A DIALOGUE WITH THE HEALTH COMMITTEE OF PARLIAMENT IN PROMOTING HEALTH CARE
The parliamentary oversight function is one of the cornerstones of democracy. Strengthened oversight of parliament is a critical factor in influencing an inclusive delivery of public goods and services. STAR-Ghana, for over 10 years has been supporting targeted Parliamentary Select Committees’ engagements with citizens and their issues, so they can better represent them in their legislative and oversight roles. to deliver on its mandate. One of the strategies used by SGF to support parliament to deliver on its oversight function is through the provision of evidence.
Since March 2020, and under its COVID-19 project and Partnership Beyond Aid, STAR-Ghana has supported civil society to generate information around the impact of COVID-19 on health, education, and social protection. Some of the partners it supported include the Christian Health Association of Ghana (GHAG), SEND-Ghana, African Education Watch, and Ghana Developing Communities Association (GDCA)
Eunice Agbenyadzi, Programs Manager
A one-day strategic meeting was held with the Parliamentary Select Committee on Health to discuss findings from the research and implications for policy. The meeting sought to provide evidence to strengthen the capacity of the committee to hold ministries, departments, and agencies to account for ensuring inclusive delivery of health services.
Highlights of reports
Report 1: Rapid assessment of the impact of covid-19 on health services delivery · Generally, Out Patient Department attendance over 12 months declined but Antenatal attendance increased over the same period the previous year. There were also more pregnancies recorded in the facilities assessed compared to the previous year. The increase started in May 2020 (2 months after the first case was reported). This phenomenon could be attributable to the “lockdown” or “work from home” work culture adopted during the COVID season. · Respiratory tract infections declined significantly compared to the G before the first case of Covid-19. Importantly, diarrhoea diseases declined throughout the period probably as a result of the increased uptake of hand hygiene culture. None of the facilities assessed recorded cholera cases. This is the first time in the history of Ghana when there has been no cholera outbreak · Vaccines for immunizations were largely available in all facilities to meet the needs of children on vaccination. However, two (2) facilities were not providing immunization services because there was no cold box or Community Health Nurse. All facilities had hand hygiene facilities installed Recommendations • Personal Protective Equipment (PPEs)– The need for Government to invest in local production and make PPEs a routine component of the consumable supplies • Burden of Disease/outbreaks – Investment in Health promotion holds potential to reduce our healthcare expenditure on disease outbreaks treatment of certain disease conditions. Need to continuously promote hand hygiene, mass masking, and physical distancing given their impact on diarrhoea, cholera, and respiratory tract infections
Report 2: Report on Joint Monitoring of COVID-19 commodities allocations and supplies · It was observed that about 478 different items in different quantities were allocated to agencies and facilities since the onset of COVID. About sixty (60) of them that were common to all facilities · Some discrepancies between items allocated, supplied, and received. Whiles some institutions received the exact items and the amount that were allocated, others did not. Factors that might have accounted for these discrepancies include poor documentation, personal influence on supply, and non-adherence to allocated quantities during supply. · some components of equipment for managing COVID were missing while others were not properly maintained. Critical equipment like Pulse Oximeters that were supplied was non-functional. Furthermore, there were inadequate Biomedical Engineers to service faulty equipment. Thus, maintenance of this equipment had to be outsourced and thereby increasing operational costs to the facilities. Recommendations • An investment in recruitment and capacity development for Biomedical Engineers is recommended to assure continuous working of equipment as well as a reduction in the maintenance cost for these institutions • Staffing and Human Resource: Community Health Nurses must be in every facility, Re-institute 2–3-year mandatory district practice for Medical Officers to keep MOs at the district level · Future allocations, distribution, and supply of COVID-19 commodities should make room for institutions to make requests of what they require or need before items are supplied
