Perspectives on NDC’s 2016 Health Manifesto
As would be expected, the National Democratic Congress (NDC), as the ruling government, starts its 2016 Health Manifesto by cataloging the government’s achievements in the health sector before launching into a number of post 2016 health initiatives.
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Can the government legitimately claim credit for massive infrastructural developments, improvements in our life expectancy, declines in HIV infection rates and improved survival among mothers and children?
To many, this may be a moot point. Recently, a few have sought to argue that government can and should only claim credit for those interventions for which it has directly accessed funding and/or perhaps initiated. Of course I do not agree with this view. To the extent that the government of the day manages the environment within which public bureaucracies work, including the provision of resources and policy direction, it is only right and fitting for any government to take full credit for any achievements that may be recorded.
Maternal mortality rates
To this extent, the NDC government lays claim to increases in the life expectancy of Ghanaians by three years from the 2008 baseline of 60 years and well above the sub Saharan average of 56.8 years.
Similarly, relative to 2008, infant, child, under five and maternal mortality rates have all recorded significant declines.
In the area of under-five mortality, although Ghana failed to achieve Millenium Development Goal (MDG) of 67 per cent reduction, Ghana’s Demographic Health Survey showed clearly that the country had maintained its downward decline by recording a further 25 per cent decline in under five mortality rates between 2008 and 2014. Transmission of HIV from mother to child has reduced by 50 per cent and annually recorded deaths due to HIV reduced by 43per cent.
Investments in health infrastructure
By far, the greatest concrete achievements of the NDC government over this period lie in the massive investments in health infrastructure. And it would appear the government does not shy away from making this claim in the manifesto.
Among the many achievements listed are the expansion in the Tamale Teaching Hospital by an additional 400 beds, the state of the art 617 Legon Teaching Hospital, commencement of the construction of the 500 bed Military hospital in Kumasi, the massive Ridge Hospital expansion project into a 620 bed facility, design, construction and equipping six new district hospitals and expansion of many others in CHPS compounds, health centres and polyclinics.
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Also making a difference to the equipment needs of many facilities has been the medical equipment replacement programme initiated by the government which saw “the MRI machines, CT scan, fluoroscopy machine, x-ray machines, digital mammography machines, oxygen plants and ambulances to over 150 hospitals across the country.”
What is the overall effect of this massive infrastructural developments? Presumably, access to healthcare will improve at various levels. And with access to care, will inevitably come the cost implications of providing care. Indeed, the section of the manifesto that dwells on the National Health Insurance Scheme (NHIS), points to ever increasing figures in outpatient utilisation from 9.3 million in 2008 to 29.6 million in 2015 accompanied by significant ballooning of the amount reimbursed to health facilities in claims from GH¢183 Million in 2008 to GH¢1,073 billion in 2014. Clearly, the sustainable financing of healthcare will be a critical issue to address going forward.
On this score, I am of the impression that the NDC manifesto did not do sufficient justice to the issue of sustainable funding, beyond identification of the need to diversify funding sources of the scheme to include a proportion from the petroleum revenue. The manifesto was manifestly weak in the extent to which the government applied itself to the current ongoing proposals to reform the basic design of the NHIS way beyond simply identifying funding sources.
It is instructive to point out that with the current proposal to provide universal coverage for priority primary health care services including maternal and child health care, while instituting other funding arrangements at higher levels, the question of if and how much will be needed in additional funding is yet to be actuarially determined.
The reforms will therefore fundamentally change the current funding arrangements including addressing claims reimbursement delays, access for high priority conditions, and hopefully address the question of financial sustainability of the scheme.
Overall, I would strongly argue that by failing to acknowledge the proposed reforms in its 2016 manifesto, government has succeeded in communicating mixed signals about its commitment to bold radical reform.
Closely linked to access is quality of care, quality defined in terms of the extent to which care aligns with evidence based best practices by a motivated health workforce. Reading the manifesto, one gets the impression of various quality related initiatives that are not necessarily presented in a coordinated fashion to address defined population level priorities.
A key population priority will be maternal and newborn health, but here again, beyond stating its commitment to a 50 per cent reduction in deaths, there is no indication about any breakthrough interventions to drive performance over the coming years. On improving quality of care, the government woefully fails to do sufficient justice to current ongoing initiatives within the health ministry to propose a harmonized national healthcare quality strategy.
Mental Health
When it comes to mental health, there are many initiatives for which I will always credit the NDC government for throwing more light to this otherwise dark area.
The determination of the government in passing the mental health act (Act 846) in 2012 was wholly commendable.
Globally, Ghana’s mental health act has been hailed as a shining example of a modern approach to care that integrates community based approaches to the relevant facility care.
This significant milestone does not however mask the severe funding and other resource challenges that bedevil issues of access and quality on the mental healthcare front.
Not a day passes without cries from the Accra Psychiatric hospital which in the manifesto, government intends to relocate to Pantang.
Without a serious look at the funding of mental healthcare, and greater proactivity from the mental health Board to fully activate the provisions of the act, while independently leveraging resources available through the global Mental Health networks funding innovative work, issues of inability to feed patients, stock out of essential drugs and general demotivation of staff etc. may be with us for a while.
In the manifesto, although the government advocates “mainstreaming mental healthcare”, it was not immediately obvious to me how these concrete challenges will be addressed. The emphasis on “training of more psychiatric specialists (doctors and nurses), encourage more psychologists and allied professionals” is however commendable.