- To achieve this, however, will require an acceptance that there is more we can do even with our current poor healthcare professional ratios than we are doing.
“A choir is made up of many voices, including yours and mine. If one by one all go silent then all that will be left are the soloists. Don’t let a loud few determine the nature of the sound. It makes for poor harmony and diminishes the song.”
Health expenditure as a percentage of GDP has been rising in Ghana for the last three years and is estimated at 6.57% for 2018. Considering that, the overall economy is expanding, in real terms, there has never been more money available to this sector in dollar equivalent than any time in the country’s history. Yet, our health outcomes have not appreciated significantly commensurate with the available funds. Ghana is not alone in this predicament. According to a report from the World Economic Forum, “emerging economies are managing larger investments in health than ever before, and they will have to make forward-thinking choices about how to allocate these additional resources. In 2014, emerging economies contributed 23% to global health expenditures, up from 10% in 1995, and they are expected to reach 33% by 2024—a $4 trillion investment per year.”
In the same report it is claimed that “at current rates, it would take Nigeria 300 years to achieve OECD levels of doctor access.” This revelation for me is worrying if to be believed as by extrapolation from Nigeria’s doctor to patient ratio of approximately 1:4000 and ours of 1:9000, it would take us six centuries from now to achieve international parity. Fortunately, thanks to the likes of Bill Gates who set himself an ambition to place a computer on each table worldwide and Steve Jobs who decided with his colleagues in Apple to challenge the status quo and allow individuals to rival multinationals through the use of handheld devices and smart technologies, Africa and Ghana have a big opportunity to develop their own health systems rather than copy those of the West and by so doing transform healthcare not in centuries but in decades and in our lifetime.
To achieve this, however, will require an acceptance that there is more we can do even with our current poor healthcare professional ratios than we are doing. It will also need an acceptance by all especially government that though health is classified as part of public goods that are normally expected to be provided by the state, competition amongst different national socioeconomic needs and the high cost of health staff remuneration is such that government is incapable of bearing the entirety of costs in this sector. There is, therefore, a need for an opening up of the health sector for considerable private partnership.
I know thanks to our poor harnessing of Public-Private Partnerships (PPP) and the connotation that such schemes are froth with nepotism, insider dealings and corruption, many will squirm at this view. Truth is, currently there is considerable private involvement in our health sector; from direct private investment driven health facilities to quasi-government/ missionary outlets. Then there are philanthropic institutions that may donate entire hospitals, buildings or equipment to existing institution or central government. Further, there are some aspects of our healthcare delivery system that is outsourced entirely to private institutions to run at a profit because they are perceived to manage these functions better than the state.
In all the above examples, these partnerships have been based on fixing a failing system akin to papering over the cracks than charting a new course based on the opportunities the shortcomings of our current system present. In essence, we have set tasks based on failure and found options to reverse the trend. In doing so we have relied on our closest circle, awarding contracts based on trust and kickbacks with little to show by way of improvement in our healthcare outcomes. This is what has to change.
The partnership I propose should be based on outcomes and start from the thought process stage. It should be one where we are clear why we are seeking these partnerships and encourage innovators to think out options to achieve these outcomes. Our outcomes should be primarily aimed at improving health access at the primary care level, they should be measurable, time constrained and achievable. They should be partnerships hugely underpinned by technology and not brick and mortar.
The role of government should be one where red tape is cut and multiple stakeholders are allowed to try their hands and ideas out in incubators, approaching the few who will dare to experiment whilst ignoring the majority at the outset. It should be a partnership where the government is not the primary contract provider but an enabler through the provision of the right environment for thinking to thrive.
My proposal is that we adopt a partnership approach based on the “law of diffusion of innovation,” where those who dare are willing to deal with early adaptors of health opportunity and engage with innovation knowing perfectly well that there are inherent risks.
Yes, this is a high-risk strategy but one touted as the only way for countries like ours to create a health care system that is fit for purpose without copying solutions that leave us centuries behind the pack. Such an approach is bound to be met with considerable resistance as it will initially alienate a large percentage of those involved in the health sector currently and who will do all it takes to preserve the status quo. It will also require government and innovators to stay the course and take considerable flack.
It is an approach that will follow Mahatma Gandhi’s view on transformational change that “first they ignore you, then they laugh at you, then they fight you, then you win.” It will be a rollercoaster in an environment where contrarian views are frowned upon. However, it’s a journey that some on our continent are already embarking on with gritted teeth. One such example is the Six County initiative in Kenya where the private sector has been partnered to improve reproductive, maternal, newborn, child and adolescent health. This initiative is set to also become a platform for additional projects, including telemedicine solutions, family planning activities and training. The initiative is supported by Safaricom, Huawei, Philips, GSK and Merck, Sharp & Dohme with no contracts awarded by the government.
I know it is within us to dare and achieve more with little, thanks to the power of our brains. The barrier to us changing the course of our health care system does not lie with any external forces or institutions it lies in the level of belief we have in ourselves that we can. The noise from the choir will always be loud but it is not supposed to silence us. Rather like fans in a sporting arena, it is aimed at sparring us on to sing at a higher decibel, challenging ourselves in the process to achieve more.
For sixty years we have listened to the voices of the bureaucratic and technocratic soloist single in melancholy as to why the path we have taken this far is the best we can, the results of their dirge stare us all in the face. If these outcomes don’t scare us and encourage us to adopt new ways then we might as well start to question the value of our intellect. The time to challenge the status quo and dare to dream in the full glare of the loud few is now.