Prevention is better than cure
I do not think there is a single Ghanaian who believes that the state of our healthcare delivery system is topnotch.
The President’s acknowledgment that the coronavirus (COVID-19) pandemic has exposed the state of our healthcare during his last address to the nation was not a revelation per se, but rather an emphasis on the obvious.
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Of course the deterioration has not been an event, but rather a process, capturing years of underinvestment and the lack of full commitment to ensuring that every citizen, from a street sweeper to the President, is guaranteed decent healthcare in their lifetime should the need ever arise.
That is an important hallmark of a civilised society.
Mr Kwaku Agyeman-Manu — Minister of Health
Silver lining?
One sentiment I have come across over and over is that it is good our borders are shut and seeking treatment abroad for the virus is out of the question, because of the sheer pressure those systems are buckling under, else our political and ‘middle’ class would abandon us and fly out for treatment.
Now we are all in the rickety boat together, come whatever storms. I share that view.
In all of this, one key takeaway of the pandemic is that fact that at present, in the absence of a cure or vaccine, the emphasis is on prevention, hence the constant reminders about social distancing and hygiene protocols, as well as the other measures by government such as the partial lockdown in selected places, the closure of our borders and ban on social gatherings.
The aim of all of this is to contain the virus and prevent its spread. While there is a lot more work to do in public education and it must not relent, I think significant public awareness has been created of this disease to enable citizens to take the necessary steps to protect themselves.
I am not a health expert, but I think healthcare delivery goes beyond shiny hospital buildings, hi-tech equipment and screaming ambulances, critical as they are. I believe that as a nation one of the areas we have not done too well in recent times is preventing diseases in the first place through public education and law enforcement.
Maybe the new national passion for COVID-19 can be carried over to the realms of preventive health. If we can, that would be a silver lining around this dark pandemic cloud hanging over our heads.
‘Tankas’ of old
Many Ghanaians of a certain age would agree that there was a time that it was risky to allow gutters in front of one’s shop or home to become choked, or weeds to overgrow. This was because of a morbid fear of sanitation officers from the town councils (‘tankas’, as they became known) who wielded enormous powers of enforcement and could make your life miserable.
Today, our towns and cities are adorned with filth almost as a spoilt and vain prince would adorn himself with jewels. Of course, this means an increase in malaria, dysentery and cholera cases, which we then spend our scarce resources to treat in our hospitals. It is absurd.
In addition to the poor financial strength of most of our citizens to be able to finance their healthcare, the state of our healthcare system makes it imperative for this country to invest in preventive health as a matter of priority.
Pizza vs kontomire
In February 2020, a former Director-General of the Ghana Health Service and renowned pathologist, Professor Agyeman Badu Akosah, was reported in the Daily Graphic as noting that there was an increasing prevalence of diabetes, cancers, kidney disorders among Ghanaians and urged us to place more focus on our local, unprocessed, natural and fresh foods, in order to prevent the onset of certain avoidable diseases.
Of course, for many younger people especially, the allure of pizza, fried rice or ice cream is much appealing than boiled plantain with kontomire, and probably all the public education on our local foods may not make a dent.
Indeed, many of us love to overindulge not only in junk foods, but in alcohol and risky sexual behaviour.
Perhaps they feel invincible and their mortality is lost on them and public education and admonition may not register in their minds, but that does not mean we should not try.
Public health, the bridesmaid
Public health as a discipline may not be as glamorous as some of the others, but it is crucial to a safe and robust healthcare system. In an online article of May 1, 2020 by Julie Rovner on www.npr.gov and titled, Always The Bridesmaid, Public Health Rarely Spotlighted Until It's Too Late, she explains that “in general, the health care system cares for patients individually, while public health is about caring for an entire population. Public health includes many things a population takes for granted, like clean air, clean water, effective sanitation, food that is safe to eat, as well as injury prevention, vaccines and other methods of ensuring the control of contagious and environmental diseases.”
She goes on to argue that “in fact, it is public health, not advances in medical care, that has accounted for most of the increases in life expectancy during the past two centuries. Well before the advent of antibiotics and other 20th Century medical interventions, public-health activities around clean water, food safety and safer housing led to enormous gains.”
COVID-19 lessons on prevention
I think that one of the things COVID-19 has taught us is to be on the watch and prevent things from happening in the first place. Our health professionals remind us that fruits and vegetables are crucial to our health and must be incorporated into our diets. We must go beyond that.
For instance, the state, with its enormous purchasing power, can incorporate these into the school feeding programme and the dining hall menus in our senior high schools. The upside of this is that aside helping to fortify these young bodies, we get to inculcate a positive eating behaviour that hopefully they will carry into adulthood.
Further, in intensifying public education, our churches and mosques could be drafted in to propagate the message of living well and taking the necessary preventive measures for a healthy life, including sexual behaviour, diet, alcohol consumption and exercise, in addition to the various in-house events organized by many of these bodies to educate the faithful.
We have always had challenges with enforcement, but areas such as road safety is crucial to our health, given the number of people who perish or are maimed on our roads every year and require healthcare.
Sometime in March this year, the Executive Director of Centre for Democratic Development Ghana, Professor H. Kwasi Prempeh, made an interesting suggestion that we could make it a condition for the licences of radio and TV stations to be premised, among others, to carry official health campaigns free of charge. I think it is a laudable suggestion worth looking into and would make a huge difference.
Healthy national cake
Of course, we must continue to invest in the best infrastructure possible to provide care to our citizens. It is unacceptable that 88 districts in this country cannot boast of a district hospital to take care of our most vulnerable citizens, and along with the Ghana Medical Association, I support the President’s bold commitment to ensure that they get their share of the (healthy) national cake. No matter our best efforts, we cannot prevent all healthy casualties and so we must prepare for the inevitable.
But we can, and should, go into COVID-19 mode and make preventive health our shield and our banner in healthcare.
Rodney Nkrumah-Boateng
E-mail: [email protected]