership from organisations like the Stroke Association Support Network-Ghana (SASNET-Ghana) and the GHS NCD Control Programme is vital, particularly in implementing the CVD Score Card (2022).
However, progress is hindered by a “Brain Drain”—the migration of medical specialists, radiographers, and nurses due to poor working conditions and limited infrastructure. Furthermore, the COVID-19 pandemic strained the healthcare system, reducing available services for specialized stroke care. To move forward, we must address the fragmented response and the lack of high-quality evidence-based data that currently limits the delivery of structured care.
11. Conclusion: The Path Forward
The rising tide of stroke in Ghana is a manageable crisis, not a biological certainty. Stroke is largely preventable, and the current high rate of late diagnosis is a reversible systemic issue. We must shift our focus from treating individual failures to repairing the infrastructure that allows risk to accumulate. By funding NCD care, curbing the migration of our multidisciplinary workforce, and ensuring affordable medications, we can alter the current trajectory. Systems can protect Black lives; infrastructure determines outcomes.
https://amhg.ca/wp-content/uploads/2026/02/Ghana_Stroke_Systems-1.pdf
https://amhg.ca/wp-content/uploads/2026/02/Ghana_Stroke_Systems-1.pdf
This slide reframes stroke from an isolated medical emergency to a lifelong systems issue that affects families, economic stability, and generational opportunity. It highlights that most strokes are preventable and shifts the focus from crisis response to infrastructure, rights, and long-term protection.
Reviewing this slide helps audiences understand that protecting cardiovascular health is not only about treatment—it is about dignity, disability rights, prevention, and safeguarding the economic future of the next generation.
Why Watch This Video?
This video moves beyond crisis headlines and offers clarity, context, and practical protection. If you care about health equity, family stability, and long-term community wellbeing, this conversation matters
Stroke is rising rapidly in Ghana—but this is not a story about biology or inevitability. It is a story about systems, prevention, and protection.
In this episode, you’ll understand:
- Why stroke has become one of the leading causes of death in Ghana
- How hypertension and diabetes operate as “silent killers”
- Why late diagnosis—not genetics—is driving disability and premature death
- How health infrastructure gaps shape survival outcomes
- What families can do now to protect their health
- Why prevention is the key to safeguarding the Black lifespan
Prevention changes trajectories. Systems can protect.