Report 3: COVID-19 awareness and adherence to, and effect of government of Ghana’s covid-19 response measures, transparency, and accountability around covid19 inflows and expenditure · COVID 19 Alleviation Program: Majority (67%) of the participants registered their displeasure with how food was distributed, diversions of food items, and bias in the selection of frontline workers and business owners. · COVID-19 Open Budget Survey, 2020: In terms of oversight, the COVID-19 OBS report revealed that the legislature debated and approved the supplementary estimates related to the COVID response, but they had very limited time for the debate and the government had already started implementing some of the emergency response without legislative approval. Funds for the COVID 19 National Trust Fund, which is an extra-budgetary fund also used to finance the response, did not go through legislative oversight. Also, the Auditor General did not announce any special audits or actions to provide additional oversight for COVID-19 related spending Recommendations • Government should de-politicise and adopt a bottom-up approach in planning and implementation of social interventions. Additionally, Government institutions must demonstrate openness and involve CSOs and citizens groups to lead in the distribution of relief items to ensure efficient and effective delivery. • The Auditor General should conduct special audits into COVID-19 related spending, to ensure value for money in the emergency fiscal policy interventions. All COVID-19 commodities including equipment that Government receives, or purchases should be costed before being supplied to institutions • Parliament should ensure Government demonstrates a greater commitment to its policy frameworks such as the Medium-Term National Development Plan Framework (MTNDPF) 2022–2025 (strengthen the healthcare delivery management system); Health policy 2020 (to ensure sustainable financing for health). The SDG target 3. (Substantially increase health financing). Take steps to execute the health sector budget as planned · A proportion or percentage of the COVID 19 levy should be appropriated for the establishment and implementation of the health emergency plan/National Action Plan for Health Security (NAPHS) which include a robust national laboratory system, real-time surveillance, workforce development, emergency response operations, vaccination, medical Center measures, and medicine or vaccine development
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Key Areas for Parliament-CSO joined-up efforts
The following were agreed on actions to be taken on by the Committee:
- Engage Ministry of Finance, Ministry of Health, and Ghana Health Service on health sector budget execution and investment in health promotion
- Engage the NHIS on the medicine price list and the availability of essential but basic medicines for pregnant women
- Hold a stakeholder dialogue on the migration of health professionals especially nurses to the UK and other foreign countries and remodel enrolled nurses’ courses to provide career guidance
- Monitoring visits to selected abandoned health facilities in the country
Social Protection Mechanisms in a Covid-19 Pandemic ; Understanding the impacts, response and lessons
REPORT ON SOCIAL PROTECTION FORUM
Theme: Social Protection Mechanisms in a COVID-19 Pandemic: Understanding the intersection of impacts, response, and lessons
FEBRUARY 2022
1.0 INTRODUCTION
The COVID-19 pandemic has had enormous negative socio-economic impacts and tested the resilience of people across all income levels. However, as with most crises, the poor disproportionately face the largest challenge in coping with economic shocks given their low asset base and social net worth.
Under its COVID-19 Response and Recovery Plan, the government introduced several interventions to mitigate the socio-economic impact of the pandemic on the vulnerable. Measures have included several months of free water and free or subsidized electricity services to public utility customers; soft loans to qualified micro, small, and medium-sized enterprises. The government has also leveraged its main social safety net programs, including Livelihood Empowerment Against Poverty (LEAP) program to support Ghana’s poorest and most vulnerable families.
Under its Partnership Beyond Aid programme, funded by the UK Aid, STAR-Ghana Foundation collaborated with the Centre for Social Policy Studies (CSPS) of the University of Ghana to undertake an analysis of the State of Social Protection in Ghana, examining programs that were deployed in response to COVID-19 and identify new needs that have emerged because of the pandemic that has to be adequately addressed by existing interventions.
SGF convened a forum on February 24, 2022 to share and discuss, findings from the report.
Objectives of the meeting
Participants
Participants were made up of Academia, International NGOs, Donor organizations, Ministries and Agencies, MMDAs, CSO, and professional bodies.
2.0 PROCEEDINGS
2.1 Opening
The program started at 10:00 with an opening prayer, followed by self-introductions. The forum was moderated by Dr. Esther Ofei- Aboagye, Chairperson, Governing Council, STAR-Ghana Foundation.
