Assessing the drivers of non-communicable diseases prevention activities in primary health care facilities in Ghana: a case study of some selected districts

Primary health care (PHC) is pivotal to equity and disease control in low- and middle-income countries. In Ghana, the rising burden of non-communicable diseases (NCDs) demands a shift from curative to preventive PHC. Evidence on the extent and drivers of PHC-led prevention, however, remains limited. A cross‑sectional, facility‑based survey was conducted between November 2023 and March 2024, covering 210 primary‑health‑care facilities in 10 randomly selected districts of Greater Accra and the Eastern Region, Ghana. An adapted WHO‑SARA questionnaire was administered to facility heads or senior clinicians, capturing facility type, ownership, service‑readiness scores, and four self‑reported NCD‑prevention activities, community durbars, home visits, screening tests, and nutritional counselling. Multivariable logistic regression identified predictors of each activity, and a zero‑inflated negative‑binomial model evaluated the association between preventive engagement and NCD‑related outpatient‑department visits. Overall, 31% of facilities conducted Community Durbars, 63% Home Visits, 59% Screening Tests and 54% Nutritional Counselling. CHPS compounds (56% of facilities) were the most active—81% provided home visits, while only 8% of private clinics did so. CHPS status strongly predicted home visits (OR 26.89, 95% CI 1.20–604.85). Facilities offering Community Durbars (β 1.24, p < 0.01) or Nutritional Counselling (β 1.72, p < 0.01) recorded higher NCD-related OPD use. Higher district NHIS coverage was inversely associated with preventive engagement (OR 0.26, p < 0.01). NCD prevention in Ghana is led by lower-tier, government PHC facilities, yet resource gaps and treatment-centred financing limit wider uptake. Re-aligning NHIS incentives, investing in CHPS infrastructure and tailoring outreach to underserved groups especially men are critical for shifting Ghana’s PHC from reactive care to sustainable NCD prevention.