Healing Letter To Nana Addo’s “Ailing” Health Minister

Hon. Minister of Health,
What is ‘so far, so good’ about the IMANI assessment of the one-year performance of the NADAA government that I am reading about on the Peace FM website? What is good about the report if the assessment of the government on health intervention is not worth describing as abysmal, but a failure?

Yes, it is true that Ghana is part of the global world; hence achieving SDG 3 is mandatory. SDG 3 is aimed at ensuring healthy lives and promoting well-being for all ages. As clearly stated by IMANI, to achieve this goal, Ghana needs to meet certain targets such as achieving universal health coverage and addressing any disparities in the health sector that may be due to social and economic inequities within the polity.

Reading from your 2016 NPP manifesto on the health sector, one finds that the NPP made eloquent promises of delivering affordable, equitable and accessible healthcare to the people of Ghana. These promises were so appealing that Ghanaians were presumably persuaded to vote for the NPP party in the last polls.

Analyzing IMANIs report and the various publications related to the health sector performance one does not see any positive intervention in the year under review. The least they could have done in their first year was to present to Ghanaians with road maps or blueprints of what they intended to do to improve upon the impressive legacy of remedial interventions that the last government had begun and bequeathed to them.

Let us take a look at the three powerful adjectives (affordable, equitable and accessible) they used to describe how they intended to manage the health sector

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_AFFORDABLE HEALTHCARE_
Mr. Minister, where is the affordable healthcare you promised? Not only has cost of health services not been maintained at the levels the Mahama government left it; it has actually shot up, with the effect that patients are now seeking unconventional means to treat their maladies. Fake doctors and nurses, and quack herbal medicine practitioners and spiritual healers are having a field day. I would have thought you would preoccupy yourself with getting Parliament to slash taxes on the importation of health products in order to, at least, maintain or reduce fees charged on drugs at our various dispensaries and pharmacies. This way, you might be demonstrating some commitment towards meeting your goal of providing affordable healthcare. So, you see, the ‘so far, so good’ claim has no basis here.

_EQUITABLE HEALTHCARE_
My dear Minister, how do you intend to make healthcare more equitable than what you inherited from your predecessor? I can see from the several media publications that rather than build upon the impressive infrastructural legacy, you have been busy trampling under foot, what your government inherited: halting ongoing constructions of health facilities and abandoning the several projects that were completed by the previous government and only needing to be operationalised by your Ministry. Just to cite one example, Mahama saw it prudent to give the people of Garu-Tempane a befitting hospital, but you came to halt it. This District has a population of over 160,000 people. Sadly, it does not have a hospital.

The highest qualified medical professional in Garu is a physician assistant. It was for this reason the Mahama government decided to provide the district with a facility that comes with accommodation intended to attract health professionals to accept posting to Garu. This action of your government is widening the equity gap and I hope you will take a look at this so you do not incur the wrath of the people of Garu and several others suffering the same predicament. Similar facilities suffering the same fate include the University of Ghana Medical Centre at Legon, the Volo Digital Village, the Bank of Ghana Hospital and several others. Under your watch, HIV cases in your first year have increased by 80% simply because you have not provided funding for the public health division to continue with the good work.

_ACCESSIBLE HEALTHCARE_
The NHIS set up to improve accessibility to healthcare is drowning under your watch. Before the NDC left office the scheme owed providers GH¢ 1.2 billion, accumulated over several years. In your vetting you promised to settle this debt within three months, banking your hopes on the phantom monies that Bawumia said existed. This pronouncement of yours gladdened the hearts of Ghanaians, including myself. However, as the days pass by, the tunnel also gets longer and darker, with no sign of light in sight.

Let me take this opportunity to applaud you for paying off about 50% of the 1.2 billion in one year, this figure cannot be compared to what you promised. But let me ask this incompetent question: What is the current indebtedness of the scheme to service providers? How much of debt has this government added to the scheme? We want to know this because as Ghanaians we have not seen any improvement in the health sector since you took over from Hon Alex Segbefia. My Minister, we are still waiting to see the magic you are bringing to the Ministry and the NHIS. Be warned however that increasing VAT to finance the Scheme will not work. You said during the campaign that there was abundant money for that, you did not say you would force us to squeeze water out of stone by further burdening us with taxes. I remember you said doctors are not good managers of health facilities and I thought you were coming with a magic solution for health managers. Here we are without a single solution to the numerous problems facing the health sector.

