Addressing Public Health Issues in Ghana: a brief assessment of Ghana’s Health Policy (2020-2025)
Tittle: Ghana Health Policy (2020-2025) addresses the Emerging Public Health Issues in Ghana
Introduction
Public health care is imperative to all human beings universally. It is imperative that it should be made accessible, especially primary health care, to individuals and families by means acceptable to them and through their active participation in programmes and policies at national level. Public health care forms an integral part of a country’s health system as it is the center of a country’s socio-economic development (WHO,2020). Health care entails the improvement or maintenance of health through prevention, treatment of illness or injury, diagnosis and treatment of any other mental impairments in humans.
The World Health Organisation (WHO) constitution (1946) envisages “…the highest attainable standard of health as a fundamental right of every human being.” The preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. According to WHO, understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality (WHO, 2020). This statement sets the basis of the prerequisite to countries to set health policies that encompasses these determinants of effective health care is to be attained.
In Ghana several steps have been taken by the government in the development of health sector policies, strategies, protocols and guidelines at all levels. These include, but not limited to the National Adolescent Policy and strategy 2016-2020, National nutrition policy, the two editions of national new-born strategy and action plan 2016-2018 and 2018-2023, National HIV and AIDS strategic plan 2016-2020, National Health Financing Strategy, National Action Plan for Health Security and the recent National Health Policy (2020-2025) as UN (2020) acknowledges.
In terms of improving access to healthcare in the past decades, Ghana has made major strides. Evidence of an increase in coverage by health facilities and Community-based Health Planning and Services is quite enough to prove how health care has been promoted. Similarly, in 2003, the National Health Insurance Scheme (NHIS) was created to provide financial access to quality basic health care for residents in Ghana, the adoption of free maternal care in 2008 and free mental health care services in 2012 are notable efforts made by the Ghana government. However, despite these efforts, Ghana presently faces public health issues especially linked to primary health care. These challenges have been experienced both by the citizens of Ghana, as well as the health care professionals.
Issues in Ghana’s Healthcare System
According to the Ministry of Health (2020) Ghana has not achieved the desired level of health because they have not adequately addressed, in a comprehensive manner, all the key determinants of health. Historically, the major health problems affecting Ghanaians have been primarily communicable, maternal, perinatal and nutritional diseases. Ghana is now acknowledged as having a more complex burden of disease. This is evident across different age, gender, location, and socio-economic status groups in the country.
For children, communicable diseases remain the major health conditions affecting them, with malaria prevailing. Maternal and neonatal health conditions remain a challenge, especially in rural areas and amongst poor women. NCDs such as hypertension, strokes, cancers, diabetes, eye disorders, oral health conditions; those of genetic origin such as sickle cell; injuries, substance/ medicine abuse and related conditions are increasing in prevalence (Ministry of Health, 2020).
Inequity in accessing health care services has been highlighted as one of the problems that needs to be addressed to improve health outcomes in Ghana (Ministry of Health, 2014). Evidence of urban populations and richer households more likely to access health care than rural and poorer households show these inequalities which exist. Pregnant women from poorer households deliver less often in a health facility than those from richer households (Ghana Statistical Service, 2011).
The introduction of the National Health Insurance Scheme (NHIS) in 2003, a social intervention program introduced by government to provide financial access to quality health care for residents in Ghana, was intended to eradicate inequities of service provision between rich and poor but, to date, it has not achieved this aim (ACCA, 2018). In a survey undertaken to assess access to health care for people from different socio-economic groups, the poorest members of society were found to be more likely to self-treat than to visit a hospital.
Another challenge is that the availability of healthcare institutions and professionals is limited. The healthcare cost and expenditures related to prevention and treatment of diseases are rising which has grown concern to the citizens of Ghana. Similarly, Pallas et al (2015) asserts how Ghana suffers from a chronic shortage of health workers as well as inequities in both the distribution and skills mix of workers. This has restricted access to services and hampers achievement of national health objectives. According to the UN (2020) in 2020, the country had just 11 doctors, nurses and midwives per 10,000 population, less than half the number (23 per 10,000) deemed necessary by the WHO.
