Epidemic Preparedness Financing: key to improving public health – experts
“If there is one thing that must be learnt from the outbreak of COVID-19 in Ghana and by extension across Africa, particularly sub-Saharan Africa, then, it should be how to raise enough funds in preparation for epidemics financing.”
Public Health Advocate, Mr Augustine Donkor who made the above statement in an interview, believes that failing to institute measures to raise funds or increase budgetary allocations in Ghana for epidemics preparedness would only expose Ghana’s public health to danger in the near future as epidemics continue to emerge.
For him, there is nothing like waiting for the danger to strike before preparing to face it or protect yourself against it.
“It is only the fool who waits for adversity to happen before thinking about escape. If are we to act to protect our public health sector and health facilities, we need to set aside enough funds for epidemics and outbreaks,” he notes.
The case of Prof Jacob Plange-Rhule
Epidemics do not alert before they strike and when they hit, they hit so hard, sometimes taking to the grave the very best of any country. That is why the circumstances that led to the death of Ghana’s renowned surgeon and teacher, Professor Jacob Plange-Rhule still remains fresh on the minds of many people, particularly those in the medical profession.
Prof Jacob Plange-Rhule, who was Rector of the Ghana College of Physicians and Surgeons, died on April 10, 2020, at the University of Ghana Medical Centre where he had been receiving treatment at the Intensive Care Unit after testing positive for COVID-19.
Granting an interview on Accra-based Joy News’ “News File” weekly show after the death of the renowned surgeon, Dr Anthony Nsiah-Asare, Presidential Advisor on Health, said government tried its best to save the life of Prof Jacob Plange-Rhule but to no avail.
Dr Nsiah-Asare explained that Prof Plange-Rhule’s doctor had requested for Actemra, a drug used in the treatment of Rheumatoid Arthritis to be administered on the ailing physician, adding that Actemra until the request, had not been licensed for use in Ghana and that the only place they could get the drug was either in Kenya or South Africa.
For this to be done, Dr Nsiah-Asare said an instruction from a higher authority was needed, so President Akufo-Addo was contacted, disclosing that President-Akufo-Addo immediately released the Presidential Jet to be used to get the drug into the country as soon as possible.
“We used the Presidential Jet within a matter of 24 hours to bring the drug but unfortunately by the time it reached here, my good friend was gone,” Dr Nsiah-Asare said on the News File show.
Prof. Plange-Rhule’s case represents one of the many instances where we have lost industrious sons and daughters of the country to death who could have been saved if we had adequate emergency response systems in place, such as epidemic preparedness financing.
Explaining further why there is the need to set aside enough funds in preparedness for epidemics, Mr Donkor said, “COVID-19 reminded the world that a disease threat in one country can be a threat to all. Countries that prioritise and invest in systems to find, stop and prevent epidemics are better prepared — saving lives and protecting economies.”
He said the COVID-19 pandemic revealed critical gaps in epidemic preparedness across low, middle and high-income countries, resulting in devastating social, economic and health impacts.
For him, if countries, particularly low and middle income countries had prepared ahead of the pandemic, at least, it would have lessened the impact of the pandemic on such economies and on the populace.
Mr Donkor said, for instance, that when vaccines started coming up for COVID-19, it was the countries with the financial muscles that were procuring them for their citizens, leaving the poor countries to their fate.
He said had it not been the COVAX offer, many countries in Africa would have been left out of the list of countries that procured COVID-19 vaccines for their citizens.
COVAX, which means ‘COVID-19 Vaccines Global Access’, is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization, alongside key delivery partner, UNICEF.
“So you ask yourself, if COVID-19 vaccines should have been sold to African countries, how many countries could have afforded them? Certainly only a few countries could have done so. That is why it is important to set aside money for epidemic preparedness financing,” Mr Donkor noted.
He said many African countries do not have budgets set aside solely to fight epidemics, stressing that many African countries are often overtaken by events before they find solutions, particularly when it comes to epidemics financing.
For him, increasing funds allocated to epidemic preparedness and response would help to position the country to better prevent and contain outbreaks when they occur.
“How quickly and effectively countries respond to a new outbreak matters. Countries that use their preparedness systems and can trust and rely on leaders who communicate clearly, engage with their people and use data-driven policies to slow the spread are most likely to save lives,” Mr Donkor noted.
