Fragmentation and Continuity: A Systems Analysis of Multi-morbid NCD Care in Ghana's Mixed Health System

Abstract

This conference paper presents a systems analysis of the challenges to care continuity for patients with multi-morbid non-communicable diseases (NCDs) within Ghana's pluralistic health system. The research problem centres on the detrimental impact of systemic fragmentation—characterised by siloed public and private providers, disparate financing mechanisms, and uncoordinated information systems—on patient pathways and outcomes. A rigorous qualitative, multi-method approach was employed between 2022 and 2024, comprising in-depth interviews with patients managing hypertension-diabetes co-morbidity (n=35) and key informant interviews with policymakers and clinicians (n=22), triangulated with a thematic document review of national NCD policies from 2021-2025. The findings demonstrate that fragmentation manifests concretely as duplicated diagnostics, conflicting treatment advice, and significant financial burdens due to self-referrals across sectors. Patients, particularly in urban settings, navigate a disjointed system with little formal guidance, relying on personal resources to bridge care gaps. The analysis concludes that without integrated governance and shared clinical records, the growing NCD burden will exacerbate health inequities and undermine Ghana's progress towards Universal Health Coverage. It underscores the urgent need for context-specific, African-led frameworks that formally link public and private sectors, advocating for policy shifts which prioritise patient-centred care coordination over isolated disease programmes. This research contributes critical evidence for health systems strengthening across the continent facing similar mixed-system challenges.

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