Improving the evidence base for healthcare in Ghana through improving access and supporting local scholarship

In Ghana, the health training institutions which is made up of colleges of health, nurses and midwifery training colleges primarily train middle level healthcare professionals. The Ministry of Health through the Health training institutions secretariat directly regulates these institutions. The health training institutions are affiliated to universities to award certificates, diploma and degrees. To be admitted into the relevant health profession and qualify for employment, health trainees have to pass the relevant professional examination. It is therefore, imperative that health trainees are educated with the most current evidence based resources to improve professional competence and health outcomes. This means that teaching and learning should be informed by the most current literature.

Unfortunately, there is a dearth of accessible evidence upon which to base mental health education and practice in Ghana. This is because the health training institutions do not have the resources to subscribe to key international journals. Consequently, they do not have access to the most up-to-date research and theory to underpin mental health practice. Therefore, health tutors rely on academic materials that are freely available on the internet or old hardcopy books shelved at the college library to prepare their course modules to teach students. This may affect the quality of health practitioners churned out in Ghana because they may not be abreast with the current evidence based practices that improves health outcomes.

The lack of access to key international journals and books affect practice and scholarship. This is because local researchers and scholars may not have access to the most current literature to situate their articles or academic writings within the contemporary context, or interrogate their findings using relevant theory, or to become socialised into the requirements for publication in high-ranking international journals. The lack of access to the most current good quality evidence from international journals and texts prevents local scholars from developing their research and getting it published in reliable journals.

Therefore, it is important for local scholars from across the Global South to develop and publish an evidence base on mental health because mental health is a culturally and socially constructed phenomenon. The current evidence base, developed mostly in the UK, USA and Australia, represents knowledge from the perspective of high income, white, westernised nations. Such evidence is not directly transferrable to the cultural, social and economic context of Ghana and other countries in the Global South.


In response to the challenge of inaccessibility of academic resources i.e. journals and books in low-income countries, the World Health Organisation launched the HINARI project in 2002. The main object of the HINARI programme is to enable academic, medical institutions, hospitals, and government offices in low-income countries to register free access to full text journal (WHO 2021; https://www.who.int/hinari/en/). Almost two decades since the launch of the programme, there is evidence to show that access to full text journal remains a challenge in low-income countries. In Ghana, for example a casual count from the HINARI website suggests that over 200 institutions have registered for the project yet health tutors at the various health-training institutions rely on other sources to prepare handouts for students. This is demonstrated in a five African countries survey to determine the awareness reported use and factors influencing use of on-line medical literature via free access initiatives. Smith, et al (2007) reported that less than 50% of the participants were aware of HINARI. In addition, it was found that participants faced challenges such as lack of access to password, Librarian strict control of password and restricted access to some peer reviewed papers.

The problem
There is a lack of culturally appropriate, good quality evidence to support the education and development of mental health practice in Ghana and probably across the Global South. This means that it is difficult to educate community workers and health care staff so that countries can meet the healthcare needs of communities as they strive to create universal health coverage as part of the UN’s Sustainable Development Goals.

Aim of this project:
Phase 1
1. To explore and develop an understanding of the limitations and barriers to accessing contemporary, good quality, research and theory literature in Ghana.
2. To engage with key stakeholders to raise awareness of these barriers and develop collaborative solutions
Phase 2:
3. To work to build partnerships to promote the development of culturally appropriate evidence for mental health work in Ghana