It’s time for Public Health Emergency Fund in Ghana
The birth of Little Kojo (not his real name) brought immense joy to his parents, who had waited over five years after marriage, to have a child.
He was a healthy lively boy, delightful to his parents.
However, the parents’ joy turned to pain and agony after little Kojo died suddenly.
Madam Asana (not her real name), little Kojo’s mother, who narrated the circumstances surrounding her son’s death to the Ghana News Agency at Kojokura, a remote community in the West Gonja Municipality of the Savannah Region, said he fell ill and was passing dark urine.
“So, we quickly prepared local medicine (herbs) for him, but his condition persisted, and he began bleeding and suddenly died,” she said.
Kojo’s death in November 2021 was a big blow to the family.
“He was our source of strength and happiness. We went through a lot of challenges before conceiving and giving birth to him,” Madam Asana said, in tears.
“It was later discovered that my son died of Yellow Fever. We do not have any health facility here. We did not know it was such a severe disease. If we had had a hint of that disease, we would have sent him to the hospital.”
Another resident of Kojokura, Madam Amina (real name hidden), also told the GNA that her four-year-old daughter recovered from the Yellow Fever disease at the West Gonja Municipal Hospital, where she spent about four weeks, describing these moments as very distressful to her family.
She thanked God for saving her daughter, saying it was a butcher, who came to buy cow in our community, who advised that we should send her to the hospital.
“The hospital is far away from us, but we managed to send her there,” Madam Amina said.
Mesdames Asana and Amina were not the only persons who either lost their loved ones to Yellow Fever or had family members attacked by the disease in 2021. A lot of families suffered the consequences due to the disease.
On the corner of the veranda of a chamber-and-hall building at a village in the Lambussie District of the Upper West Region, sat a 58-year-old widow.
She had a frame in her hand, which she often watched. It was the photo of her only child; ‘Peter’. He was 35, a petty trader, who died of Cerebrospinal Meningitis (CSM) in April 2020, during an outbreak of the disease.
“My son was my everything. He was feeding me and taking care of my medical bills. I am diabetic. Since his death, life has not been easy for me. I have missed many sessions of medication for my condition. Now, I feel very weak,” she told the GNA.
“The outbreak of the CSM has robbed me of my support system. I wished the authorities’ response to the outbreak had been quick. My son would have been alive now.”
She is not the only one reeling through this pain. Many other families in the region, who lost their relatives to the disease, also have similar stories to share.
Outbreak of yellow fever, CSM and other diseases
Records by the Ministry of Health, and the Ghana Health Service (GHS) show that within the space of three years (2020 to 2023), Ghana recorded eight major diseases outbreak.
These were Yellow Fever, CSM, the COVID-19 pandemic, Polio, Monkeypox (Mpox), Marburg virus disease, Measles, and Lassa fever.
In October 2021 the Savannah Region reported suspected cases of yellow fever, which were later confirmed positive by the National Public Health Reference Laboratory and the Noguchi Memorial Institute for Medical Research.
The disease spread quickly to 13 of the 16 regions and over 40 deaths were recorded. The GHS, on April 15, 2020, reported 409 cases of CSM in five out of the 16 regions. By the second week it had reported 40 deaths.
The magnitude of the outbreak was severe and unprecedented in the past decade but the response to it was slow, largely because the national health team was overstretched in the response to the COVID-19 pandemic.
This outbreak led to many deaths. The country recorded her first two cases of the COVID-19 pandemic on March 12, 2020. Besides its negative impact on her socio-economic development, statistics by the GHS showed that more than 1,400 deaths were also recorded.
In 2022, there was the confirmation of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Ghana from two acute flaccid paralysis cases; one each from North Gonja District in the Savannah Region, and West Mamprusi in the North East Region.
In July same year, the country confirmed three cases of the Marburg virus, two of which were fatal.
Also, 116 Mpox cases were confirmed that year, resulting in four deaths. In early 2023, the country battled with measles, which was recorded in many regions due to the non-availability of vaccines for children, and Lassa fever where two cases were confirmed in February 2023 with one death.
Whilst the past three years (2020-2023) has put a lot of strain on the country’s health system in terms of the ability to respond to public health emergencies, the subsequent years could even be worse because other major disease outbreaks could be recorded.
In all these, how did the country prepare and respond to such outbreaks?
The last three years (2020-2023) have been one of the busiest for all health professionals in the country. The resilience of the health system to respond to public health emergencies was tested.
It was realised that Ghana did not have the adequate funds to timeously respond to public health emergencies. Development partners had to support to contain the situation.
