Costs and Budget Impact of a Health System Strengthening Intervention for Hypertension and Cardiovascular Disease Care in Ghana

Abstract

Objectives

 Cardiovascular diseases (CVDs) are a leading contributor to morbidity, mortality, and healthcare spending in low- and middle-income countries (LMICs). Despite this burden, economic evidence on system-level interventions to strengthen hypertension and CVD care in sub-Saharan Africa remains limited. This study estimates the costs and budget impact of the Ghana Heart Initiative (GHI), a multi-component health systems strengthening intervention.

Methods

 We conducted a retrospective cost analysis from the health system perspective using an activity-based costing approach. We estimated the financial and economic costs incurred during the design (2018–2019) and initial implementation phase (2020–2022) of the GHI across 42 public health facilities in the Greater Accra Region. Costs were disaggregated by activity cluster and input category. We then projected the budget impact of hypothetical national scale-up under three implementation scenarios that varied in scope and cost-sharing assumptions. All costs were inflation-adjusted and reported in 2024 US dollars (US $).

Results

 The total economic cost of designing and implementing the GHI over 4 years was US$1.96 million, of which 91.5% was attributable to implementation activities. Human resources were the primary cost driver. Average annual economic costs were US$11,960 per health facility, US$997 per targeted health provider trained, and US$39.9 per outpatient attendee. Projected annual costs for nationwide scale-up ranged from US$12.1 million to US$30.1 million, depending on implementation scenario, with a streamlined service-delivery–only model representing a lower-bound estimate.

Conclusions

 This study provides granular, activity-level cost estimates for a complex health system strengthening intervention targeting hypertension and CVD care. The findings offer policy-relevant inputs for budget planning and highlight how implementation choices influence the fiscal implications of scaling up system-level CVD interventions in LMICs.