Linked to the above, long distances traveling for healthcare in rural areas is not affordable. Rural areas, in comparison with urban areas, are particularly poorly served as regards access to health care. For instance, according to Ghana Statistical Service (2004) there was one doctor for every 5,103 people in Greater Accra, compared with one doctor for every 50,751 people in the Northern Region. Although the government has introduced a number of schemes to try to address this problem including the Deprived Area Incentive Scheme, which offered an additional allowance of 20–35% of basic salary, this has since been discontinued; the Health Staff Vehicle Hire Purchase Scheme; and various housing schemes, but none of these has proved to be successful as Pallas et al (2015) asserts. Other challenges faced by Ghana healthcare system include poor hygiene and sanitation, inadequate financial health investments or limited workforce and facilities (UN, 2020).
According to (ACCA, 2018) the structure of the health care workers in Ghana is fragmented, involving a lot of hierarchy persisting even up-to-date. To add, there still shows evidence of inequalities between the different professional categories, which are usually with various professions being subordinated to the knowledge and practices of medicine. Moreover, there has been inadequate and insufficient training of health workers in Ghana. These challenges have been further exacerbated by the changing disease landscape, as the burden of non-communicable diseases (NCDs) is increasing and creating a dual burden along with infectious diseases. The COVID-19 virus is a pertinent example and has been a challenge in Ghana.
The Ghana Health Policy (2020-2025)
Ghana’s revised National Health Policy (2020-2025) seeks to address key health determinants and introduces a new concept of building resilience for public health emergencies such as the COVID-19 virus. According to the policy, the development aspirations are consistent and aligns with the UN SDGs (Agenda 2030), which seek to build a world that is just, equitable and all-embracing, with the desired end results being inclusive economic growth, social development and environmental protection for all, without discrimination. This adoption of a new National Health Policy is a response to ensure that no one is, indeed, left behind.
Similarly, UN (2020) gives how the latest National Health Policy resonates with other global initiatives, including the Sustainable Development Goals Declaration, principles of the African Union Agenda 2063, the Astana Declaration on Primary Health Care (2018), Universal Health Coverage (UHC) 2030 Compact, and the UHC Political Declaration adopted at the UN High-Level Meeting in September 2019 (UN, 2020). This policy further seeks to address economic, social and environmental determinants of health and aims to reduce risk factors by mainstreaming a Health in All Policies (HiAP) approach.
Ghana has not achieved the desired level of health because they have not adequately addressed, in a comprehensive manner, all the key determinants of health (National Health Policy, 2020). It is mainly due to this reason that the new National Health Policy (NHP) has been developed to promote, restore and maintain good health for all people living in Ghana.
The NHP, already in place, is ensuring healthy lives for all people living in Ghana recognizing the wider operational definition of health as being “a state of complete physical, mental and social well being and not merely the absence of disease and infirmity” (WHO). It further recognizes all organizations, people and their actions which impact on the health of the population and not just those directly involved in the provision of healthcare services. This scope is intended to ensure that we all work towards the achievement of healthy lives for all people living in Ghana through an enabling policy framework that recognizes, empowers and brings together, in a coordinated manner, all stakeholders using the following five (5) policy objectives:
To strengthen the healthcare delivery system to be resilient
To encourage the adoption of healthy lifestyles
To improve the physical environment
To improve the socio-economic status of the population
To ensure sustainable financing for health
All these are within the framework of multi-sectoral collaboration, strategic partnerships, decentralization, equity and citizens’ involvement and social accountability (National Health Policy, 2020).