In the case of yellow fever, persons aged nine months to 60 years (except pregnant women) in the affected regions were injected with the preventive vaccine to keep them safe from the disease.
The first phase of the vaccination campaign was held in December 2021 but it was realized afterwards that pockets of the disease still existed, and some new communities also started recording cases.
Therefore, a second phase of the vaccination exercise was held from February 26 to March 2, 2022. This was led by the GHS with support from partners including the United Nations Children’s Fund (UNICEF).
UNICEF worked with the GHS Expanded Programme on Immunization (EPI) providing technical assistance and financial support to build the capacity of health staff, provide the needed vaccines and logistics and support the EPI in community mobilisation and sensitisation efforts.
In the case of polio, the Government, supported by the World Health Organisation (WHO) and other partners under the Global Polio Eradication Initiative (GPEI), rolled out a vaccination campaign targeting children under five years across all 16 regions.
The first round of the campaign was held from September 1-4, 2022, with the second round taking place from October 6-9.
It was to increase the population’s immunity against type 2 poliovirus and break transmission of the disease. Over six million children countrywide were expected to receive the novel Oral Polio Vaccine Type 2 (nOPV2) for each of the rounds.
The WHO and other GPEI partners supported the Government with financial, logistical, and technical support to reach and vaccinate all eligible children across the country.
With the COVID-19 pandemic, amongst other support packages, UNICEF, WHO, and the Government of the United States of America assisted Ghana to procure the first set of vaccines under the COVAX facility, of which the Government took delivery in February 2021 to begin the first set of vaccinations.
Subsequently, the World Bank contributed $430 million to Ghana’s efforts to combat the COVID-19 Pandemic whilst some donor agencies also supported in the recovery efforts with grants.
Challenges in responding to disease outbreaks in Ghana
Over the past couple of years, funding for routine disease surveillance activities or integrated disease surveillance and response (ISDR) has dwindled.
Budgetary allocations to the health sector go into emoluments for health staff and the construction of health facilities, leaving significantly fewer resources available to undertake routine disease surveillance activities.
This implies that diseases that could be detected and managed on time would be left to degenerate into an epidemic level with their devastating consequences on the population.
In the year 2021, the total national health budget was $1.3 billion. This budget included payment of salaries and health research amongst others.
Out of the figure, $803 million was expected to be spent on health delivery, and $9 million on goods and services. Epidemic Preparedness and Response (EPR) fell under the goods and services budget.
This was woefully inadequate considering the volume of work expected under the EPR. In subsequent years too, budgetary allocations to the health sector have been inadequate.
As has been witnessed over the years, diseases will continue to come.
Therefore, the country needs to be prepared by strengthening her ISDR through ensuring funds to undertake public health emergency activities.
Just as efforts were made to create the Health Insurance Fund to ensure resource availability to tackle the clinical aspect of Ghana’s health care system, the country must also establish a Public Health Emergency Fund (PHEF) to ensure availability of resources to effectively support the public health aspect.
The government could channel some percentage of tax revenues from mining and telecoms sectors into the PHEF as well as encourage the World Health Organisation and other donors to also support the PHEF with some grants.
The way forward
Disease outbreaks do not only have consequences for the well-being of the population but also affect a country’s economy. If the response to the outbreak is not timeous and adequate, many lives could be lost.
For the past three years (2020-2023), donor partners were highly supportive of the government to help contain the disease outbreaks to lessen their impact on the population.
But for their support, not much would have been achieved, and many of the citizens would have suffered the consequences.
The challenge for government has been how to mobilise enough funds to respond to public health emergencies. Now that donor support is dwindling, there is the need to establish the Public Health Emergency Fund to hand related issues without having to depend on development partners for assistance.
The importance of the PHEF could not be overemphasised, as it even found space in Ghana’s National Medium Term Development Policy Framework (2022-2025) to ensure availability of funds to effectively support the public health aspect of the health care sector.
Through this Fund, emergencies impacting on public health could be better handled, which would reduce pressure on the clinical aspect, and ultimately lessen the burden on the health budget.
Just as disease outbreaks will continue to occur, Ghana must be prepared to adequately respond to them to save lives. The country cannot continue to rely on donor support to respond to public health emergencies.
As the saying goes: “To be forewarned is to be forearmed.” The country must, therefore, commit to preventing the impact and consequences of these diseases on the populace by putting the effective mechanisms in place (in this case the PHEF) to deal with these diseases and related issues, when the need arises, in order not to be overtaken by events.
By Albert Futukpor
Source: GNA