Our Climate, Our Health, Our Wealth

Muntari Abbas must be a very worried man: The deplorable conditions under which he lives have been compounded by the recent floods which occurred in his community.

The skinny-looking scrap metal dealer lives in some of the worst urban conditions in Ghana. The main road to his seven foot square shack at Ashaiman Jericho, near Ghana's Port City of Tema, is almost knee-half in litters of all sorts.

The open drain down his alley overflows with black sewage. Fires always smolder in the vicinity. Armies of hawkers sell their wares of all kinds in every available space in Muntari's neighbourhood. It appears there is always some smoke in the air here; and rubbish is dumped all over.

“Everyone here wakes up around four in the morning to face each day and goes to bed around one in the morning. That is the life here in Jericho,” says the 33-year-old father of four. “It is so frustrating and challenging to live here. It is as if you are a second or perhaps a third class citizen in your own country.

But since you have no other place to go, you just have to endure until your luck shines one day,” he said in Twi.

Ashaiman, a big slum nestles Ghana's capital city Accra and the country's industrial city, Tema. Life at Ashaiman is extremely hard but that is no deterrent to several boys and girls who keep trooping there from other parts of Ghana especially the North to make a living. No one knows the actual population of Ashaiman.

Nima, Chorkor and Sodom & Gomorrah share some similar traits with Ashaiman in demographic terms. Such places are always in the news for the wrong reasons.

Following the recent floods which killed a number of residents of Ashaiman, most inhabitants are just eking out a living in makeshift shacks built of all sorts of material, waiting with anxiety to see when government will carry through its threat to demolish all structures in waterways. “Now the situation is such that people just have to share rooms with others.

There are always about ten or more people in a room,” says Muntari. Most of them have no tenancy rights because they are not tenants, they are squatters. They have no ventilation, so they get ill.

They have no health insurance, so they don't go to the hospital when they are sick. There is absolutely poor drainage in Jericho, Muntari's part of Ashaiman.

The situation at Lebanon, another part of Ashaiman is almost an exact photocopy of Jericho. Sampson, a 31-year-old resident blames politicians for disappointing the inhabitants of his area.

Though he blames “those big people in Accra”, he nevertheless appeals to them to come to the aid of Ashaiman “since we are all Ghanaians and one man's situation affects his neighbour.”

Sampson shakes his head, points towards the direction of a group of children who are excitedly playing in the muddy, stagnant pools of water just receding on the third day after the heavy rains.

“Look at these young ones, we all have to do something for them so that they don't continue to live in a place like this when they grow.”

For him “being constantly ignored and rejected by those in authority is worse than poverty itself, especially when it is your own vote that put those people in authority.”

The resultant frustration, he thinks, is the main cause of the high rate of criminal activities at Ashaiman.

The top-most priorities for Ashaiman are potable water and proper sanitation which if provided, would reduce the health expenditure of residents.

This demand of these inhabitants is in line with goal number six of the Millennium Development Goals: combating HIV/AIDS, malaria and other diseases.

Although Sampson does not know anything about climate change, he thinks “the irregular patterns of the rain and the sun are things of great concern because I remember very well that when I was young, our elders could predict when the rains would come but nowadays the rains only come when they like.”

He is however certain, not scientifically though, that the unpredictable pattern of rain and sun could affect many things including “our lives, our health and our wealth”.

The right to health is one of the most acknowledged rights that will be impacted by climate change in Africa. Article 25 of the Universal Declaration of Human Rights states that everyone has the right to a standard of living adequate for the health and wellbeing of himself or herself or his/her family.

Article 24 of the Convention on the Rights of the Child also stipulates that state parties must ensure that every child enjoys the highest attainable standard of health. Of all the countries in the world, Ghana was the first to ratify this convention.

According to experts, climate change will affect the right to health in Africa because of projected increases in the incidence of malaria and the infestation of previously malaria-free zones with malaria, as well as outbreaks of other epidemics.

The Intergovernmental Panel on Climate Change reports that the previously malaria-free highland areas in Ethiopia, Kenya, Rwanda and Burundi could experience modest incursions of malaria by 2050.

