A National Audit of Facilities, Human and Material Resources for the Comprehensive Management of Diabetes Mellitus in Ghana-A 2023 Update

Abstract Background It is expected that Sub-Saharan African countries are expected to experience the largest increases in the prevalence and complications of diabetes by the year 2045. However, the human and material resources as well as the systems for managing diabetes in Africa are inadequate. Thus, this study or needs assessment, aimed at updating the human and material resources, identifying the gaps and unmet needs for comprehensive diabetes care in Ghana. Methods : We conducted a national audit of 122 facilities in all 16 administrative regions of Ghana comprising 6 Teaching, 10 Regional, 100 Municipal/District Hospitals, and 6 private and quasi-government hospitals. Information obtained covered areas on personnel and multidisciplinary teams, access to medications, access to laboratory services, financing, screening services, management of diabetes complications, and availability/use of diabetes guidelines or protocols. Data was analysed using STATA version 16.1. P-values <0.05 were set as significant. Results : Only 85(69.7%) out of the 122 surveyed facilities had a dedicated centre or service for diabetes care. Twenty-eight (23%) had trained diabetes doctors/specialists; and whilst most centres had ophthalmic nurses and dieticians, majority of them did not have trained diabetes educators (nurses), psychologists, ophthalmologists, podiatrists, and foot/vascular surgeons. Also, 13.9% had monofilaments, none could perform urine dipstick for microalbumin; 5 (4.1%) and just over 50% could perform laboratory microalbumin estimation and glycated haemoglobin respectively. Access to and supply of human insulins was better than analogue insulin in most centres. Nearly 100% of the institutions surveyed had access to metformin and sulphonylurea with good to excellent supply in most cases, whilst access to Sodium Glucose Transporter-2 inhibitors and Glucagon-like peptide-1 analogues were low, and moderate for Dipeptidyl peptidase-4 inhibitors and thiazolidinediones. Overwhelming majority of the health facilities (95.1%) offered NHIS as payment mechanism for clients, whilst 68.0% and 30.3% of the patients paid for services using out-of-pocket and private insurance respectively. Also, 91.8% surveyed used the National Treatment Guideline in their practice and 15 (12.3%) had Diabetes Support Groups in their locality and catchment areas. Conclusion : Significant gaps remain in human and material resources, which requires urgent multisectoral collaboration to promote and achieve acceptable comprehensive diabetes care.