Introduction

In Ghana, hypertension and diabetes have become significant public health problems. Evidence from cross-sectional studies conducted in urban areas reveals prevalence levels of hypertension that ranges between 28% and 40% (Amoah, 2003; Cappucio et al ., 2004; Agyemang, 2006; Hill et al ., 2007). In rural areas, prevalence figures that go as high as 35% have been recorded (Cook-Huyne et al ., 2012). According to the Ministry of Health (MOH) and Ghana Health Service (GHS), between 1990 and 2010, newly diagnosed cases of ambulatory hypertension in public and mission health facilities in Ghana (excluding teaching hospitals) increased more than ten times from 60,000 cases to about 700,000 cases (MOH/GHS, 2014). As the third most common newly-diagnosed outpatient disease among adults in Ghana, hypertension has ranked in the top five outpatient diseases for more than fifteen years (MOH/GHS, 2014). Hypertension has therefore been declared as an epidemic in Ghana and stakeholders have called for urgent action (Bosu, 2010).
Similarly, the prevalence of diabetes has increased from 2.0% in the early 1960s (Dodu & De Heer, 1964) to 6.4% in the early 2000s (Amoah et al ., 2002). In the urban areas, a prevalence range of 6.0% to 9.5% has been recorded (Hill et al ., 2007; Owiredu et al ., 2009). In 2012, the Ghana News Agency reported that about four million people may be affected with Type I and type II diabetes mellitus in Ghana; a figure which represented about 20% of the Ghanaian population at the time (Ghana News Agency, 2012). In health facilities, reported newly diagnosed cases of diabetes increased five-fold from 25,000 cases to about 120,000 cases between 2005 and 2009 (MOH, 2012). Diabetes affects the active population group in Ghana as 58% of cases of diabetes were persons between the ages of 20 and 59 years in 2011 (MOH, 2012).
Despite this alarming trend, policy-makers have paid more attention to managing communicable diseases with interest in managing hypertension and diabetes only emerging recently. Aikins (2007), for example, questioned the logic behind making HIV/AIDS with a national prevalence of 3.2% a Millennium Development Goal target while hypertension, with a prevalence of 28.7% remained neglected.
Evidence is limited in Ghana as epidemiological studies and health services research on hypertension and diabetes have been in the form of cross-sectional surveys of isolated populations and pockets. Both planning and implementation of policies, therefore, are likely to have limited impact in the absence of epidemiological data based on a nationally representative sample. Besides, as Robles (2004) has argued, the impact of health policies and their formulation, with respect to non-communicable diseases (NCDs) such as hypertension and diabetes, are influenced by the process by which such policies are made, implemented, and how various stakeholders respond to the challenges. This may also be a limitation in Ghana. The aim of this paper is to conduct a case study at national and district levels to generate empirical data on the management of hypertension and diabetes in Ghana.
This goal will be achieved by meeting the following two objectives: first, examine how policies for managing hypertension and diabetes are made and implemented in Ghana; second, examine the response to the challenge of diabetes and hypertension from the perspective of key stakeholders in the Ghanaian health sector.
The rest of the paper is organized as follows: section two explains the conceptual underpinnings of the study (health policy, policy formulation and policy implementation); section three provides a brief explanation of the context of policy-making in Ghana; section four describes the methods for the study; section five presents the results of the study; section six discusses the results in the light of existing literature; and, section seven concludes and draws out policy lessons from the study.