Notable Improvements
The policy has been able to deal with the challenge of COVID-19 as the emergency health issue that recently occurred. Through the stipulation of the policy, the government has provided technical assistance to coordinate the COVID-19 response, strengthen laboratory capacity to test for COVID-19 cases, build capacity to improve surveillance, trace contacts and strengthen health systems including the training of health workers and provision of Personal Protective Equipment (PPE) to adequately manage COVID-19 whilst protecting frontline health workers (UN, 2020).
COVID 19 has taught the world, including Ghana the need for a more resilient health system and indeed all related sectors that impact on the health of individuals, families and communities. The revised policy of Ghana provides a cross-sectoral response and collaboration among Ministries, Department and Agencies (MDAs), and other identifiable organizations working within the ‘Health-in-All’ and the ‘One Health Policy’ frameworks UN (2020). Ghana has undoubtedly been able to invest and has refocused investment to the health sector, building back and ensuring resilience.
Ghana has also made notable efforts in supporting communities and districts that were most affected by COVID-19 to minimize the impact on the disruption of essential social services such as health, nutrition, water, sanitation and hygiene services through the Multi Partner Trust Fund (MPTF). To ensure that there are well trained health professionals, the government has also been involved in the procurement of equipment and training of doctors and critical care nurses for case management. This cross sectoral approach is in tandem with what is envisaged in the National Health Policy in addressing causes and consequences of health problems.
Conclusions & Recommendations
Ghana has made significant efforts in developing health guidelines and policies ( Health Policy 2022-2025) and conducting in-service training. Supervision, monitoring and evaluation have also received attention. The Health policy is very critical in determining the needs of people and finding the right approach to addressing those needs. However, to have the policy is one thing, and ensuring their implementation is another. It should be important to note that in implementing the National Health Policy, it will be important that the Government’s focus on Universal Health Coverage (UHC) includes the strengthening of all the 6 building blocks of the health system and strengthening of primary health care. The aim should be to have a health system that is efficient, responsive and resilient to equitably deliver quality health services and resist future shocks.
Collaborations are also a key in ensuring the success of the implementation of this policy. Government, development partners, the United Nations, Civil Society Organizations and all stakeholders can strengthen and make this policy operational. Particular attention must be played on the implementation processes if these collective efforts of addressing the health challenges outlined in this paper are to be tackled the needs of the people of Ghana are to be fulfilled. Moreover, building on a strong investment mindset on health issues, focusing on reforms that improve the efficiency of health financing schemes and ensuring its viability and sustainability is also imperative.
REFERENCES
Ghana Statistical Service, author. Multiple Indicator Cluster Survey. 2011
Ghana Statistical Service, Health Research Unit MoH, ORC Macro, author. Ghana Service Provision Assessment Survey 2002. Calverton, Maryland: 2003.
Ministry of Health, author. Holistic Assessment of the Health Sector Programme of Work 2013. Ghana: 2013.
Ministry of Health, author. Health Sector Medium term Development Plan 2014–2017. 2014 Draft document, 2014.
Nyonator F, Awoonor-Williams K, Phillips J, Jones T, Miller R. The Ghana Community-based Health Planning and Services Initiative for scaling up service delivery innovation. Health policy and planning. 2005;20(1):25–34.
The Association of Chartered Certified Accountants (ACCA). (2018, November 16). Key health challenges in Ghana. Key Health Challenges in Ghana – WATHI; www.wathi.org. https://www.wathi.org/debat_id/systemes-de-sante/wathinotes-systemes-de-sante/key-health-challenges-in-ghana/
Pallas S, Nonvignon J, Aikins M, Rugerc J. Responses to donor proliferation in Ghana's health sector: a qualitative case study. Bulletin of the World Health Organisation. 2015;93(1):11–18.
United Nations. (n.d.). Launch of the Revised National Health Policy in Ghana | United Nations in Ghana. United Nations Ghana; ghana.un.org. Retrieved November 2, 2020, from https://ghana.un.org/en/108895-launch-revised-national-health-policy-ghana