He is of the view that epidemic financing helps nations to track, monitor and marshal early preventive response to epidemics, saying that disease epidemics have the capability to thwart any economy, overwhelm their health sector, and burden their national kitty.
“Epidemics like COVID-19 grounds everything—it stalls economic growth and gains, make nonsense of your little resources and overburden your health sector,” he explained.
Even though it is true that nobody buys his own coffin and keeps whilst alive, many people make plans for their funerals. But unlike buying coffins and keeping them, devising ways to generate funds to finance epidemics has become very necessary in any nation that prioritises the health of its citizens. This is because diseases, particularly epidemics remain a major threat to any human society.
Just like death, diseases (epidemics) are inevitable. They had been there and will continue to be with man. Although through research and advancement in medicine and technology, many diseases have been eliminated, there are many emerging diseases which have become threats to public health. This is where the issue of epidemic financing becomes very necessary as it serves as an enabling factor in tackling epidemics on time and effectively.
The Deputy Country Director of SEND-Ghana, Dr. Emmanuel Ayifah, is quoted to have called on the government to increase the Emergency Preparedness Response (EPR) budgets at various government levels to fully fund the National Action Plan for Health Security (NAPHS) implementation and empower the relevant government entities to track and regularly report on NAPHS implementation progress and spending.
For him, disease epidemic has the potential of derailing Ghana’s growth and increasing poverty, and he says “Epidemics of such high magnitudes such as COVID-19 affected economic performance and stalled growth by reducing overall projected Gross Domestic Product (GDP) from 6.8 per cent to less than one per cent.”
The Ministry of Health in November 2020, published “Ghana COVID-19 Emergency Preparedness and Response Project & Additional Financing: Environmental and Social Management Framework” with the objective to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Ghana. It was financed by the World Bank.
For Mr Donkor, Ghana cannot continue to rely on external sources such as the World Bank to support its Emergency Preparedness and Response Projects, saying that it was critical to develop internal revenue streams to finance such policies.
“We have always relied on foreign and donor support to implement our policies. What if those sources fail us? Does that mean that we will no longer get things working?” he quizzed, adding “That is why it is necessary for us to get our own money set aside for some of these things so that in the event of any serious outbreak, we are able to solve our own problem without having to wait for someone to help us before we could take action.”
Ms Gifty Owusua Asiedu, a social media health influencer supports the idea that increasing funding for epidemic preparedness “will help to strengthen inter-governmental, public and private sector collaboration to improve health service delivery and contain future epidemic outbreaks.”
She has therefore, called on the Ministry of Finance to set aside a dedicated budget to finance epidemic preparedness and the implementation of the National Action Plan for Health Security (NAPHS) and the Ghana Centre for Disease Control.
She was of the view that setting aside a dedicated budget by the Ministry of Finance for epidemic preparedness and implementation of the NAPHS would provide adequate response to the threat of epidemics and ensure equitable and effective health care delivery in times of outbreaks of any disease.
Ms Asiedu expressed the concern that due to the COVID-19 pandemic, funding for diseases such as malaria has reduced, hence affecting the gains so far.
“There is no two ways about the fact that COVID-19 pandemic has affected other health interventions such as immunizations, particularly among children,” she observed, adding “Some parents are scared to visit health facilities for their children to be immunized due to the COVID-19 scare.”
She was of the view that many Metropolitan, Municipal and District Assemblies (MMDAs) across the country do not have funds to support epidemic fighting at the district level and would have to rely on the central government.
“Epidemics break out in the communities first. So we need to get the district well prepared before even the national teams come in,” she noted, adding “Unfortunately, we do not have such systems at the MMDAs. Most of the MMDAs do not have dedicated budget for epidemic preparedness financing.”
SEND-Ghana, a subsidiary of SEND Foundation of West Africa, is one policy research and advocacy civil society organisation that has been advocating for epidemic preparedness financing in Ghana.
SEND-Ghana in partnership with the Global Health Advocacy Incubator (GHAI) has been advocating for epidemic preparedness financing in some selected regions and districts to influence the prioritisation of budgetary allocation for epidemic preparedness financing in Ghana.