Ghana’s Epidemic Preparedness Fund: A story of the two builders?
A popular Biblical story or parable is told of two builders in the teachings of Jesus Christ. One built his house on a rocky foundation but the other chose to build his house on sand. They all completed their buildings and went into it, probably with their families. It was not too long after they had moved into their houses when their buildings faced an unexpected test in a form of storm, rain and floods.
According to the Bible, the rain came down, the streams rose, and the winds blew and beat against the house that was built on rock; yet it did not fall, because it had its foundation on the rock. However, when the other house whose foundation was built on sand, was subjected to the same condition, according to the Bible, “it fell with a great crash.” This is recorded in Matthew 7:24-27.
Building on the sand is much easier than building on the rock. It costs less, it is faster and requires less effort. And so, the unwise builder, who did not consider what the future holds for his building decided to ignore his security and built his house on the sand.
Even though the story has more theological meanings or interpretation than that of health, this story teaches an important lesson—preparing for the unknown. Just as preparation and making the right decisions are key in building, such conditions are equally critical in the health sector, particularly in the area of public health emergency preparedness.
Epidemic preparedness is key in the health sector. The reason is that one cannot tell when an epidemic will occur and because we cannot tell when an epidemic will occur, the best thing to do is to prepare our health systems such that they can easily absorb any shocks that may occur in the form of disease outbreaks or public health emergencies.
Just as the builder who built his house on rock and prepared for the unknown future saved himself and his family from the unexpected natural disaster, making preparation for public health emergencies will not only save lives, it will not put a strain on the national budget for an unplanned expenses. This is because the system has been designed to take up such challenges and so it will not be taken us by surprise.
Failure for us as a nation to make provisions for public health emergencies will only cause us to suffer the calamity that the unwise builder suffered. The reason he suffered was because he did not think about those natural disasters and therefore did not prepare his house to face such challenges.
Threats of epidemics
We are constantly threatened by epidemics. It is for this reason our elders say “no one knows tomorrow.” The fear of the unknown only calls for preparation. Even though nobody wishes to experience any epidemics in this country, we cannot also rule out the fact that we live in a world where we are not immune from experiencing epidemics.
Ghana has experienced a number of disease outbreaks including Chickenpox, Cholera, Measles, Meningitis, Yellow Fever, Marburg virus Disease, Lassa fever, Monkey Pox, and COVID-19 pandemic. These epidemics should serve as a lesson for us to prepare ourselves for other epidemics.
The difference, however, is that those who prepare for epidemics are not overwhelmed when they encounter such incidents. But the same cannot be said for those who do not make any preparations for them at all.
Why epidemic preparedness
Epidemic preparedness is not only about putting aside dedicated funds, it includes but not limited to building the capacity of health workers and health institutions to remain ready to face any unplanned public health emergencies.
It is for this reason that SEND Ghana, a civil society organisation (CSO), rallied its network members to petition the Presidency and Parliament for the establishment of a public health emergency fund (PHEF) to enable the country to respond adequately to epidemics. The petition received endorsement from almost 600 individuals and other CSOs in 2022.
According to SEND Ghana and its partners, the impact of the COVID-19 pandemic and the strain it put on the health sector underscored the importance of such a fund—PHEF.
The petition said the idea of a PHEF was nothing new but originated from the government itself through a policy to set up the PHEF as part of the country’s Medium-Term National Development Policy Framework (MTNDPF) from 2022 to 2025.
“Such a fund will be critical in helping increase resilience in Ghana’s health system to prepare and respond with urgency to current public health risks and future epidemics and pandemics,” the petition indicated.
The petition further indicated that even without any new epidemic, the country continue to experience re-occurring disease outbreaks such as cholera, meningitis and influenza, which needed to be handled effectively and efficiently.
For SEND Ghana, “Responding too late to disease outbreaks costs lives and affects economic growth, national security, and the well-being of people. The poorest and most vulnerable people in developing economies such as Ghana are the most affected.”
