Omane Boamah writes: Free primary health care at last!

Congratulations once again, Professor Naana Jane Opoku-Agyemang! As President John Dramani Mahama emphasised, your nomination as his Running Mate for the December Presidential and Parliamentary elections is “over and above affirmative action.”

The nomination is a reflection of your undoubted competence, your innovative approaches to public policies, your admirable integrity as well as gender equality.

It is also a bold statement of intent that gender should never be an obstacle in the way of leadership.

Professor Opoku-Agyemang, in your acceptance speech, you proved President Mahama right for nominating you to the admiration of the millions who watched you live. You did so, not only with your eloquence but also with the rich, arresting content of your speech – which resonates with all generations and transcends gender barriers.

Many young girls and boys, women and men, are already totally inspired by the leadership they have seen in you and acknowledge your new role as a refreshing departure from the norm.  Ayekoo!

Dear reader, the courage and incredible vision of John Mahama cannot be lost on us and as Prof. Opoku-Agyemang acknowledged, “President Mahama, you have respected women… the women of Ghana will not forget.”

Professor Naana Jane Opoku-Agyemang further stated, “In today’s turbulent political and economic climate, there are four crucial factors to consider in tackling issues relating to youth and gender. 

First, we must be mindful of the fact that 60% of our population will be under the age of 30 in a few years. That is why it is so critical that we systematically reform all our systems to effectively address the aspirations of our youth and country.

Second, we need meaningful, quality and comprehensive education that goes beyond access and responds to the future we can actualize.

Third, we must leverage on vocational and technical training to equip many into meaningful and fulfilling work. 

Fourth, we must provide opportunities that transcend political patronage, ‘connection’ and the practice of whom- you- know. Equal and fair opportunities based on merit are an imperative for sustainable economic growth. The time for that shift is now.”

These are certainly reassuring words, which take into consideration Ghana’s quest for sustainable development at a time when maladministration and manifest incompetence combined with incoherent and patronising responses to COVID-19 have conspired to disillusion many a Ghanaian, particularly the youth.

The quest for sustainable development must be a movement, lest we fail to meet the 17 goals set by the United Nations to be attained by the year, 2030. Another target aptly crafted and yawning for attention and decisive action is the Africa Union’s blueprint, “Agenda 2063: The Africa We Want.”

None of these noble aspirations can be successful without providing fair opportunities for all – the core of social justice. Notably, social justice was the common thread in the speeches of both Prof. Naana Jane and President John Mahama.

I was glad that, social justice – providing opportunities for all – is once again taking centre stage in our national discourse. 

Free Primary Health Care

As a medical doctor and a health policy planning and financing analyst, I am encouraged that President Mahama seeks to implement Free Primary Health Care for all Ghanaians, including the young and the elderly because there are still many Ghanaians who cannot afford the cost of basic health care.

Primary Health Care, proposed by the World Health Organisation 42 years ago, advances the frontiers of social justice – inclusivity. It will serve as a fitting linchpin for the realisation of Sustainable Development Goal (SDG) 3, Health for All.

All Ghanaians deserve quality health care. This is why I agree with the WHO’s Primary Health Care Declaration that, “The attainment of the highest possible level of health is a most important worldwide social goal whose realisation requires the action of many other social and economic sectors in addition to health”. (WHO, 1978).

Fortunately, the world led by the United Nations is back to where we were in 1978 with Primary Health Care as declared in Alma Ata, Kazakhstan. This is because the SDGs is a relevant drift away from the vertical nature of the Millennium Development Goals. SDG 3 adopts a health system and multi-sectoral approach and guarantees sustainable development.

Hence, as a health practitioner, you can understand my joy when President Mahama announced Free Primary Health Care for all Ghanaians as a significant policy direction for his incoming administration.

What must be new about this health policy, and what should be the deliverables of such a plan

Below are some of the provisions of Primary Health Care:

• Health education/promotion;
• Proper nutrition;
• Adequate supply of safe drinking water and sanitation;
• Maternal and child health including family planning;
• Immunisation against major infectious diseases;
• Prevention and control of locally endemic diseases (including sanitation and good drinking water);
• Appropriate treatment of common diseases and injuries; and
• Provision of essential drugs.

