“If someone can show me that what I think or do is not right, I will happily change, for I seek the truth, by which no one was ever truly harmed. It is the person who continues in his self-deception and ignorance who is harmed.” Marcus Aurelius
Since the withdrawal of the appointment of Dr Baffour Awuah as the new Director-General of the Ghana Health Service (GHS), I have tried to think through how health leadership is perceived in our country. This is because healthcare is an area where outcomes are directly correlated to planning, continuity, and evaluation. Thus, many health services worldwide have strategic plans that indicate what their ambitions are and how these ambitions can be turned into tangible health improvements. In such plans also can be found the commitment of health service leaders to be accountable for specific deliverables over a given period.
Often, these plans coincide with the tenure of the health leaders. For example, the National Health Service in England published the NHS Five Year Forward View following the appointment of Simon Stevens as its new Chief Executive Officer in October 2014. This document sought to enhance the integration of primary and specialist care, physical and mental health services, and NHS and social care. In 2019, with the five years elapsed, the outcomes of the plan were reviewed against its key objectives and gaps in delivery identified. The result was that a new strategy, The NHS Long Term Plan was published on 7 January 2019. The new strategy describes the funding support that NHS England and NHS Improvement will provide to the health system to turn the ambitions in the plan into improvements in services provision across the United Kingdom.
Sadly, this cannot be said to be the case for Ghana. A look at the website of the GHS indicates that in September 2007 it published the Quality Assurance Strategic Plan for Ghana Health Service 2007-2011. No other plan has been published since; neither is there a review of this document or any next steps. Thus, it will be fair to say that since 2011, the GHS has been functioning without any written strategy that Ghanaians could hold its leadership accountable to. This revelation has led me to a few questions around corporate governance and made me wonder how the governing board of the GHS holds the Director-General to account and how he, in turn, evaluates his directors. It also made me wonder, how the previous and current presidents evaluated the performance of those they put in charge of our health service.
As citizens, this situation should concern us. It must because we also have no means of measuring the performance of this institution. We have no idea what plans are provided to the regions, districts and end-user hospitals, polyclinics, etc. Thus, when we receive below par service, it is difficult for us to measure this against any institutional service expectation of good practice. However, I do not see any such plans being written and implemented anytime soon. My reason is that thanks to how people are appointed to leadership in such institutions, many are without tenure. Even when they have tenure, this is only subject to the outcomes of our national elections. Compounding this further is the knowledge that the President who hires can fire at any time and without reason. This means the motivation of these officeholders is to be in the good books of the executive and not to focus on the complex task of improving healthcare delivery and outcomes for the everyday Ghanaian.
Using the previous Director-General Dr Nsiah Asare as a case in point, the two-and-a-half-year period for which he was in office hardly afforded him time to settle in, study the institution, engage in stakeholder consultation to inform the writing of a strategic plan. This was compounded with whispers about him being removed. Upon his removal, his replacement Dr Baffour Awuah did not even last a month.
The chances are within the next few days or weeks, we will have another person in the saddle. The reality for this individual is that he can only look as far as January 2017 as his mandate will be heavily reliant on the outcome of the elections of 2020. With such limited time, is there the prospect of the individual having a short- or medium-term strategic plan in place for our health service? My gut feeling is surely not. The point is if he went through the motions of even getting one in place, the probability of the document being jettisoned should he be out of office is extremely high.
This is why I believe a second look should be taken at how leaders of the GHS and similar institutions are appointed. My view is that as a minimum, they should be given a guaranteed tenure that is insulated from the risk of termination by the executive before expiration, except on grounds of breach of contract or gross misconduct. It will also be a good idea if irrespective of the outcomes of presidential elections these technocrats are allowed to see out their term. This, in my view, could be accommodated in the current appointment framework by way of a convention.
I believe we must learn a lot from the fallout of this appointment revocation. If anything, it must tell us that our current system does not ensure good institutional governance, generates fear and mistrust, and may potentially be short-changing the electorate.
I cannot end this piece without making it clear that I feel sorry for Dr Awuah and the situation he finds himself in. This saga has put his political loyalty under the spotlight in a negative manner. Should governments change also, the NDC could view him as a flirt who jettisoned them for his selfish ends. In short, he has become akin to a political prostitute with no real home. I wonder if we will want this politicisation across the span of our entire health system. Some may argue that it already exists and I cannot fault them for that view. However, I would want to caution that if this is not curtailed, our health system as we see it will always take baby steps in providing us with the health security we need.
By Kwame Sarpong Asiedu