Fifty years of hemodialysis in Ghana—current status, utilization and cost of dialysis services

Abstract

Background Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana. Methods A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana. Results There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4–10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana. Conclusion There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.

Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece

“…Sustainability is not a priority for patients when most cannot afford medications, transplantation, or dialysis, such as in Uganda, where 90% of patients in need of kidney replacement therapy cannot afford it. 26 In addition, access to care is inequitable as most dialysis and transplant programs are located in urban centers, 14 , 20 and many patients incur substantial out-of-pocket expenses ( Table 1 ).…”

“…Care delivery tends to be concentrated in urban centers contributing to a significant travel footprint. 20 In India, up to 60% of patients must travel >50 km to access hemodialysis. 27 In Uganda, dialysis facilities are present in 4 districts that cater to the country, as well as to the Eastern Democratic Republic of Congo and South Sudan.…”

Global Dialysis Perspective: Ghana

“…The number of hemodialysis centers has increased over the years from six centers (three public and three private) in 2015 10 to 40 functional units currently. 11 There is inequitable distribution of dialysis centers in Ghana. 12 Most patients with KF are on hemodialysis (96.2%), functioning kidney transplant (3.5%), and 0.3% on continuous ambulatory peritoneal dialysis (PD) according to the first renal registry published in 2021.…”

“…Currently, there are 299 hemodialysis machines in Ghana with 9.7 dialysis machines per million population (pmp) in our latest survey. 11 The capital city, Accra, has the highest number of dialysis machines with 50.8 dialysis machines pmp with the least being western region with 0.97 pmp 11 (Figure 1 ).…”

“…There are now more dialysis centers in the private centers ( n =27) than in public centers ( n =13), and there are more patients in the private centers (609) as compared with public centers (586). 11 The cost of dialysis is higher in the private than the public centers. Although the cost of dialysis in US Dollars may be relatively low in Ghana, cost is still prohibitory with the majority only able to afford twice a week dialysis schedule instead of the recommended three times a week.…”