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Engaging the health establishment is a necessary evil

Kwaku Agyemang Manu – The Minister of Health

I am a passionate reader of medical history and get fascinated by the obstacles that those who have dared to make a dent on the world’s healthcare landscape have had to face. From the days when the likes of Edward Jenner pioneered the smallpox immunisation (the world’s first known vaccine) through the work of Emil J. Freireich in the battle against leukaemia, many of the successes we take for granted today were opposed by the establishment. However, one characteristic learning from these pioneers is the fact that though they worked hard to break down the misconceptions that were impacting on the overall healthcare of humankind, they engaged with the establishment when they had to. At times they could have been said to be in bed with the enemy. However, the result was their views moved from the fringes to the periphery and finally became mainstream.

On Tuesday, April 9, 2019 there was an advertisement in the Ghanaian News Online inviting Ghanaians to submit memoranda on the Ghana Health Service and Teaching Hospitals (Amendment) Bill, 2019. In the said communication, it was indicated that soft copies of this Bill could be found on the website of the Parliament of Ghana. For a few days after some of us visited www.parliament.gh in an attempt to obtain copies of the document so we could submit our views with little success. As I type, though the publication gave a two-week time window which elapses on April 24, this document is still unavailable. Perhaps this is a game of “pilolo”.

However, whilst making efforts to obtain copies, it emerged that there was also in existence a second document, a draft National Health Policy for Ghana entitled “Ensuring Healthy Lives for All.”  We thus set ourselves to obtain both documents. Strangely, we managed to obtain the latter but have till date been unsuccessful in obtaining the former. Unperturbed, Thinknovate Ghana set itself to study this document. We did because we were of the view that a policy that was going to shape the future direction of health delivery in Ghana could not be left to a selected few.

We came to this decision based on the fact that a look at the Ministry of Health, Ghana’s website indicates a number of policies that are supposed to underpin health provision in Ghana are gathering dust. Two of such documents are the “Ghana National Healthcare Quality Strategy (2017-2021) which was adopted on the December 1, 2016 days before the December 7 election of that year that the then government lost; and the “Adolescent Health Service Policy and Strategy (2016-2020). It doesn’t take a rocket scientist to work out that these two documents are gathering dust because the requisite buy-in of most major stakeholders and the political forces in our country was not obtained at the time of their inception. With that in mind, it was easy for them to be jettisoned when political power was lost and a new government was in place. Having campaigned on their own manifesto and with little belief in the health policy direction of the previous NDC government, the political will of the current government to see these policies to fruition is clearly missing.

Not surprisingly, most Ghanaians are even unaware of the existence of these policies or other similar health policies since the inception of the Fourth Republic. Sadly, this is the health of our nation we are dealing with. It is not the health of any single political colour and cannot be subject to the uncertainty of our political gravy train. We cannot continually reinvent the policies around health without evaluating the success or otherwise of any previous policy documents. No country has shown considerable strides in healthcare outcomes by engaging in such reckless behaviour and our view is that this must stop.

In 1960, whilst Ghana’s life expectancy at birth was 45.83 years, China’s was 43.73 years and the world average was 52 years. Today after twelve successive five-year development plans with health, education, and industrialisation at the heart, China has a life expectancy of 76.4 years surpassing the world current average of 72 years; whilst Ghana is struggling to hit the 64-year life expectancy mark (currently 63.8 years). Comparatively, a read of Ghana’s health history points to the fact that at no point have we had a coherent national health plan that we have stuck to and evaluated. Indeed, there is value in planning, implementation, evaluation, and learning.

This is why we are deciding to publish the draft National Health Policy for Ghana irrespective of the fact that we obtained it illegitimately. We take this step not because we want to be seen as a rogue organisation but in the hope that Ghanaians will read the document and come to their independent judgement on whether it is capable in its current state of helping to evolve the standard of healthcare, we all aspire for. If it is not, then we would encourage that all interested parties leverage their Members of Parliament, Ministers in the executive arm of government, civil society and Ghanaians as a whole to engage with the drafters of this document to ensure the final document has the requisite buy, is fit for purpose and capable of delivering the import of its title, “Ensuring Healthy Lives for All.”

To those of you who work in Parliament either as staff or as MPs, we refuse to accept the excuses that you adduce as to why the Ghana Health Service and Teaching Hospitals (Amendment) Bill, 2019 has still not been published on your website. To put up an announcement directing us to that source without availing the information is not only disingenuous but also insulting to our intelligence as Ghanaians. It is indicative of the disdain and contempt you have for the electorate the minute we queue in the rain and sun to cast our ballots to get you elected. Some of us will refuse this treatment and refuse to be what you want us to be. Supine cogs in your wheels dancing to your off-beat music in despair. We hope by taking this step you will do the needful and make the Bill available.

History teaches us that true change never happens from the inside without interested contrarians agitating from the outside whilst causing significant discomfort for the establishment. However, contrarians who have made significant contribution have also done so when they have exploited opportunity irrespective of how small, and engaged the establishment as frenemies. This is what we are seeking to do and for which reasons we make no apologies.

Some such as Nicolaus Copernicus, the sixteenth century mathematician and astronomer who formulated the model of the universe that placed the Sun rather than the Earth at the centre, were patient enough to wait over two decades before challenging conventional wisdom and upset the status quo; because those who had dared to say the world was round rather than flat had been sentenced to death and burnt at the stick. Five centuries on, we cannot wait even a day for health policy to be the preserve of a few when the impact affects us all.

We would want to end by emphasising that the notion those in charge of our health policy know it all is overblown. They cannot have a better idea of the quality of care we receive as individuals compared to us the recipient. When we die from “no bed syndrome” they set up committees but are never able to ensure it does not happen again.  As the saying goes, “he who feels it knows it more”. As an individual who has had to deal with Ghana’s health system over a period of time and has lost loved ones to its iniquities, “there is a feeling and I know it.”

By Kwame Sarpong-Asiedu

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