Q2 2026
West African Wastewater Surveillance
Country profile · Q2 2026

Ghana

Active polio, cholera, typhoid and influenza WES with regional AMR leadership. Detailed cost and coverage data still being collected.

At a glance · today
—
Active sites
—
Population coverage
—
Sewered coverage
—
Cost / sample
8
Pathogens tracked
30+
5-yr target sites
Trajectory

Today vs the 5-year target

Today
Active sites
—
Provinces covered
— / 16
Population coverage
—
Cost / sample
—
5-year target
Active sites
30+
Provinces covered
16 / 16
Population coverage
25%
Cost / sample
—

TBC

Pathogens monitored

What is being tracked today

  • Poliovirus integrated
  • Cholera integrated
  • Salmonella Typhi integrated
  • Influenza integrated
  • SARS-CoV-2 researched
  • E. coli researched
  • Antimicrobial Resistance (AMR) researched
  • Hepatitis A/E researched
Cost economics · per sample

What it costs to monitor

Cost decomposition for Ghana is still being collected. The headline cost-per-sample (—) will be broken down by type, activity and driver as soon as the field data is entered into the workbook.
Capability

Strengths and challenges

Capability scorecard
  • Sewer coverage
    Moderate
  • Logistics
    Moderate
  • Testing capacity
    High
  • Use of information
    Moderate
  • Cost & value
    Moderate
Inside the system
Operational and institutional factors
Strengths
Infrastructure & Capacity
  • Ghana has a strong, nationally-recognised laboratory capacity at NMIMR with WES implementation experience and can run multi-pathogen surveillance (Polio, Cholera, Typhoid and Influenza) from a single sample.
  • Ghana has a clearly structured public health delivery system from national, regional to district level. A ready-made implementation framework for scaling WES.
Coordination & Integration
  • Ghana has the highest integration rate of the five countries, with all four surveyed pathogens formally integrated into national disease surveillance.
  • Existing cross-sectoral relationships between NMIMR, Ghana Health Service, Environmental Protection Agency and water utilities provide a foundation for One Health coordination.
Financial Resources
  • Ghana has an existing and funded AMR-WES programme that is a component of a $16M Pandemic Fund grant.
Challenges
Data & Methodology
  • Programme scale, site numbers, geographic coverage, and unit costs are still being established, limiting the ability to build a credible investment case or targets.
  • The sampling methodology for non-sewered, peri-urban, and rural settings is underdeveloped, creating a representativeness gap as a significant proportion of the population live in these areas.
  • WES data management and reporting systems are not standardised yet with inconsistencies in how data is recorded, stored and reported across institutions.
Infrastructure & Capacity
  • Whilst NMIMR has strong capacity, Ghana relied on external technical assistance for advanced sequencing and genomic analysis, creating a potential bottleneck.
External environment
Political, economic and ecosystem factors
Strengths
Financial Resources
  • Strong political incentives to invest in WES due to Ghana's regional leadership position on AMR surveillance. Widely recognised leader on AMR across West Africa.
  • Diversified financing base provided by the multiple active and interested donors (World Bank, AfDB, Pandemic Fund, USAID, EU).
Policy & Governance
  • Stable democratic governance and functional public financial management systems reduce fiduciary and implementation risk for external funders.
  • Alignment with Africa CDC's integrated disease surveillance agenda provides a continental policy anchor. Strengthening the political case for WES both domestically and internationally.
Challenges
Policy & Governance
  • WES remains vulnerable to reprioritisation when competing health demands arise as no dedicated national WES policy, strategy or mandate exists.
  • Political transitions have created continuity risk for health sector priorities, meaning surveillance investments and programme momentum stall.
Coordination & Integration
  • Responsibility sits across NMIMR, GHS, EPA, and water utilities with no designated lead agency, creating coordination fragmentation and making a scale-up challenging.
Financial Resources
  • Ghana operates under an IMF-supported debt restructuring programme that limits new government expenditure across sectors.
  • Risk of losing access to financing windows before domestic revenues are sufficient to replace them as the country moves towards upper-middle-income status.
Financing landscape

Where the funding could come from

Domestic public
  • Domestic government expenditure
    possible

    Stronger fiscal position. Expansion possible if WES integrated into national health plan.

Multilateral development banks
  • World Bank IDA
    possible

    Could explore new IDA project framed around health system strengthening.

  • European Investment Bank
    likely

    EIB building health commodity capacity in Africa. Ghana's governance framework makes it attractive.

Global health funds
  • Pandemic Fund
    possible

    Existing $16M PF grant can be leveraged for AMR-WES integration where Ghana holds regional leadership.

  • IPSN (WHO Pathogen Surveillance Network)
    likely

    Ghana holds regional AMR leadership and has existing genomic surveillance capacity. Strong alignment with IPSN's One Health and pathogen genomics agenda.

  • The Global Fund
    possible

    GF active in Ghana. WES could be integrated into existing grant structures if in national health strategic plan.

Bilateral & philanthropic
  • Gates Foundation
    possible

    Gates active in Ghana health sector. WES investment would need to align with integrated disease surveillance agenda.

  • Rotary Foundation
    possible

    Possible for polio-linked WES investment.

  • Bilateral GHS donors
    possible

    Active bilateral donors in Ghana. WES framed as pandemic preparedness aligns well.

Strategic pathway

What to do next

Phase 1 · 0–2 years
Immediate
Phase 2 · 2–4 years
Medium term
Phase 3 · 4–6 years
Long term
Immediate · 0–2 years
  1. Leverage Ghana's existing $16M Pandemic Fund grant to integrate AMR-WES into national surveillance — building on Ghana's regional leadership in One Health.
    Cost: low Timeline: immediate
  2. Develop a cost-effectiveness analysis for WES multi-pathogen scale-up — to support the case for domestic government expenditure expansion.
    Cost: low Timeline: immediate
Medium term · 2–4 years
  1. Integrate SARS-CoV-2 WES into national surveillance system — building on existing polio/cholera/typhoid/influenza infrastructure.
    Cost: medium Timeline: short
  2. Explore IDA project vehicle for WES lab strengthening — if structured around health system strengthening with strong MoH ownership.
    Cost: high Timeline: medium
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