The direct and indirect benefits are endless. From the above, it stands to reason that the benefits basket of Free Primary Health Care should include free health screening for non-communicable diseases like diabetes mellitus, hypertension and cancers.

With this, cost as a barrier to accessing care at the primary level will be eliminated. Furthermore, screening will lead to early detection in order for the most common illnesses afflicting majority of Ghanaians to be treated early at lower cost even before they develop complications.

I believe as President Mahama promised, during his soon-to-be-rolled-out Policy Dialogue Sessions, he will engage citizens in a detailed discussion that will lead to the attainment of Health for all Ghanaians – not just a few.

When effectively implemented with the necessary tailoring – as envisaged by the Alma-Ata declaration and re-emphasised in contemporary times by the SDG 3 – Ghana will soon attain universal health coverage.

This is perhaps Ghana’s last opportunity to achieve universal health coverage since 1978 when the World Health Organisation adopted Primary Health Care in Alma-Ata. In pursuing this goal, we must be well aware of the ever present obstacles to Primary Health Care.

The obstacles have been both internal and external pessimists. These include Walsh and Warren (1979) who within just one year after the Alma-Ata declaration and while admitting that Primary Health Care was above reproach, still strongly advocated, “Selective Primary Health Care” instead of Comprehensive Primary Health Care.

There may be such ‘Walsh and Warrens’ in Ghana and abroad, today. But they must be brought onboard in the spirit of Health for all, not just a few.

Cuba remains a shining example of what Primary Health Care can achieve for all if we commit to it. That, Cuba can and could export doctors to Europe to assist in the fight against Coronavirus Disease is an indication that with good planning, dedication and political will Ghana can achieve even more.

Indeed, in addition to SDG 3, the Social Determinants of Health which looks at health as an interplay between the individual, community, environment and socioeconomic factors has also highlighted the relevance of preventive health, inter-sectoral collaboration and appropriate use of resources.

President Mahama has four years to serve as President (2021 -2024). But Free Primary Health Care must live beyond his term in office to benefit all Ghanaians for many years to come. Therefore, it will not be enough to implement this vision on the basis of his charisma alone.

For sustainability, inspiration must also be drawn from SDG 3 and the Social Determinants of Health. To this end, useful lessons can be gleaned from the Jamkhed in India (Taylor-Ide and Taylor, 2002) where the attempt to roll out Primary Health Care taught the overriding need for community ownership of programmes.

Fortunately, the SDGs will live beyond 2024 up to 2030, so we must run Free Primary Health Care on a large scale, anchor it in the health system of Ghana and ensure community ownership.

This will demand adequate and motivated human resource for health, innovative and efficient financing, equipment, infrastructure particularly in unserved and underserved communities and last but not least political will.

Conclusion

It is heart-warming that President Mahama has demonstrated the needed political will to implement Free Primary Health Care. Beyond implementing Free Primary Health Care, which includes halving maternal mortality within four years, President Mahama further noted other social justice enhancing policies when he out-doored his Running Mate.

He pledged “to change the face of our politics so that no one will be considered less Ghanaian or more Ghanaian than the other on the basis of ownership of a political party card.”

He also spoke the minds of, “many Ghanaians who do not belong to the NPP, the NDC or any recognisable political party.” And added such people, “detest the persistent acrimony associated with our politics. They do not have a party card and yet they contribute significantly to build our country.”

He stressed the ever relevant need to involve women in decision-making and promised to drastically reduce the size of Government. Furthermore, he promised the people who have lost jobs, deposits and investments due to the collapse of several financial institutions restoration.

All the above intentions and many more are great and worth pursuing, including Free Primary Health Care for all – which in itself will provide job opportunities for the youth in preventive, promotive and curative health. At last, Free Primary Health Care has arrived.

Dr. Edward Kofi Omane Boamah

29^th July, 2020

The author is a Medical Doctor, Health Policy, Planning and Financing Analyst & Former Minister for Communications.