CAUTION: This is not a wholesale discussion or the defense of the drone project. It is simply an analysis of IMANI’s analysis and recommendations.
There are issues we ought to face dispassionately from a nationalistic point of view and not subject our thoughts to the musical chairs of political of personal interests. One of such issues is health. It is incumbent on us all as a people to contribute to the discourse and in doing so, from a point of insight and context to help elevate the discussion.
The problems confronting our health sector spun across several decades encompassing infrastructural deficits, inefficient emergency care, unacceptable expert to patient ratio to mention but a few.
Nonetheless, this piece is limited to the drone saga which has gained prominence in the media landscape with tons of supposedly sacrosanct information churned out from various interest groups most of which fail the litmus test of practical understanding and accuracy.
The substance of the discourse is lost the very moment partisan and egotistic undertones emerge. What will essentially happen is that the two major political parties will have extremist positions with rented voices acting as backing vocalists. This only leads us to a ‘one step forward and a million backwards’ situation. Health related issues must be tackled devoid of the unnecessary partisanship for just one reason: lives are at stake. No amount of debate, reportage and or subsequent funding can bring back lives once lost.
We find the 7 point release by IMANI Africa a faulty one embedded with factual and practical inaccuracies. In its position as a think tank, there are more relevant and contextual issues around the project IMANI should have been contesting.
What is the exact problem the project seeks to solve ? How big is this problem ? What are the other issues confronting healthcare in Ghana? Are those problems claiming more lives than our current inability to do emergency deliveries ? Could the $12 million dollars have solved any of those problems if they really do claim more lives? And if this is the biggest problem our $12 million dollars can solve, could there be a more cost-saving but practical option with equal or possibly even better outcomes? These are relevant opportunity cost questions we should seek answers to from the powers that be. We are interested in these questions and will be happy to set the platform for the Ghana health service to respond accordingly. What we do not come to terms with is IMANI’s posture of expertise on the issue
i. In point 1 of their release, they claim that using the drone service to deliver blood adds an additional cost of $20 per bag. That is untrue. Every unit of blood given to a person is screened. Patients’ relatives pay processing fees at hospitals and convey the blood to wherever the transfusion is to take place. In most instances, relatives travel hours on our terrible roads (which can all paradoxically be fixed with $12 million dollars) to blood banks for the collection of blood and then back to the patient for the transfusion to be done. Put a cost to the time spent and cash paid as transportation cost vis-à-vis the $20 per head IMANI quotes as additional cost added because of drone delivery and it clearly is a smack of ingenuity. In any case, government is this time bearing the cost previously borne by patients’ relatives and also shortening the delivery time. Mind you, this project is not aiming to supply these essentials to patients on admission at Korle bu, ridge or Komfo Anokye hospitals. The screening process isn’t going to change because of drone deliveries. They probably presume that the drone will have to make a return trip with patients’ sample for blood grouping and crossmatching before dispatching the crossmatched blood. They have made this argument on another platform. But that is inaccurate and a cursory look at any doctor’s operational protocol would have schooled them on this matter. No properly trained doctor faced with an emergency situation where a patient needs drone-delivered blood will have to go through that. And those are the kind of situations this project seems to want to address. But well, of course if the doctor is a pathologist waiting to perform a post-mortem on the patient’s dead body, then their assumption will hold. That presumption of an additional $20 cost is preposterous and unfounded. Patients were paying more in cash and time spent. And in some cases, with their lives. That assertion is obviously based on a textbook situation which isn’t what happens in any real emergency setting in our context.
ii. In point 2.a, IMANI alleges that all the supplies for a day can fit into a van and so it is not worth the amount and they go on to propose using a van to do the emergency deliveries. We find it difficult in understanding when a ship full of T-roll became more expensive than a wheel barrow full of polished diamonds. It is about value and not size. The amount of atropine (a very important emergency drug captured in this project) required to save a person in an emergency situation is not even up to a tablespoon full so you don’t even need a van full to save the 500 lives being spoken about as the daily target. Value isn’t in volumes. It’s in the intrinsic quality and usage of the items. The argument of using a van to supply EMERGENCY provisions via our roads in their current state is just untenable. But then again, we can fix all our roads with the $12 million first and then set up the van distribution chain alongside. And when I am told the deliveries are to be obtained urgently and someone recommends vans on our rough roads, then it just exposes the person’s competence with regards to the situation at hand. Maybe we should not allow ourselves to get to the point of needing emergency deliveries in the first place. But that will definitely not cost us $12 million to fix.
iii. In point 2b, they also suggest that ONLY 500 people per day will benefit. Yes, only 500 LIVES. Apparently, it is not so bad to just look on while 500 lives are possibly lost.
The worst error of their analysis comes in when they project the future cost of the project with 50,000 daily out patient department (OPD) attendees. It is called out patient department because the patients don’t stay in the hospital. They come in for non-urgent conditions, receive prescriptions and go back home. They are not patients in need of any form of emergency care. Patients in need of emergency care will be in-patients. We therefore cannot fathom how IMANI is doing projections of people who will need emergency services using figures of the number of people who attend OPDs/ GPs. There is virtually no correlation between the two and we find this totally out of place.
iv. Point 3 rather unfortunately makes a case for the drones albeit not how it should be. IMANI probably wants us to wait till we get all our roads fixed with the $12 million capital for this project and buy 1000 more delivery vans, build district hubs (for the over 200 districts and community health centers) with clinical grade refrigerators before we do anything about emergency deliveries in this country. In the meantime, we can keep losing the number of lives we are losing at the moment. It is alright according to what IMANI will like us to believe. It’s a sacrifice they want the country to afford.
v. Point 4 makes a pointless case, especially coming from a research based think tank. What is the importance of representative trials? Why are researchers keen on choosing appropriate sample sizes and populations for their research works with stated confidence intervals and P values? Isn’t it because you want to be able to replicate the same thing in another geographical location without going through the stress of another trial with its additional cost when you move to new territories? Rwanda has done a trial and Tanzania has also done one. In as much as we don’t admire these comparisons, why do we have to conduct another trial if we can adopt their data, findings, and recommendations and tweak it to suit our own situation? Why push for another trial to waste time and resources?
It is worth noting that 99% of drugs prescribed in Ghana were not trialled in Ghana. So why use them then? How about having local trials for all imported drugs to be sure they are good for us before prescribing them? The data, results and recommendations are already there for us to study and apply but according to the position postulated by IMANI, all of that remain irrelevant.
We must all appreciate that this is healthcare. This is about decisions which put human lives at irreversible risk. Every single day we waste doing nothing is a vote for losing precious lives. Lives which cannot be brought back. Someone’s father, someone’s mother, someone’s wife/husband etc. Timeliness is key in emergency situations. A second is all that may be needed to stop an eternal loss.
But then again, we cannot blame IMANI for their stance. Their god is in Accra. They probably don’t believe that we record more than 500 avoidable deaths in Ghana on a daily basis. So a cost of $17 per head to ensure that essential medical supplies reach the hinterlands is too much money to spend in an emergency situation to save a life.
Our healthcare system must be given a holistic overview/audit to unearth the issues we are yet to come to terms with. Government and all other stakeholders must put in frantic efforts to ensure that the perilous situations are given commensurate redress.
By all means, let us interrogate issues. By all means, let us question those in charge. But let our questions be relevant and contextual. And let them be solution oriented. No pissing in from the touchlines for no reason.
Lives are at stake!
Dr. Kofi Appiah
Mr. George Sarpong