FARGO – Sanford Health is working with the government of Ghana to build 300 clinics in the African country by 2020 in the most ambitious project of its international clinic initiative.

Sanford has signed an agreement with the government of Ghana, a nation of 28 million on the Atlantic coast, and plans to invest $30 million over the next decade. The government of Ghana also will contribute “multimillions of dollars.”

“We can make our dollars go much further in a developing country like Ghana,” Jim Slack, Sanford’s vice president of international clinics, said Wednesday. “Really this is a true public-private partnership.”

Because of the lower costs in developing countries, clinics can become self-sustaining within two years, Slack said, giving one reason Sanford is investing so heavily in Ghana through its international clinic initiative. The initiative is one of five priorities under a $400 million gift in 2007 by namesake benefactor T. Denny Sanford.

Sanford, which has five clinics in Ghana and just broke ground on a sixth clinic, expects its clinics will serve 4.5 million patients a year by 2020.

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Plans call for establishing hub clinics in each of Ghana’s 10 regions, each serving remote, rural “satellite” clinics, with telemedicine links to enable physicians and physician assistants to consult with nurses and midwives.

By locating hub clinics in urban centers, it will be easier to recruit and retain doctors, Slack said. “It’s tough to find enough physicians, especially who want to go out into these rural areas,” he said.

In rural areas, the program will provide housing for nurses and midwives because finding adequate housing is a big hurdle to providing services in remote areas, he said.

Sanford’s involvement in Ghana began in 2012. Its five clinics have treated more than 180,000 patients.

Kojo Taylor, president of Sanford International Clinic-Ghana, said the partnership will make a big difference in the underserved African country.

“Much of the rural population in Ghana does not have access to basic care,” he said in a statement. “The addition of these clinics will greatly change the scope of health care across the nation. Thousands of families will no longer be forced to travel for basic services.”

Cindy Morrison, a Sanford executive who was part of the team visiting Ghana, saw firsthand the demand for medical services at the clinics with full waiting rooms and people seated in hallways.

“Until you see it, it’s hard to fathom,” she said.

Sanford’s efforts in Ghana also include collaboration with George Uwusu, a wealthy oil developer, who is investing $2 million, with the goal of increasing to $10 million with contributions from others.

Sanford is establishing a clinic – the project that recently broke ground – that will evolve in time to include a 100-bed hospital with attached housing for nurses and patients that Uwusu is planning.

Ghana has a national health insurance program and a stable, democratic government, Stack said.

“Ghana is really looked at as a leading African country in terms of health care,” he said. “That’s really what made Ghana so attractive to us.”

Outside of its primary service area in North Dakota, South Dakota and Minnesota, Sanford Health has clinics in Oklahoma, California and Oregon. It will open its first clinic in China this fall, with plans for more clinics in China and Mexico.