The right to health is one of the key rights that African governments including Ghana's are struggling to deal with, and the projected impacts resulting from climate change are only bound to make it harder for African governments to meet their obligation of promoting and protecting the health of their citizens.

Malaria alone is one of the greatest health challenges facing sub-saharan Africa, along with HIV/AIDS.

The 2008 World Health Organisation Malaria Report states that there were 247 million malaria cases recorded worldwide; 86% recorded in Africa, 881,000 malaria-related deaths worldwide, 90 percent in Africa.

An estimated 85 percent of the deaths in Africa occur among children under age five.HIV/AIDS, according to the report, kills an estimated 1.5 million people annually in Africa, resulting in an estimated 11 million orphans.

Climate change, experts say, is set to further constrain the capacity of African governments to deliver the right to health of their people.

Amidst this health catastrophe, there seems to be a misunderstanding between two health authorities in Ghana.

The National Insurance Authority (NHIA) has rejected claims by the Ghana Medical Association (GMA) that the National Health Insurance Scheme is collapsing ostensibly due to quality improvement and cost containment measures such as enforcement of the gatekeeper system, prescribing levels and the conduct of clinical audits by the NHIA.

The Authority maintains that the greatest threat to the sustainability of the scheme is the increasing fraudulent practices at some provider and scheme sites.

“The Ghana Medical Association should accept the fact that when their members submit fraudulent claims, payment will naturally be delayed by the need to spend more time vetting them properly.”

A statement issued by the National Health Insurance Authority recently stated: “Increasingly, hospitals, clinics and maternity homes are found to have indulged in malpractices such as alteration of diagnoses, irrational prescription of drugs, billing for services not rendered, diagnoses not consistent with treatment, wrongful application of tariffs, all in a bid to increase their incomes through fraudulent means.

“The situation where over 30% of claims from providers are found to be fraudulent is not acceptable and represents the single most dangerous threat to the sustainability of NHIS.”

Ghana has no clearly defined research agenda specific to health and the environment, says a report on Situational Analysis and Needs Assessment (SANA). Dr Edith Clarke, Head of Occupational and Environmental Health of the Ghana Health Service disclosed this at a national workshop on SANA.

The report recommends the setting up of a body to coordinate cross-cutting environment and health issues that will save financial resources through harmonization of research.

Urban areas in Ghana are mostly characterized by indiscriminate dumping of waste, poor industrial and medical waste management, severe air pollution from vehicular and untarred roads, and sale of food in unhygienic settings, water rationing, poor infrastructural planning and a high incidence of malaria.

Dr George Amofa, Deputy Director-General of GHS says about 60 to 70% of diseases are attributable to poor water and sanitation; calling for a situation analysis especially in the wake of climate change and its effects on health.

Although Rufus, another inhabitant of Ashaiman did not complete Senior High School, he strongly believes that “the dreadful environment of any community is directly linked to escalating health problems.” Malaria, typhoid and tuberculosis, he claims, are common in his community because it is a busy place where people keep travelling to and fro.

This means families are spending more on health and are therefore becoming poorer. “It is true that there are many things we need here. But for now, what we need most are water and sanitation,” says the 26-year-old school dropout turned labourer.

Leonard Ackon of the MDGs/GCAP Campaign Secretariat thinks that though Ghana is making some positive strides in healthcare delivery, there is still room for improvement.

The reduction of the prevalent rate of HIV/AIDS from 1.9 percent in 2008 to the current figure of 1.6% is commendable. “Malaria is however a major bane in health care” says Ackon who suggests that “the onus of fighting malaria lies on us as citizens to keep our environment clean to drive away mosquitoes, the vectors of malaria.”

Available statistics show that about 80% of the country's Out Patient Department (OPD) cases are sanitation and water related. “But attaining the MDG target six is still a major challenge as access to potable water and guinea worm infestation in Northern Ghana still exist,” says Leonard, a former journalist who has written extensively on the MDGs.

By Sylvanus Nana Kumi ( )