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STAR-Ghana Convenes discussions on the State Of Healthcare Delivery in Ghana

STAR Ghana in Partnership with the Ghana CSO Platform on the SDGs, the Graphic Communication Group and ten CSOs in the ten regions of Ghana including the Presbyterian Health Service of Ghana, ANSKET, the BAOBAB Market (led by the GDCA), AHEFS, ARII, BANGO, Coalition of NGOs on Health (led by HERO Network), PRONET and Omega Project Management Foundation organised a national dialogue on health under the theme:  “Ensuring sustainable and equitable access to quality health services: Prospects and Challenges” from November 29 – December 14, 2018.

The nationwide dialogue was necessitated by the need to initiate and catalyse conversation on the poor and increasingly inaccessible healthcare delivery to Ghanaians. The sources of health financing in Ghana have remained largely the same over the years with only about 50 percent of the budget coming from the government of Ghana. Compared to twelve other lower middle income countries, Ghana’s spending on health is quite low (Aikins and Koram, 2016). The HSMTDPII warns of financing challenges ahead as 71 percent of expenditure on preventive and public healthcare is sourced from development partners and the remainder (29 percent) sourced from government and NHIA (MOH, 2015).

STAR Ghana Foundation being the centre for active citizenship as well as the champion of accountable and responsive governance is very concerned with the quality and the availability of social services delivered to the people of Ghana. STAR Ghana Foundation primarily carries out its core mandate of ensuring accountability and responsiveness in governance via the 3C and L which stands for Convening, Catalysing, Coordinating and Learning. The 3C and L is a non-grant making strategy that seeks to position STAR-Ghana as a convener of civil society spaces, a catalyst of key actions and a coordinator of processes with an overarching end of identifying key learning curves to facilitate good governance and active citizenship.  Consequently, STAR Ghana Foundation through its eagle eye is constantly on the lookout for topical and emerging issues that threaten sustainable and quality delivery of social services to the Ghanaian public.

It is along these lines that STAR Ghana Foundation identified both rooted and emerging challenges saddling healthcare delivery in Ghana and sought to catalyse conversations among key stakeholders on healthcare delivery in Ghana.  

The convening sought to achieve the following objectives:

  • To create a space for critical and constructive dialogue on the health sector, thereby, enabling the perspectives of key stakeholders to be surfaced and discussed;
  • To identify opportunities for collaboration among and between key stakeholders to sustainably address the health challenges in Ghana;
  • To identify entry points for catalysing and coordinating stakeholders’ issues with support from the STAR-Ghana programme.

The convening were organised across the ten regions of Ghana by CSOs based in these regions. This was to ensure the localisation of the issues discussed at the regional levels. Consequently, each region had a theme that was of relevance to their local context. In the Upper West Region for example, the theme was “Ensuring Access to Quality Health Care Services: Leave No One Behind” whilst in the Ashanti Region, the convening was captioned “Regional Dialogue on Right to Health”. 

The convening brought together a wide range of stakeholders from CSOs, government institutions, health practitioners and the general public. The resource persons used for the convening were a mix of technical experts from the national level and regional resource persons. To mention a few, some of the resource persons who contributed to the regional convening were: George Osei-Bimpah, Director SEND Foundation and Co-Chair of the CSO Platform on the SDGs, Dr. Ernestina Dankyi, the Centre for Social Policy Studies, University of Ghana, Legon Dr. Antoinette Tsibu-Darkoh, the the Centre for Social Policy Studies, University of Ghana, Legon, Dr. Gilbert Buckle, Former CEO, Korlebu Teaching Hospital. Also, present during the Accra convening were some members of the parliamentary select committee on health.

The outcome of the convening cannot be overemphasised. A total of about 700 participant were directly reached by the convening and over 10, 000 people were reached via the live radio broadcast in nine of the regions and Facebook live streaming by both Daily Graphic on https//www.facebook.com/dailygraphicghna/ and our partners in the various regions. Cross cutting issues were raised and discussed at the various convening.   The NHIS was one of the most trending issues raised and discussed in all ten regions. The issue of quality healthcare under the NHIS, the delays of payment of claims to service providers leading to delays in the release of medical supplies as well as delays on the part of the contractors of medical supplies.

The most worrying and to some extent retrogressive trend with regard to the NHIS was the re-centralisation of payment of claims. While, the entire country is moving towards decentralisation, the NHIS was moving towards centralisation. The financial challenges of the NHIS was among the issues discussed-mention was made of the unrealistic premiums paid by beneficiaries of NHIS. Some participants suggested the increment of taxes on health impeding products such as cigarettes as a measure of augmenting the NHIS. The skewed distribution of health personnel, especially doctor/patient ratio was particularly topical in the northern part of Ghana. There is however, a glimpse of hope as the approval of doctors’ salaries is now decentralised. Thus, the power of incorporating doctors’ names into the payroll has now been given solely to the regions and until doctors report to the regions, their names will be withheld. Nutritional need of pregnant women, children under five and lactating mothers were also discussed dispassionately.  

Relevant and thought provoking ideas and recommendations were proposed in each of these convening.

  • The rate at which appointments to the NHIA is politicised is of major concern to many stakeholders. They called for the need to depoliticise appointment of the top hierarchy of the NHIA in order to allow for continuity.
  • There was also caution to the NHIA on the centralisation path they have undertaken. The centralisation of the payment of claims is blamed for the delays in the release of funds to service providers which in turn, delays the entire health delivery process.
  • Participant and stakeholders also recommended the raising of the premium to realistic levels and the taxation of products that affect the health of the public.
  • It was also proposed that more effort should expended into preventive healthcare. This was especially emphasised with regards to the nutritional needs of the children, Pregnant women and lactating mothers.

Next Steps:

  • The reports from the various regions shall be collated into a single report to provide a broader picture on the key health concerns of the people of Ghana.
  • Various reports from the technical experts will also provide a nuanced perspective on the health needs and concerns of Ghanaians. These reports shall be developed into a policy brief for dissemination to the ministry of health and development partners to inform them on the needs of the various regions and the needed interventions in these regions.

At the heart of the STAR Ghana Foundation’s 3Cs is learning. The ultimate goal of the convening is to identify major learning events capable of influencing social service governance for the better. A key learning curve that emerged during the convening was the concept of the district father or parent. This concept is used in the Upper West Region as a means of tracking the nutritional performance of the various districts in the regions. This is a practice with a great potential of enhancing nutrition governance in the country. There is therefore the need for further studies into the concept and practice in order to scale it up in the entire country.    

This convening would not have been a success without the support of our partners in the various regions; PRONET-Upper West Region, Presbyterian Health Service-Upper East Region, BAOBAB Market-Northern Region, BANGO-Brong Ahafo Region, ARII-Eastern Region, Omega Development Management Foundation-Volta Region, Ghana CSO Platform on the SDGs-Greater Accra, Coalition of NGOs on Health (led by HERO Network)-Central Region AHEFS-Ashanti Region and ANSKET-Western Region. 

STAR Ghana Foundation sends a very big congratulations for the successful implementation of the health convening.

By: Dr. Maliha Abubakari

(Consultant on the 3C & L, STAR-Ghana)

With Thanks to our Funders

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