Tue, Feb

A Barrier or Opportunity in Health Access Improvement? Image credit - Ted Eytan

Thoughts From Afar
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On a webinar this week about health policy in the developing world, I was asked what I envisaged healthcare in Ghana will look like in 15-20 years. I was initially pensive...

James Allen in As a Man Thinketh argues, “A strong man cannot help a weaker unless the weaker is willing to be helped, and even then the weak man must become strong of himself; he must, by his own efforts, develop the strength which he admires in another. None but himself can alter his condition.”

On a webinar this week about health policy in the developing world, I was asked what I envisaged healthcare in Ghana will look like in 15-20 years. I was initially pensive as I combed my mind for answers. The initial mind’s eye picture was gloomy. I started off by admitting based on our current statistics that I did not expect or healthcare professional to patient ratio to change much even though there were signals that steps were being taken to train more doctors, nurses, pharmacists and other professionals. I was of this view because our population wasn’t going to be stagnant and with our projected growth trends which estimates that by 2035 Ghana’s population will hit 40 million (an increase of 11 million from the current 29 million), there was no indication that these numbers were being factored into our calculations.

I further indicated that over the past twenty years, thanks to a combination of population growth, brain drain, human resource losses through retirement, ill health and mortality; our doctor to patient ratio had not seen significant change and had yo-yoed between 1 doctor to 8000 or 10,000 Ghanaians with the figure being better in the urban areas especially in the Greater Accra and Ashanti Regions but obnoxious in the three north most regions where this figure can rise up to 1 doctor to 55,000 Ghanaians. Compounding this was that our health strategy had seen us spend more in the urban dwellings where the ratios were better and less on the rural areas. Suddenly there was a spark in my eye, this to me presented a significant opportunity and was the reason why we could have more improved healthcare if we saw this expenditure imbalance as an opportunity.

My reasons for this were as follows; a look at mortality and morbidity data for Ghana gives a clear indication that our disease burden is shifting and so are our leading causes of mortality. Gone are the days when communicable diseases were the leading cause of death. Even in the rural areas, chronic diseases are increasingly becoming a huge factor in individual family health budgets. However, many of our citizens are oblivious to this new reality and pay little attention to this aspect of healthcare. Therefore, concentrating on this and creating awareness could go a long way to change our healthcare indicators in a positive way.

Secondly, it is known that with chronic conditions, early intervention and proper management results in fewer visits to health facilities, better quality of life and will make the requirement for more brick and mortar in all corners of the country less of a priority. This in effect will cut the cost of healthcare capital expenditure, circumvent to an extent the impact of poor healthcare professional ratios on healthcare delivery and improve quality of life.

A few things, however, stand in the way of this reality. To start with, few Ghanaians over the age of thirty-five routinely see a doctor or any other health professional to have a conversation about preventative healthcare or check their health numbers. Many reading this may find this bizarre but truth is, apart from some in urban dwellings; it is highly unlikely for rural folk to visit a health facility unless they were physically unwell. A number of reasons can be adduced for this including; financial constraints, lack of adequate health facilities, distance, time spent at these facilities and loss of earnings.

Compounding this further is the reality that over the years, implementation of primary health care programs targeting the rural areas has created a new set of images: empty rural health clinics and CHIPS compounds without staff, drugs, or working equipment; poor people bypassing free primary public clinics to pay for services from private providers and quack doctors; government-supplied drugs being sold on the black market, through illicit drug peddlers etc. Some have argued that these images are the result of our innate tendency towards criminality as a people and policymakers using health as a political tool at elections.

Whatever the reason it is clear that these images are the biggest indication of our lack of understanding of the gravity of our primary health problem. This lack of understanding could be because the weaker party in healthcare (the rural patient) has failed to be actively involved in conversations around healthcare policy and expenditure. As citizens, we have become too accepting of the narrative fed us by policymakers and politicians. In doing so we have come to agree with them that brick and mortar is the sure answer to everything in our failing healthcare system and have seen these edifices as an indication of development activity. Our behaviour goes to entrench the long-held view that the expected impact of primary health care was too often calculated as if health status were entirely a technical affair and individuals were the passive recipients of government action. We have therefore not paused to research and understand how others confronted with issues similar to ours have used innovation to improve their lot.

We have hence failed to realise that, an equal increase in spending on all areas of health will have a very different effect from an increase in spending on only the most effective interventions. In instances, we have failed to identify these high priority interventions or have glossed over them because of a fear that they will realign health expenditure to the advantage of primary health and rural communities. This is why the time to educate the weak rural dweller to understand that policymakers and politicians will always look after themselves and try to preserve the status quo is now. In this drive, they need to be encouraged to become participants and not spectators in conversations around health and to advocate for consideration to be given to the new frontiers that technology has brought.

The current clear malaise towards any innovation that prioritises brick and mortar to the advantage of intangibles like the simple analogue mobile phones plays to the disadvantage of rural dwellers. As these new frontiers provide access to parts of the country that will never be reached in the next two decades irrespective of how hard we try if we fail to utilise technology as a means of breaking health barriers. This malaise towards technology must change. It is only when these rural dwellers begin to understand and actively engage will they gain the strength to turn their weakness around and bring truth to James Allen’s argument. By the end of my answer, in my mind’s eye, the glom picture had gone bleak and suddenly bright, this is why I am hopeful.

Feature Image Courtesy of Ted Eytan

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