The Ghana health debate: going in cycles
Christophe Galfard in his book The Universe in Your Hand argues that “a clock that is moving through space at a very fast speed does not tick at the same rate as a slow-moving watch gently attached to your wrist as you stroll on a tropical beach. The idea of a universal time – a godlike clock that could somehow sit outside our universe and measure, in one go, the movement of everything in it, how its evolution unfolds, how old it is and all that – does not exist.”
Being very interested in sports I tend to agree with him. Measurement of anything in absolute numbers has very little relevance. Thus, in professional football, for example, teams are relegated because although they may win several games over a season, others win a lot more and surpass them. Sadly, in Ghana’s health sector we seem to enjoy discussions in absolute numbers, treating the country as an isolate.
It is not uncommon therefore to find a discussion around say health worker recruitment numbers being had based on which political party employed more while in government compared with the other. I have over the years followed some of these debates in complete surprise as to what if any the value addition is. In doing so I have wondered if there is any benchmarking when having these debates?
Let me use the number of doctors in our country for an illustration. The country as at the end of 2017 had 4,016 doctors according to data from the Ghana Health Service with a doctor to population ratio of 0.2: 1,000. However, the optimum doctor to population ratio that the World Health Organisation recommends is 1: 1000. Meaning, the country with a population of 29.2 million in that year required about 29,200 doctors. A look at the total number of doctors by year-end 2016 will show that there were 3,365. On the surface, it is easy for the current government to argue that they added approximately 700 more which was higher than any year since 2008.
But, in reality, this must not be a cause for celebration. It is not because, with a population growth rate of 2.25 per cent and approximately a net number of 700,000 citizens being added to our population annually, the requirements for doctors is also increasing at 700 each year. The result being that this level of recruitment is not even good enough or at best breaks even in catering for the medical human resource needs due to population expansion, let alone attempt to make a dent in the deficit we already have.
This illustration has led me to wonder how citizens have allowed this debate to fester all this while without any concerted challenge to this otherwise warped and baseless self-aggrandisement? As if that is not bad enough, we carry this into our technocratic discussions around many health-related indicators. It is as though Ghana is an island and our health outcomes stand in isolation. Let’s just look at a couple of these indicators.
In 2018, Ghana’s infant mortality rate was 34.9 deaths per thousand live births. Infant mortality has fallen from 120.5 deaths per thousand live births in 1969 to the current figure in 2018. A four-fold decrease over five decades to 3.49 per cent. Looking at it as a standalone value, again it’s easy to celebrate. But in comparison not so much so. Rwanda in 1969 had an infant mortality rate of 129.1 deaths per thousand births rising to 148 deaths per 1000 in 1977 at a time when Ghana’s rate was is in steady decline. In 1994 the figure for that country was 125.80 deaths per thousand births. Currently, Rwanda has an infant mortality rate of 17 deaths per thousand births or 1.7 per cent (50 per cent) less than Ghana’s death rate.
The result of this is that Ghana is the 45th country in which a mother is likely to lose their child at birth or within the first year of life amongst 193 countries ranked by the WHO whilst Rwanda is fourteen places better at 59th. Having dropped three places since the turn of the millennium. With Kenya, Senegal and Malawi all passing us by.
Another indicator I will want to look at is female life expectancy. In 2017, female life expectancy for Ghana was 64.5 years. Having increased from 49.4 years in 1968, growing at an average annual rate of 0.55 per cent. On the other hand, female life expectancy for Liberia was 64.7 years in the same year passing Ghana in the world rankings from the previous year. Their longevity increased from 40.3 years (9.1 years lower than Ghana) in 1968, growing at an average annual rate of 0.97 per cent (just under twice the growth rate of Ghana over the same period). This was in spite of them fighting two civil wars between 1989 and 2003. Here too, Ghana dropped eleven places from 153 in the year 2000 to 164 in 2017. Having been bypassed by countries like Rwanda, Liberia, Eritrea, Ethiopia and Sudan just to name a few. Should society and mothers especially be proud of our backward slide? In my view, hell no.
It is safe to say from the above that though Ghana has been making advances in many of its health indicators, other countries are doing a lot better. To use the analogy of football again, if Ghana was in the first division in 1970 for many of our health indicators, we would have been relegated to division three though we have won a few matches along the way. This is why I insist that how we have our debates in health comparing one set of mediocre outcomes to another and thumping our chests in the process is flawed. We need to accept that Ghana is not an island but a country that once prided itself as the star of Africa. A star which based on some of these performances is dimming rapidly.
I will conclude by saying the only reason why our governments have gotten away with this till date is because as citizens, we have failed to depoliticise our health outcomes and have turned it into a turf ground where political opportunists play Russian roulette with our ignorance, health and quality of life. The only way we can reverse this is to make ourselves conversant with comparative data especially for countries that are achieving better outcomes whilst spending less money per citizen in the health sector.
Just to put some financial context on these outcomes, all countries mention in this text have spent less per citizen on health compared with Ghana since the year 2000. With Rwanda which has consistently spent the least achieving the most impressive outcomes. As of 2017, the health expenditure per capita of that country was $48.08 with Ghana and Liberia at $68.31 and Kenya $66.21. We have been strolling on a tropical beach with much to spend but little to show.
By Kwame Sarpong Aisedu