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Gold is the most important export commodity of Ghana, followed by oil and cocoa (The World Bank in Ghana, 2019). The gold mining sector is growing and ereby creating jobs and promoting the localeconomy. Gold is mined in large-scale industrialmines and in artisanal and small-scale gold mines (ASGM). any of the latter operate illegally with marginal knowledge about the implications that unsafe mining practices have on their and their communities’ health and the environment.The World Health Organization (WHO) has been requested to assist the Ministry of Health (MOH)to develop a Public Health Strategy as part of the National Action Plan (NAP) as stipulated in Article 7 of the Minamata Convention. This report presents the assessment of the institutional readiness to detect, address and prevent health issues associated with ASGM and aims to provide inputs to the MOH on how to best define key priorities in the Public Health Strategy on ASGM. Based on the consultation of MOH representatives and other key agencies and stakeholders concerned with ASGM-related health topics, institutional capacity strengths and challenges in the public health sector were assessed and key stakeholders identified who appear criticalfor the development and implementation of a public health strategy tailored to the ASGM sector. The assessment was guided by the following questions:
■ To what extent are existing regulations, policies, structures and processes in place at the national and subnational levels to respond to ASGM
health-related issues?
■ Are the current institutional capacities at MOH sufficient to deal with health issues in the context of ASGM?
■ What strengths and opportunities exist that could strengthen capacities and what challenges need to be addressed? 

Methodologically, we focus on the following four health priority areas: (1) Health hazards in ASGM communities, (2) Occupational health hazards related to ASGM, (3) Environmental hazards related to ASGM that have implications for health, and (4) Chemical management related to ASGM. For each of those areas, we assess three institutional dimensions: (1) the policy and regulatory level, (2) the organizational structure and resources, and (3) the procedural setup. The health priority areas and the institutional dimensions result in a matrix with health priorities and institutional dimensions as the axes. Topic-specific indicators guide the assessment in each of the cells of the matrix. The assessment reveals a range of institutional
strengths on which the MOH can build its ASGM health strategy on. To start with, Ghana’s health legislations are quite comprehensive and provide a basis to manage ASGM-related health issues. Although there is no chemical code, EPA and the MOH exert some strong institutional capacities which are important and that can be built on. At the structural level, Ghana’s health care system is decentralized and Primary Health Care (PHC) is provided in a three-tier way (embedded in a fivelevel structure). This system is suitable to potentially satisfy ASGM-related health needs. Mandating the focal agency has set grounds to further develop and streamline ministerial capacities on both the horizontal and vertical level while also improving equal accessibility for ASGM communities to health services. Various structural gaps have been identified and corrective initiatives initiated. In view of the Public Health Strategy, these gaps mainly concern the accessibility of quality health services as well as operational chemical emergency response. At large, however, other ministries and their departments are expected to address their ability to govern (health) concerns affecting ASGM communities.
Institutional capacity is reasonably developed, and inter-ministerial coordination seems to be effective in most instances. Deficits exist on one hand in the vertical coordination between national and subnational levels as well as in the availability of technical equipment, infrastructure and capacity in rural areas where ASGM effectively takes place. Finally, the well-crafted regulatory framework is contrasted by significant gaps in the documentation of implementation measures (except for the recent Inter-Ministerial Committee on Illegal Mining (IMCIM) efforts), which makes it difficult to assess the extent to which regulations are implemented.