This paper describes the Evidence Advisory System (EAS) in Ghana, a lower-middle income
country located in West Africa and a member of the African Union.
Ghana is a unitary state with some decentralised functioning affecting health policy-making and
planning, but with a great deal of authority remaining in the hands of the national Ministry of
Health (MoH) and the Ghana Health Service (GHS). Ghana is a recipient of high levels of
international donor finance and aid which has significant implications for policy-making and the
use of evidence.
Ghana has embraced the language of evidence-based decision-making in health with a specific
reference to health service management, including data usage and performance review.Planning and research divisions/departments have been established within all health sector
bodies, including the MoH, the GHS, and all the other ministerial agencies. These bodies are
tasked with reviewing their performances against the strategic objectives set by the MoH (with
the support of Development Partners (DPs)) in the Health Sector Medium Term Development
Plan (Ministry of Health Ghana 2014). These reviews are supported by a well-established
information management system, which is organized by the Policy, Planning, Monitoring, and
Evaluation (PPME) division of the GHS, across all levels of governance: district, regional, and
national. Evidence is mainly synthesised in the form of health performance indicators.
The predominant use of evidence for performance review has its counterpart in the governance
structure of health decision-making. This is marked by a continuous collaboration with DPs in
which evidence is used to evaluate health policy performances and inform policy-making. More
challenging, however, have been in efforts to use evidence to plan resource allocation or priority
setting across the health sector and health service more broadly. Reviews and performance
indicators do not automatically translate into policy lessons and informative planning. The
formulation of policy in health lacks clear lines of accountability between the MoH and its
agencies across the national, regional and district level, clear coordination between DPs, the
MoH, the Ministry of Finance (MoF) and the National Development Planning Commission
(NDPC), and clear mechanisms of stakeholders’ participation1.
Further, a national framework for health technology assessment (HTA) in Ghana has not yet
been implemented. This has direct relevance for decisions made by various stakeholders,
including the National Health Insurance Authority (NHIA). In recent years, various DPs have
supported a series of initiatives with the MoH and associated agencies to raise awareness on the
role and value of using evidence-based approaches in decision making and priority setting
within the health sector; however, many plans have not yet been fully developed (Ganoo 2015).
There are some indications of progress in this area, though. For example, Ghana supported the
HTA resolution at the 67th World Health Assembly (2014) calling for countries to work towards
Universal Health Coverage using HTA as a tool for priority setting (World Health Assembly
2014, Ghana National Drugs Programme 2016); and the MoH is piloting the use of HTA to guide
decisions on prioritisation within the NHIA, and is being applied to the selection of medicines
and the development of Standard Treatment Guidelines for hypertension (Ghana National Drugs
Programme 2016).