Ghana is a country in West Africa with a population of 33.8 million in 2023. 1 Ghana became a lower- to middle-income country (LMIC) in 2011 and has experienced rapid economic growth since the 1990s. Reference Walker and Osei2 The prevalence of mental health conditions in Ghana is estimated to be 10%; a cross-sectional study in 2023 showed a prevalence of probable depression at 15.6% and psychotic symptoms at 12%, Reference Ae-Ngibise, Sakyi, Adwan-Kamara, Lund and Weobong3 and official reports from health authorities show a trend of increased substance misuse since 2018. However, the proportion of cases not detected (and therefore not treated) ranged from 94 to 99%. Reference Ae-Ngibise, Sakyi, Adwan-Kamara, Lund and Weobong3 Thus, as in all parts of the world, the treatment gap between those with mental health conditions and those seeking and receiving treatment is a significant challenge in Ghana, and is a focus of mental health policy. Reference Ae-Ngibise, Sakyi, Adwan-Kamara, Lund and Weobong3,4
The first piece of mental health legislation in Ghana dates back to 1888. The most recent mental health act was passed in Ghana in 2012, which aimed to ensure the quality of treatment and rights of people with mental disorders, and to establish procedures for the organisation, funding and provision of mental health services. Reference Walker and Osei2 Ghana’s mental health policy for 2019–2030 was published in 2018, laying out a number of guiding principles for mental healthcare as well as challenges to, and opportunities for, its development in Ghana. 4
Despite significant progress and the development of legislation and policy for mental healthcare in Ghana, there are currently only 88 qualified psychiatrists for the entire population. 5 Significant efforts have been made to stimulate interest among medical students to choose a career in psychiatry, which have had some success. Reference Agyapong, Hrabok, Agyapong-Opoku, Khinda, Owusu-Antwi and Osei6 However, there remains a lack of subspecialty training, with all psychiatrists currently being trained as general adult psychiatrists.
To address this need for subspecialty training through strengthening the capacity of general psychiatrists, the Ghana College of Physicians and Surgeons (GCPS)’ Faculty of Psychiatry requested partnership with the Royal College of Psychiatrists and, funded by the Tropical Health and Education Trust (THET; now known as Global Health Partnerships), launched the Ghana Global Health Workforce Programme in 2022. This paper describes the lessons learned from the early stages of its implementation, successes and challenges, and can serve as an adaptable roadmap for similar efforts to build psychiatry subspecialty training in LMICs.
Programme overview
The Ghana Global Health Workforce Programme has three main aims, in line with the Royal College of Psychiatrists International Strategy: 7 (a) to strengthen the capacity of general adult psychiatrists in Ghana in specific psychiatric subspecialties; (b) to improve the quality of psychiatric training and services in Ghana; and (c) to promote knowledge exchange between psychiatrists in Ghana and the UK.
Fifty psychiatry trainees in Ghana took part in the programme, and were registered as pre-membership psychiatric trainees with the UK Royal College of Psychiatrists, as well as 20 supervisors who were registered as international associate members as part of the programme, to facilitate access to the relevant educational resources and platforms.
The Psychiatry Faculty of GCPS has a well-established training scheme in psychiatry, but it was felt that some subspecialties could benefit from strengthening of its components. Therefore, the Psychiatry Faculty specifically asked for the programme to be focused on four subspecialty areas of psychiatry: children and adolescents, older people, forensic and addictions.
The training programme comprised an initial introductory module of four sessions to provide an overview of the programme, followed by six sessions for each of the four subspecialty modules. Each session in the subspecialty modules included a pre-recorded lecture circulated 1 week in advance, followed by a 60 min online live session for interactive discussion.
Subspecialty modules ran from June 2022 to May 2023 and, following a second funding award, further modules ran between April and October 2024, with the addition of three in-person interactive sessions in October and November 2024. These in-person sessions included facilitators attending from both the Ghanian Faculty of Psychiatry and the UK Royal College of Psychiatrists and focused on the subspecialty modules, with an additional session on gender equality and social inclusion. A local coordinator and a monitoring and evaluation lead were also appointed during the second phase, funded by the THET grant, to strengthen the programme and address logistics challenges identified in the first phase.
Three members of the Ghanian Faculty of Psychiatry attended the Royal College of Psychiatrists International Congress in Edinburgh in June 2024 as part of the programme, and visited specialist forensic and addictions services in Fife (Scotland). Three Ghanian trainees attended the Congress in June 2025 in Newport, Wales.
Feedback was gathered from participating trainees following the completion of the introductory module, the main subspecialty modules and the in-person modules.
Feedback from trainees
Feedback from the introductory module shaped the planning of the main modules. All trainees reported that they found the sessions useful and rated the facilitators as either excellent, very good or good. Trainees expressed a preference for incorporating case-based discussions into future sessions, which was adopted for the main modules and live sessions.
Feedback from the main modules was gathered through pre- and post-session questionnaires before and after the modules. However, the response rates were low overall, particularly for the post-session feedback forms. Overall, 89.5% of trainees who responded to the questionnaires reported that they would be very likely to apply the knowledge and skills gained in their clinical practice, and 10.5% said that they would be somewhat likely to. In terms of usefulness of the sessions, 97% of the module sessions were rated as 4 or 5 on a scale of 1–5 (5 being extremely useful). Trainees commented positively on the content of the modules, but one said that the times of the sessions clashed with their work responsibilities.
