My Voice As A Clinician, A Health Advocate And A Community Member Conflict Or Opportunity?

I bring you greetings from the Nandom District in the Upper West Region of Ghana where we are experiencing a meningitis epidemic alongside the COVID-19 pandemic. I am a registered general nurse and a trained youth advocate under the Youth Leaders for Health Program [1] . I live in the Goziiri community.

My work as a clinical nurse in COVID-19 times

I faced daily challenges in my work before and now during COVID-19 and I presume the challenges will persist after COVID-19. These include the scarcity of drugs, diagnostic tests and vaccines, shortage of Personal Protective Equipment (PPEs), thermometers, pulse oximeters etc. This routinely compromises the quality of care and in COVID-19 times this has worsened.

There are patients quite ill referred from other district hospitals such as Lambussie and Sissala Districts and having to travel many kilometers to my hospital for basic care e.g. requiring intra nasal oxygen or pregnant women having to sleep in the open space overnight waiting for an obstetric scan the following day thus putting their lives at risk of contracting other diseases such as malaria, or people been referred to my hospital over many kilometers away for a routine CT scan or MRI or to see a specialist. Travelling can take up to days or a week adding to the cost of treatment, creating avoidable complications, preventable deaths etc.

Now, the patients dont travel long distances to my hospital anymore.

COVID-19 has introduced fear of travel even for medical care. Therefore, there has been a sharp decline in both outpatients and inpatients. People who are unwell do not report for care and others report late when complications have already set in.

This week, a child convulsed for over an hour because other health facilities lacked anticonvulsants. The child travelled many kilometers to my hospital and by then other life threatening complications such as hypoglycemia and hypoxia had set him. Parents were reluctant to bring him to the hospital because of COVID-19. The child was saved.

A number of children under five years who have presented with malaria over the past 8 weeks had severe anemia as well. The gains made in the fight against diseases such as malaria, TB, HIV etc. could be lost if more investments are not made.

All in all, there are numerous challenges faced by health workers and our already weak and overburdened health systems.

Must governments wait for another pandemic before strengthening their health systems?

The answer is a big NO.

My work as a health advocate

There is much advocacy to do these days but there are fewer patients and fewer opportunities.

Vulnerable patients such as pregnant and lactating women, those with chronic medical conditions have been asked to stay at home for fear of exposure to COVID-19 in the hospital. So my target audience within the hospital has reduced.

As a clinician, it's sometimes difficult to advocate especially when information and data you put together is confidential and cannot be used to advocate e.g. for increased resource. Sharing such information requires authorization. There seems to be more sensitivity in COVID-19 times with regards to evidence based advocacy.

My life within my community

Community advocacy has come to a halt because I spend long hours working in the hospital. Prior to COVID-19, I would organize small groups within my community and discuss and share ideas of keeping safe from malaria, improving hygiene and sanitation etc.

I am too tired these days.

The lessons learnt

My voice as a clinician, a health advocate and a community member has both conflicting and opportunistic moments.

Conflicting moments because I work in an ideal environment to advocate about health however, COVID-19 has taken away and reduced my target audience.

Conflicting moments because, my long hours at work make it difficult to advocate in my community.

I must think of new opportunities to talk about health. I worry about Health System strengthening.

Moving forward post COVID-19 and Health System Strengthening

What is a health system?

"A health system includes all the organizations, institutions and resources that are devoted to producing health actions whose primary intent is to improve health. A health systems vital functions are; Service Provision, Resource Generation, Financing and Stewardship. [2]

Improved performance in controlling emerging and re-emerging diseases (i.e. malaria, HIV, Meningitis, COVID-19 etc.) in developing countries is dependent on the quality, equity and efficiency of health systems. Rapid progress towards targets for diseases elimination is greatly hampered by weak, poorly functioning or in some cases non-existent health systems.

What do we need to strengthen our health system?

Investing in science, research and technology

African Governments must at least commit 1% of their GDPS to investing in science and technology as encouraged by the African Union. Investing into health system strengthening by increasing health funding is essential. Priority problems for health systems need to be identified and researched in relation to development goals and in consensus with policy makers.

Procuring equipment and consumables

Availability of essential equipment e.g. CT Scanners, MRI and X ray machines, and other medical supplies is essential to help health care workers assess properly, diagnose accurately and treat promptly.

Availability of specialized skilled health care workers

This should be prioritized to ensure people have access to quality health care without the burden of having to travel 1000s of kilometers.

Domestic funding

Funding should be mobilized from within national health systems budgets rather than relying on donor support.

In conclusion, strengthening of health systems is urgently needed to ensure universal health care for all, particularly as the gains made stand to be eroded by COVID-19.

My voice will be increased in my three roles as a clinician, a health advocate and a community member. There may be conflicting times but I will also look for the many opportunities.

[1] The Youth Leaders for Health Program is a joint initiative being implemented by Results UK in partnership with WACI Health, HDT-Tanzania, Hope for Future Generations -Ghana & CISMAT - Sierra Leone. We advocate for increased domestic resources for malaria elimination and strengthening of health systems.

[2] Reference: Strengthening health systems; the role and promise of policy and systems research, Alliance for Health Policy & Systems Research, Geneva, WHO, 2004.