2.2. Welcome, Address by Dr. Esther Ofei-Aboagye, Chairperson Governing Council, STAR-Ghana Foundation.
Dr Esther Ofei-Aboagye in her address welcomed all participants to the convening. According to her, Social Protection has gained currency over the past 10 years in the country. Ghana formulated SP strategy in 2007 and from the platform-initiated work on Livelihood Empowerment Against Poverty (LEAP), which is a cash assistance program. She stated that the nation over the past years has been looking at ways to structure a response to SP. This led to the development of the second strategy in 2012. In 2016, the National Social Protection policy was formulated and launched. There have been several attempts to have a structured response to Social Protection in all dimensions to contain and include emergencies but the onset of COVID-19 in 2019 brought to the fore the need to have an appropriate shock response mechanism and mainstream these efforts to make sure they are fit for purpose. SGF is dedicated to promoting active citizenship in giving citizens a voice in formulating and responding to issues that affect them. SGF through its project Partnership Beyond AID with funding from FCDO carried out assessments and reports and collaborated with the Centre for Social Policy Studies (CSPS) of the University of Ghana to describe new initiatives and existing policies that were deployed in response to covid 19 in the areas of health, education, and livelihood and the gaps therein. This is to help generate some insights into the way forward.
According to Dr, Esther Ofei-Aboagye, this intervention is timely because the MoGCSP is in the process of reviewing the implementation of the medium-term development plans of the Social Protection Policy and looking for inputs to strengthen the SP bill that is being drafted. She urged all participants to fully participate in the program
2.3 Brief Remarks
In her remarks, she indicated that the UK has always been proud to support initiatives on Social Protection for the vulnerable and provide support to the LEAP Program. They have also over the years invested in the areas of mental health, disabilities, construction of CHP compounds among others. The FCDO committed some funds through SGF to support civil society initiatives to help Government mitigate the impact of COVID on the vulnerable. She indicated that data from the World Bank shows that Social Protection in Ghana has slowed down, the association between economic growth and poverty reduction has also weakened. Ghana
Statistical data also shows that poverty has stagnated which is a concern and a call that more must be done to cushion the poor in society.
She indicated that times like these reinforce the need to strengthen social protection and Social Policy because the well-being of human beings cannot be put on hold, while we figure out the money. There is a need to re-centre social protection and social policy as we talk about recovery and resist the attempt of making the poor, poorer. She expressed her gratitude and appreciation to SGF for bringing on board CSPS to make this country better and recentre Social Protection
Mr. Abloh was thankful to SGF and FCDO for their support over the years. He mentioned that COVID 19 has deepened vulnerability and as a Ministry, they were challenged to respond. There was a panic and knee-jerk reaction to the situation. This exposed the strategies of the ministry to scrutiny. The research as will be shared today will provide the Ministry with an opportunity to scrutinize what has been done and what can be done in the future. He said that the Ministry is currently working on the review plan of the implementation of the Social Protection Policy, also developing a Social Protection Bill and a draft Shock Response Social Protection Strategy and thus the research report is timely to enhance these policies to stand the test of time.
The hon. minister thanked SGF for the invitation extended to her to be part of the program. She indicated that Ghana has achieved favourable socio-economic development and political stability in recent years, made substantial efforts towards improving human development indicators, especially in health and education, and made significant investments in social protection. She admitted that the relatively high rates of economic growth have not benefited the population equally, resulting in persistently high levels of poverty in certain areas, in particular the rural savannah and coastal regions. Her statement also indicated an increase in the number of activities, projects, and programmes related to social protection, such as the National Health Insurance Scheme, the Livelihood Empowerment Against Poverty programme, the School Feeding Programme, and the free maternal health care programme.
She called for a stronger collaboration among all agencies and institutions working on Social Protection to avoid duplication of efforts. She also called for a monitoring framework and set of indicators to measure progress and improve the efficiency of the system.