All trainees rated the additional in-person sessions as either 4 or 5 out of 5 overall in response to the question ‘How did you find the session overall’? Some trainees commented that preparation materials were not provided sufficiently early to allow for preparation. Respondents reported that further break-out sessions in the training, and more interactive sessions and demonstrations, would be useful. Similarly, further workshops using a team approach and more practical small-group discussions were suggested as ways to improve the sessions. Several respondents also reported that more case-based discussions would be beneficial.
Feedback from supervisors
Following completion of the modules, a questionnaire based on the domains of the Consolidated Framework for Implementation Research Reference Damschroder, Aron, Keith, Kirsh, Alexander and Lowery8 was completed by four members of the Ghanian Faculty of Psychiatry involved in the organisation of the programme, to gather feedback on its implementation.
The choice of subspecialties was reported to be useful and beneficial, addressing training gaps in Ghana. Overall, the programme received positive feedback and the quality of both trainers and sessions was felt to be high. The programme was reported to be suitable for both the context and culture of Ghana, as well as being appropriate for strengthening of the psychiatric workforce. Ensuring sensitivity to the culture was enhanced by local professionals being an integral part of in-person sessions facilitation. The relationship between stakeholders was reported to be highly collaborative, respectful and productive, with local professionals leading the decision-making.
Aspects of the programme that were reported to be particularly helpful included the appointment of coordinators to facilitate the implementation of the programme, and a WhatsApp group to enable communication to residents. Accessibility of the materials prior to the sessions was reported to have assisted preparation, and the in-person sessions were reported to be especially beneficial, in particular the small-group work and case-based discussion format. The cases were selected by the Ghanaian residents to ensure cultural and clinical relevance.
The programme provided adequate resources in terms of information and communication technology, room bookings and human resources; however, financial resources were lacking, particularly in regard to supporting residents based in remote areas in attending in-person sessions. There were also some internet connectivity issues for residents in remote areas. Work schedules also prevented full participation in the training programme, and some sessions clashed with other clinical commitments.
Specific recommendations to further improve and develop the programme included the following.
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(a) opportunity for residents to undertake observerships in subspecialties outside their usual scope of practice, in both the UK and Ghana;
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(b) inclusion of multidisciplinary professionals in the programme, e.g. mental health nurses, social workers, occupational therapists;
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(c) full funding for all residents to attend in-person sessions;
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(d) incorporation of a research component and further opportunities to attend scientific conferences;
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(e) enhancement of collaborations by extending the programme to colleagues in other countries in Africa.
Conclusion
The Ghana Global Health Workforce Programme was developed to strengthen psychiatric training in Ghana, and has received positive feedback from both residents and supervisors in that country. The programme was developed throughout the two phases and was shaped by feedback delivered at each stage by incorporating this to improve and strengthen the programme. Case-based discussions and small-group interactive sessions were found to be particularly well received. The programme was extended and provided an opportunity for teaching of the modules in Kenya, as well as ‘grand round’ case-based discussion sessions delivered online to residents in Kenya, Ghana and Nigeria. This is a good example of an international partnership that facilitated collaboration across African countries in the field.
The importance of a productive collaborative relationship among all stakeholders was highlighted as being crucial to ensuring the relevance and applicability of the training to the Ghanaian context. Limitations in funding and pressures of clinical work prevented some residents from being able to fully participate. Further opportunities for collaboration and observerships would be beneficial for residents and senior faculty members in both Ghana and the UK.
Supplementary material
The supplementary material for this article is available online at https://doi.org/10.1192/bji.2026.10102
Data availability
The data that support the findings of this study are available on request from the corresponding author, M.-A.U. The data are not publicly available due to their containing information that could compromise the privacy of participants.
Acknowledgements
The authors thank Prof. Richard Adanu (Rector of GCPS), Prof. Akwasi Osei (current Chair, Faculty of Psychiatry, GCPS), Dr Pearl Adu-Nyako (specialist-KATH), Dr Emefa Fafa Dzordzorme (Accra Psychiatric Hospital), Dr Daniel Adjei (Chief Resident, Faculty of Psychiatry, GCPS) and Elen Cook for their contribution to the organisation and running of the academic sessions. For the modules and sessions the authors thank all of the module leads and volunteer trainers, including Prof. Alka Ahuja and Drs Ama S. Addo, Hasanen Al-Taiar, Stephen Attard, Alex Blackman, Andrew Dean, Andrew Forrester, William Hancox, Bradley Hillier, Harison Howarth, Andrew Iles, Gemma Johns, Richard Latham, Ashley Liew, Mark Lovell, Ivan Saeger, Josh Shotton, Helen Smith, Mary Thornton, Shivanthi Sathanandan and Anna Walde.
Author contributions
S.J.P. summarised feedback received from attendees and collected and summarised feedback received from the supervisors, drafted the initial manuscript and critically revised and edited it. P.A. submitted a report and feedback on the programme for the drafting of the initial manuscript, and participated in its review and editing. D.K.F. and S.O. submitted feedback to help in the preparation of the first draft, and reviewed and edited the manuscript. R.O.-A. submitted feedback as the head of one of the training sites, to help in the preparation of the first draft; and reviewed and edited the manuscript. A.R. managed the project and reviewed the final manuscript. M.A.-U. led the project and oversaw its implementation; developed the concept of the manuscript and its structure, as well as reviewing and editing it; and addressed reviewers’ comments following manuscript submission.
Funding
This project was funded by THET, now known as Global Health Partnerships. All volunteers were provided by the Royal College of Psychiatrists without funding.
Declaration of interest
None.
Ethical standards
No ethical approval was needed because this was not a research study.
Open access
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