- The truth, however, is none of the two political colours is being entirely honest with us. A simple review of our national budget spend for the last ten years can point all of us citizens to this reality. Fact is...
We should resolve now that the health of this nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the nation.” Harry Truman
I often wonder why health policy in Ghana is not news on a daily basis. I have had this feeling because most households deal with the health delivery system regularly and complain bitterly about its apparent ineffectiveness on the grapevine, yet, for some strange reason they never manage to get the traction or critical mass to make these concerns resonate routinely in the mainstream media. In a country like ours where reactionary tendencies are the order of the day, we seem to shout most when the press sensationally break a story about a mishap at a health facility, often associated with a loss of life or significant impact on the quality of life of the victim. Like anything else, we shout ourselves hoarse and recoil into our shells after the usual public phrases and jargons like, “we are working on it,” or “it’s in the pipeline” have been used by faceless public officials to explain away things that should never have happened in the first place. At worse committees are set up, investigations promised and bingo our anger is assuaged.
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Consequentially, we have numerous cases of avoidable deaths that have never been thoroughly investigated to ensure that the learnings prevent future happenings. The best we get is a trial by the public, a blame game and some semblances of culprits being identified somewhere in the lower echelons of the health delivery food chain; amongst the street bureaucrats i.e. frontline health workers. I have been observing this trend for a while and come to wonder if we can hand on heart say as citizens we are partly not to blame?
A few things come to mind. Since the Central Medical Stores were razed to the ground years ago by faceless individuals, we have seen two governments pussyfoot around the problem with very little by way of prosecution. We have heard foreign governments and donor agency representatives lament on how they feel about their taxpayer dollars going up in flames. Yet, as citizens who bear the brunt of the lack of essential medicines, we have conspired with our press to keep mute and see the recalcitrant lot dwell amongst us. Can we honestly say we care about our own health or are angry enough? In my view, definitely not.
If we were, how come when vaccines for new-borns run out for months due in part to the above-mentioned arson at the beginning of this year, we all went mute the minute governments were able to source new stock? Is it that our intellectual cowardice has driven us into a state of malaise where the level of decadence clouds our vision?
As if that wasn’t enough, we complain about new or almost complete health facilities dotted around the country, a legacy of the previous NDC government and wonder why they aren’t being utilised. Rather than do in-depth research, we have limited ourselves to visiting these buildings and making videos. Thankfully, our politicians understanding the shallowness of our actions have resorted to their usual politicking, blaming each other for the stalemate.
The truth, however, is none of the two political colours is being entirely honest with us. A simple review of our national budget spend for the last ten years can point all of us citizens to this reality. Fact is as, at 2014, only 33.4% of our total health budget allocation was spent on health employee remuneration. This figure crept up to 41.5% in 2015 and by 2017 had hit 49.88% rising to 58.59% in 2018. Over this period as well, no significant commitments were made to infrastructural development except in the 2016 budget when 30.53% of the total health budget was committed. Therefore, though monies were committed to putting these structures up, the escalating wage bill is such that government with the best will face a struggle to resource these facilities adequately; unless it is prepared to increase the percentage of the total budget spent on health to close to the 15% as per the Abuja declaration. Doing this can only happen in one of two ways; robbing other expenditure areas of the budget and plugging that into health or expanding the size of the economy. In my view, both options can’t happen overnight especially when free Senior High School education has been prioritised and is proving increasingly difficult to finance.
Then there is the small issue of availability of health human resource. As at 2016, Ghana had a total of 2268 health facilities that require the services of a doctor to be operational. Assuming this figure has not changed in two years and discounting the completed facilities that aren’t in use, with a total of 3365 doctors; this means each facility has at its disposal 1.5 doctors daily to operate. Considering that in practice the four teaching hospitals employ at least 80 doctors and many newly qualified are in training in these facilities, coupled with the requirements of the regional and district hospitals, the remaining facilities are left with the equivalent of 1.12 doctors over a 24hour day, seven days a week. Combining the lack of financial resources with the human resource constraints, are we not being naïve as citizens when we get played by politicians regarding these hospitals?
These financial and human resource constraints are not peculiar to Ghana. In 2015, the World Economic forum identified that healthcare access in Africa could be radically improved with a three prone approach i.e. through the use of digital technologies, getting the right knowledge, skills and resources where they’re needed and with the encouragement of public-private partnerships for health. The irony is that our healthcare policy makers travelled to Davos at taxpayers’ expense, wined and dined with the crème of health thinkers only to return and continue with their strongest link approach to healthcare delivery where putting up more brick and mortar is king because they knew that our naïve predisposition meant the optics gave political capital; even though the numbers were stack against their approach.
As a result we are saddled with many nurses and other affiliated health professionals who are trained and qualified with no jobs because they cannot obtain financial clearance to work. Sad as this may be, we need to realise that job creation in health works on the basis of the recruitment pyramid with doctors at the summit. Therefore without innovating to improve the resourcefulness of the doctors or increasing their physical numbers, the base of will be narrow and excess training of allied health workers will just be a fanciful mirage. Through innovation, we can also create parallel service industries around health delivery, improve access and create jobs. These are the conversations that in my view should be in the news regarding health.
As citizens, the time has come for us to take the politics of healthcare serious and begin some radical advocacy.
In doing so we ought to accept the need to confront what has become conventional wisdom and force policymakers down paths they would reluctantly oblige. The days of reactionary shouting should be replaced with proactive thinking and the drive to embrace innovation. We cannot accept the say-so of our public office holders in an area where our lives hinge on a thread simply because they bamboozle us with jargon. We need to engage in discussions on all media fronts and begin to show leadership ourselves. We must learn to emancipate ourselves from the vestiges of mental slavery and realise that we live or die by the actions or inactions in this area.
When New York was saddled with high crime, police commissioner William Bratton and Mayor Rudy Giuliani encouraged senior police officers to use the cities trains as a means of appreciating the impact crime was having on commuters. As a result, the broken windows theory was implemented where the most innocuous crimes were heavily clamped down on, this resulted in a decrease in crime rate and an increase in New Yorker’s quality of life. Relating this to our health sector, will it not be appropriate for citizens to start agitating for our public office holders to use exclusively public healthcare facilities? Will the citizens’ pain not be appreciated more if politicians are forced to queue and waste half a day just to get treated for the simplest of ailments? We must ensure that the ride we are on ends and that the right noises are made regarding health.
Feaure Image Courtesy of Project C.U.R.E.