_MANPOWER_
The quality of healthcare and accessibility depend largely on numbers and caliber of the human resources. Your government has refused to employ health professionals but has money to pay trainee nurses for the sole purpose of fulfilling an ‘ill-informed’ populist campaign promise. This action of yours has led to several facilities constructed by the previous government deteriorating, denying several communities easy access to healthcare. This action of yours, I repeat, can neither improve the doctor/patient ratio nor the nurse/patient ratio. One wonders why a CEO will find it prudent to use the limited money available to his/her company for student allowances at the opportunity cost of employing existing professionals to fill several vacancies in the company. What is ‘so far, so good’ in the assessment in this regard?

_UNEMPLOYED HEALTH PROFESSIONALS_
Statistics available at the MoH indicate that over 21,000 nurses are waiting for clearance to put their skills and knowledge to work. The breakdown is as follows: 4,745 community health nurses, 7,229 enrolled nurses, 1,037 registered community health nurses, 437 registered mental health nurses, 3,108 registered midwives, 7,217 registered general nurses and over 2,000 medical doctors of various categories. In the abundance of water my people are dying of thirst. Mr. Minister, it appears you do not appreciate the implications to the achievement of SDG 3, of getting these people engaged. That is why your government would prefer, instead, to use that money to pay allowances. Engaging these professionals will go a long way to reduce the workload on the existing nurses and doctors; it will allow you to operationalise facilities completed by the previous government; and the end results will be improved access and reduced inequities.

Is the problem a lack of money? No, Mr. Minister! Money is not the problem. What you need to do is to prioritize. With the GH¢149 million spent on trainee nurses in 2017, you could have catered for a year’s wages and salaries of 14,243 enrolled nurses or 9,189 staff nurses on a gross salary of GH¢871.75 and Gh¢1,351 respectively. Couldn’t this have improved productivity? Or, perhaps, you do not have health economists to advise you? I have seen in the 2018 budget another misapplied GH¢312 million earmarked for trainee nurses’ allowances. This is really incredulous! Meanwhile the two-paragraph statement in the budget dedicated to health does not state how much will be spent to engage the over 21,000 health professionals wasting away at home.

Mr. Minister, with GH¢312 million, you could engage for a year all the unemployed nurses in Ghana and about a 1,000 newly qualified nurses. What is ‘so far, so good’ in this assessment? The NPP 2016 manifesto also promised to improve upon the emergency services delivery system. For the past one year we have not seen even a blueprint to give an idea of what the Ministry intends to do to achieve this goal. Let me borrow someone’s phrase, ‘This Minister is too slow in learning’. Almighty NADMO is no more crawling on its knees but is actually lying prostrate on its belly, while the National Ambulance Service is grinding to a halt with only 55 functional ambulances from the 165 handed over to you. Training of emergency professionals (emergency physicians and nurses, trauma and orthopedic surgeons) has not received any attention from you. So, tell me, what is ‘so far, so good’ about the assessment?

_IN SUMMARY_
The assessment of the one-year NPP government so far is not good at all for the health sector. Accessibility has become difficult because the NHIS they promised to ‘revive’ is diving nose down; they presumably cannot find the money they claim existed to settle providers. The disparity in healthcare delivery is widening up because they have refused to operationalise several facilities after they have been completed by the previous government, awaiting the Minister to introduce some reforms. If Ridge Hospital was running well as envisaged, there would not have been the need to fly our Vice President to the UK with all the related expenditure. Healthcare has become less affordable because we have many patients chasing after few professionals. And while the unemployment rate among health professionals is on the rise, government is busy spending the little money we have on fulfilling a silly campaign promise of ‘re-introducing trainee nurses’ allowances. Where is the sense in training them with allowances to become jobless? Is it also true that there is shortage of syringes in the public hospitals? I will be watching to

Yours on health alert,
Assibid Dauda
The Binduri Youth Activist