Non-communicable diseases (NCDs) are now a public health threat in Ghana. Hypertension and diabetes mellitus are among the leading conditions of concern, but there is little research that assists policy development for NCDs. Historically, there has been an overemphasis on infectious disease policy research. The few studies of NCD policy focus on the appropriateness of policy content rather than the processes through which they are developed and implemented. The overall purpose of this research, therefore, was to understand the health policy process for the management of hypertension and diabetes in Ghana; particularly policy development and implementation, the use of evidence in the policy process, stakeholder engagement and response.

Using a case study design, three sources of data were used: key informant interviews, focus group discussions, and the analysis of documents. Twenty-six key informant interviews were carried out with policy makers, health service providers, payers, patient association and advocacy group representatives. Two focus groups were held, involving a total of 18 community members diagnosed with and undergoing treatment for hypertension and diabetes. A review of 19 policy and health services documents was also undertaken. An adaptation of the framework method for analysing qualitative data in multidisciplinary health research through the identification of themes and patterns was used, with data entered into NVivo 11 software for analysis.

The findings of the study show that, with the support of international agencies and despite problems such as limited data and the variable engagement of stakeholders, the Ghana health sector has developed policies and strategies for managing hypertension and diabetes, other NCDs, and risk factors such as nutrition, tobacco and alcohol. Implementation of these policies however is challenged by inadequate resources, a lack of intersectoral effort, and an overemphasis on both infectious diseases and treatment rather than prevention. Apart from surveys and global burden of disease data, the main source of evidence for NCD policy process in Ghana was from routine morbidity and mortality statistics collected from health facilities, with quality and availability of data a concern. Service providers and other stakeholders understand the hypertension and diabetes challenge, and are responding through the provision of education, advocacy, screening services, and programmes in NCD control and regenerative health. Some important factors reported as hindering management of hypertension and diabetes include an overall lack of resources, a lack of political will, corruption, poverty, under-supply of trained health professionals, traditional superstitious beliefs and poor compliance.

Contributing to NCD management discussions in Ghana, the study found that policies and strategies to manage hypertension and diabetes are in place, but there are significant implementation issues. Adopting an implementation science approach where barriers to and enablers of policy implementation are identified, could ensure more effective management of these NCDs.