2.3 Presentation of Report: by Dr. Stephen Afranie, Senior Lecturer, Centre for Social Policy Studies, University of Ghana and Professor Akua Anyidoho, Director, Centre for Social Policy Studies, University of Ghana
Health
· While the government has undertaken several and varied measures to contain the pandemic and control its impact, which include movement restrictions, PPE distributions, isolation, closure of places, there are gender and social inclusion dimensions which require some attention in the design and implementation of the measures. For instance, nose masks and facilities for hand washing were not customised to suit PWDs. The height and entire architecture of some veronica buckets for handwashing were beyond the reach of some PWDs due to the nature of their disabilities. Social distancing protocol was introduced without regard for PWDs such as the blind who needed regular assistants and human support in their daily movements.
· The provision of the PPEs has helped in controlling the spread of the virus, the distribution was skewed towards schools and other formal institutions. People in the informal sectors such as traders at markets, commuters and operators of lorry stations were largely left to the benevolence of NGOs and philanthropist individuals. While children in schools were provided with PPE, their underprivileged counterparts in the streets and deprived communities were not. While there may currently be a lack of comprehensive data on COVID-19 vaccinations, there is every reason to expect that vaccines, as other COVID-19 related amenities and services are as unequal in distribution spatially and across income and social groups.
· The shift of resources in the health sector to COVID-19 is one factor that has resulted in reduced access to other forms of health services for some vulnerable groups, including children. A UNICEF reports states that, a year into the pandemic, nearly one million children had not received routine health services during the pandemic (UNICEF, 2021).
Recommendations
Education
· The government’s attempts at providing alternative methods of teaching and learning during the period of school closures to some extent widened the rural-urban, rich-poor, male-female, abled-disabled divides in accessing quality education because of the uneven distribution of the barriers to e-learning, including high cost, infrastructure, ICT skills, accessibility to quality internet connection and electricity. The major learning channels deployed for the e-learning (radio and TV) technically excluded persons with visual and hearing impairments. The learning gap was wider for girls because of gender division of labour which place on girls a disproportionate burden of domestic and care work. Finally, whereas employees in public schools were guaranteed their salaries and conditions of service the same cannot be said of teachers in private schools who are also tax payers.
· The COVID-19 pandemic and the closure of schools has also had differential impacts on female and male learners. School closures have further deepened vulnerabilities associated with female learners in terms of increased engagement in domestic chores, teenage pregnancy, and child marriage, which pose risks to the education of girls. This has necessitated the strengthening of GES’s school re-entry policy to retain pregnant girls in schools, grant them maternity leave and readmit young school mothers to facilitate continuous education, and to prevent exclusion of pregnant school girls and young school mothers from education (STAR-Ghana Foundation and Bortei-Doku Aryeetey, 2021)
Recommendations
· Facilitate a regularization of GES collaborated Centre for National Distance Learning and Open Schooling (CENDLOS), Ghana Library Authority, and Scholastic for their services to become regular features GES service - to offer students access to the content on the iBox and iCampus, for online and self-guided learning, provide an online learning tool to students and online content at the KG and Lower Primary levels
· Call for an increase in the budget allocation to the education and health sectors to meet the UNESCO threshold of 15% of the overall budget for education
Livelihoods
On a more positive note, the secretariat of the LEAP cash transfer improved payments in terms of promptness and regularity to beneficiaries
· Ideally the social protection response to mitigate the impact of the COVID-19 pandemic should have been, among other things, a scaling up of the levels of existing social assistance or the temporarily expansion of coverage to accommodate non-beneficiaries of existing social assistance, or both. However, due to the lack of nationwide household register for targeting, interventions have been fragmented and sporadic during the COVID-19 crisis, making it difficult to rely on existing social protection infrastructure to provide relief. The government has had to adopt multiple targeting schemes for the food distribution in the lock down areas as well as universal schemes to absorb the electricity and waters bills of the entire country because the shock affected almost the entire population.
Key Recommendations
2.4 Discussion of the report: Expert Panel
The panel was made up of the following people
Highlights of the Panel Discussion
2.5 Stakeholder Consensus on key action points to take forward
3.0 CLOSING
The meeting came to an end at 2:00 pm with a closing prayer by one of the participants.
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