Epidemic preparedness fund is constitutional
Ghana scored poorly in the 2021 Global Health Security Index, which was a measure of countries' preparedness to prevent epidemics. The country scored 27 out of 100 with no change from 2019. This means that there is more work to be done, particularly in the areas of building infrastructure, acquiring medical logistics, developing human resources, and investing in health research.
A Public Health expert, Mr. Augustine Donkor believes that a fund to help the country deal promptly and adequately with epidemics, including pandemics was in line with the directive principle of state policy enshrined in Article 34 of the 1992 Constitution which promotes the right to good health.
Article 36 (10) of the 1992 Constitution makes it mandatory for the state to safeguard the health, safety and welfare of all persons in employment.
Mr. Donkor said the country was a signatory to the Abuja Declaration which makes it a duty for the country to allocate at least 15 per cent of its total expenditure to the health sector.
He expressed the concern that for more than two decades after the signing of the Abuja Declaration, the country has still not met the targets of the Declaration.
For instance, the World Bank has established the Pandemic Fund, a financial intermediary fund for pandemic prevention, preparedness, and response to strengthen the capability of low-income and middle-income countries (LMICs) to address crucial health system gaps through investments and technical support.
For her part, Dr Agnes Amoah, an epidemiologist, explained that funds were needed to build the capacity of health workers and institutions so as to prepare them for epidemics.
She noted that even though it is important to have a dedicated budget for epidemics, if the government did not build the capacity of the health workforce before epidemics, allocated funds alone might not help to address disease outbreaks.
"We should be building our capacity in all aspects and also saving and mobilizing funds for epidemic preparedness. We must get to the point where we are ever ready to face any disease outbreak,” she noted.
Dr. Amoah said the country needs a robust and resilient health structure to aid research into diseases for timely detection of future epidemics, calling on the government to establish modern Centres for Disease Control in all the regions of the country.
The Director of the Kintampo Health Research Centre (KHRC), Dr. Kwaku Poku Asante also called for more support for health research centres across the country, explaining that strengthening the existing health research centres will contribute greatly to the country’s health sector in timely detection of diseases.
He said considering the strategic location of Ghana where many people transit through the country’s borders, the country was more susceptible to diseases, hence the need to strengthen its surveillance and health research.
For him, health financing is very critical to effective healthcare delivery.
Conversion of COVID-19 Fund
Some advocates for PHEF, including SEND Ghana, have even called on the government to convert the COVID-19 Trust Fund into the PHEF fund.
The COVID-19 Health Recovery Levy, 2021, Act 1068, was enacted by Parliament in 2021 to impose a special levy on the supply of goods and services and imports to raise revenue to support COVID–19 expenditures and other related matters.
The COVID-19 Fund since its creation has mobilised some substantial amount of money. Data released by the Ministry of Finance (MoF) within eight months after the fund came into operation showed that an amount of GH¢773.93 million had been mobilised. The figure has since increased to GH¢889 million by the end of 2021 and GH¢1.14 billion in 2022 with the government anticipating to collect some GH¢2.5billion this year—2023.
Even though the World Health Organisation (WHO) on May 5, 2023, announced that COVID-19 was no longer a Public Health Emergency of International Concern (PHEIC), with President of Ghana, Nana Akufo-Addo also declaring same in Ghana on Sunday, May 28, 2023, the President however appealed to Ghanaians to continue to pay the COVID-19 Levy.
The Presidential Advisor on Health, Dr Anthony Nsiah Asare, does not seem to agree with those calling for the COVID-19 Fund to be converted into PHEF. He said the process is not an easy one as perceived by PHEF advocates.
He said the COVID-19 Levy was created by an Act of Parliament and to convert it into other uses must also go through the same parliamentary procedure.
He, however, said government was seriously considering setting up an epidemic preparedness fund.