Mahama's Free Primary Health Care, A Policy Hypocrisy! Hon Abilolo Vents!

Ghana’s health sector is quietly bleeding out and yet, somehow, once again, our country so robbed of its fortunes by our fixation on optics over substance, is being asked to applaud a populist headline. On one hand, an estimated 45,000 to 50,000 trained nurses and midwives are sitting at home unemployed, frustrated, and forgotten. This backlog as you may know, did not appear overnight but has been as a result of years of fiscal constraints, delayed postings, and a clear lack of political will. Yet on the other hand, walk into any clinic, CHPS compound, or district hospital, and you’d find them confronted with critical understaffing, overworked professionals, and facilities that struggle to deliver even the most basic services consistently. Beyond the question of inefficiency, I deem this situation a structural failure. And it is against this grim backdrop that John Dramani Mahama and the National Democratic Congress we have known for their incompetence and deceit, have decided to announce “Free Primary Health Care” as some flagship intervention. On paper, it sounds noble. But as a Public Health Policy expert, let me say this plainly: making primary health care free under current conditions is a misplaced priority; more political than practical, and more theatrical than therapeutic.

So what does “Free Primary Health Care” actually mean in policy terms? Essentially, President Mahama’s proposal suggests removing user fees at the primary health facilities level. It targets largely CHPS facilities and health centres; while expanding access to basic services like maternal care, outpatient visits, and minor treatments across various levels of healthcare delivery. The intention though clear enough: reduce financial barriers so more people can walk through the doors, there remains a fundamental flaw that no press conference or government propaganda can gloss over! Access is not just about cost. Access as a health indicator, is about availability of staff and logistics, readiness of staff and logistics, and quality of staff, logistics and service. You need these as a precondition to create demand for healthcare! So you can deceive your way as a government with all the power to make and declare something free, but if there’s no one to deliver it, nowhere functional for patients to receive it, and nothing to treat you with, then the so called free service becomes just an illusion! Unfortunately, majority of Ghanaians struggle to grasp this level of detail and that largely accounts for our Impoverishment as a country under the rule of clueless folks.

Let me put it bluntly: declaring services “free” does not magically produce nurses, midwives, doctors, equipment, medicines, or functional infrastructure. We need to be brutally honest with ourselves. I was heartbroken to have seen a beautiful lady graduate midwife selling ice cream in Kumasi at a time many CHPS zones today do not have skilled birth attendants. The most recent Harmonized Health Facility Assessment conducted by the Ghana Health Service, revealed some health centres lack essential drugs. Others operate with minimal, exhausted staff who are already stretched beyond reason. So when the NDC runs to town to herald a free primary health care, we have to ask the uncomfortable question: free care, provided by whom? Delivered where? Using what equipment? These are not rhetorical jabs but unanswered questions at the heart of a policy that feels rushed and empty.

And this brings us to the unemployment crisis, which is arguably the biggest policy blind spot in this entire conversation. While the government announces free services, tens of thousands of trained professionals remain at home, watching from the sidelines. Think about the irony for a moment! Lol! Ghana trains nurses at public cost, leaves them unemployed, and then turns around to claim it is expanding access to healthcare. That is an indefensible travesty of sound reasoning.

A rational policy sequence would look very different. First, you create fiscal space with prudent economic management. Then you absorb those unemployed nurses and midwives into the system while you strengthen facility readiness. I speak of drugs, equipment, logistics, etc. And only then, can you expand access mechanisms, including the trending mantra of cost removal. Instead, what we are witnessing is the exact reverse: as the manner of the NDC typically is, demand is being politically stimulated without supply being structurally prepared. I am appalled to identify this as health policy. It is a recipe for chaos.

Now, let’s not ignore the political undercurrent here, because pretending this is purely about health would be naive. The New Patriotic Party has historically dominated the narrative on social interventions with the introduction of the NHIS, Free SHS, LEAP expansion, MASLOC, etc. The NDC, in contrast, has often struggled to point to signature social policy wins that resonate the same way. So this “Free Primary Health Care” announcement feels less like a carefully considered strategy and more like a rushed attempt to claim social intervention credibility without the systemic groundwork, required to back it up. Public health policy must be sequenced, financed, and system-driven, not reactionary and not reduced to campaign slogans dressed in scrubs.

If we are genuinely serious about strengthening primary health care, the most logical path has been sitting right in front of us all along: expand physical access, staff the system properly, and equip the facilities to function. That brings us to the NPP's Agenda 111. Under the Akufo-Addo-Bawumia administration, the Agenda 111, was designed to build hospitals in underserved districts; indeed at least one in every district across Ghana, improve geographical access, and strengthen referral systems.

Yet today, many of these facilities remain abandoned, unequipped, and unstaffed ghost structures that offer no care to anyone. Now imagine the alternative. Imagine completing those Agenda 111 projects, equipping them properly, employing those thousands of unemployed nurses and midwives, and strengthening CHPS referral linkages. That would be real primary health care strengthening; not slogans, not photo ops, but real systems straightening. Instead, we are being offered a free sticker on a broken machine. Awerɛhosɛm!

And while at it, let’s talk about health promotion, because primary health care begins long before a patient walks into a clinic. It begins with clean water, safe food, and a healthy environment. And here, the contradictions deepen dramatically. John Dramani Mahama has publicly reduced healthy living conversations to simplistic lifestyle remarks about eating Banku at night, even as galamsey continues to poison our water bodies, contaminate our food systems, and expose entire communities to long-term environmental health risks. What makes this even more troubling is that he acknowledges actors within his own party are involved in this galamsey. Yet instead of declaring a full-scale public health war against environmental destruction, we are offered “free care” for diseases that policy failure is actively creating. We cannot be blind to call this governance approach any other, than a policy hypocrisy at its most dangerous manifest state.

Let me highlight a critical truth as clearly as I can: free does not mean functional. Free health care does not mean available care. It does not mean quality care. It does not mean timely care. And most importantly, it does not mean there are professionals to deliver it. I think President Mahama and his NDC government must realize they cannot treat what is not there, and certainly cannot staff a promise with ghosts.

So what should the real priority be if this government is serious? First, immediately employ the more than 45,000 unemployed nurses and midwives; absorb them into the system and put their training to use. Second, complete and operationalize Agenda 111, turning concrete and steel into actual service delivery points. Third, equip existing Primary Health Care facilities so that drugs, equipment, and logistics are not a gamble every time someone seeks healthcare. Fourth, launch aggressive health promotion; treat Galamsey as the public health emergency it is, protect our water and food systems like lives depend on it, because they do. And finally, build sustainable financing before expanding any “free” policy in fiscally grounded reforms and not the usual politically driven declarations.

I will end here by reminding the NDC that the era of promises is over. The National Democratic Congress is no longer in opposition! It is in government and have been endued with all of Ghana's powers to fix things. And governance demands more than announcements, emotional appeals, or political balancing acts. It demands coherence, discipline, and prioritization. A “Free Primary Health Care” without capacity is not reform but vain rhetoric. And Ghanaians deserve more than symbolic policy gestures. We deserve a health system that actually works.

Thanks for reading!
Michael A. Sarfo-Kantanka
[email protected]