A national health dialogue now!

The country's greatest resource is the human population and their ability to operate at a level that improves every fabric of society. 

There are many countries who are blessed with nothing other than the people and who have been trained such that the lowest common denominator may function at a level that will overshadow what other countries' middle-level manpower can do.

The wealth of a nation is the health of its people.

This mantra of the Ghana Medical Association (GMA) many years back is indeed a truism.

No one functions creditably if they are not in tip-top form and to be in tip-top form requires both an individual effort and a properly functioning health system whose only raison d'être must be to make patients better. 

Do we have such a system, if not why not?

That is the question we must attempt to answer in the National Health Dialogue.

By any known and acceptable indicator, the health of the nation and its people leaves a lot to be desired.

The five arms of health; preventive, promotive, curative, rehabilitation and research are all not working properly and together. 

Players

In addition, there are many extraneous players who have jumped into the fray and invariably confuse the system for their benefit.

There is no serious supervision at any level and the indiscipline of the general society has found its way into healthcare delivery with disastrous consequences.

There are difficulties with all the building blocks of Health Systems Strengthening; healthcare financing, service delivery, medical technology and drugs, information and data, human resource for health and leadership and governance.

It is important to accept that all the building blocks are underpinned by research and in our part of the world especially by community participation.

Financing

Health financing continues to exact considerable toll on families leaving many out of pocket.

Even middle-class families can be knocked off easily should illnesses such as chronic kidney disease or any of the cancers befall any family member. 

We must be working towards universal coverage where health shall be free at the point of service delivery at least at the primary healthcare level which is service at or below the District Hospital.

It is easy for elected officials to abandon the health sector in Ghana and seek services elsewhere at Ghana's expense. If they all had to use our services in Ghana, they may give it better attention than they do now.

Ghana currently spends less than $100.00 per capita on health and this includes contributions from the donor partners.

National Health Insurance Authority's (NHIA) 2.5 per cent VAT contribution and 2.5 per cent from SSNIT contributors add up but the total quantum is still woefully inadequate.

The discussions must look at alternate sources of income for the NHIA. 

Contributions from relevant sections of the Wider Social Determinants of Health must be boldly explored.

These are areas that impact on the health of the people and must therefore make contributions to improve health.

Bad roads and bad vehicles of all sorts lead to accidents, the victims of which will have to be cared for. 

Vehicular pollution also contributes to poor air and ill health.

Road fund and vehicle import levy must pay into NHIA fund; Driving licence fee must also make a contribution, Vehicular and Life insurance policies must make further contributions to the NHIA pot and small levies on food imports, toys, second-hand clothing and all products that remotely can cause injury; and tax on alcohol and tobacco, sugar tax and many others as well.

By so doing we will ensure enough funds to cover all aspects of our health delivery.

Budgetary allocation to health can cover public health, health promotion, health research and capital expenditure.

Service delivery

Service delivery in Ghana is fragmented, the legacy of cash and carry.

The public health system must be such that no money changes hands within the hospital premises. 

All who attend must be duly registered with the National Health Insurance Authority and or Private Health Insurance as required by law which will reimburse for all services provided at the CHPS, health centres, polyclinics and district hospitals including feeding the malnourished child.

Cash payment for health services must only occur at the Private Clinics and Hospitals.

Services at the Regional and Teaching Hospitals will only be reimbursed if they are referrals. Chronic ailments should be sent back to the primary facility once the acute phase has been stabilised.

In the arena of Medical Technology and Drugs, Ghana must be innovative.

We must begin to create or build patient monitors, hospital beds and lockers, regulators and stabilizers and work with manufacturers for the assembly of some items of equipment in Ghana to drive cost down.

Primary health care must only use generic drugs all of which must be manufactured in Ghana.

The issue of fake drugs which are not only sold on the move but also in Pharmacies and Chemist shops must be confronted.

Branded drugs can only be provided on a private prescription which will not be reimbursed.

Herbal pharmacopoeia can be a win, win, win for Ghana and the nation must be prepared to invest in it.

Every facility must have an equipment replacement schedule and some reimbursed money must be set aside for that.

We have a good data capture system that must be worked on and improved. It must however capture work in Teaching Hospitals and Private Hospitals to give it a national character.

The data must be properly analyzed and provided as an annual State of the Nation's Health report.

— The writer is a former Director General of the Ghana Health Service.