At the Alliance for Reproductive Health Rights (ARHR) the walls are lined with shelves containing massive binders detailing campaigns, meetings and initiatives about not only reproductive health rights, but all health-related issues. These binders contain information about anything and everything from information about malaria and HIV/AIDS, to universal access to health care and primary health care. The alliance is constantly tackling pressing issues and collaborating with the Ministry of Health and government to improve the general well-being of the country as a whole. It seems there is no issue untouched by the ARHR, and there is no shortage of projects to write about, which proves useful for an intern. The article below is something I wrote for the alliance in an effort to raise governmental awareness regarding what must happen for Ghana to achieve the 2030 Sustainable Development Goals (SDGs).
2030 SDGs and the pathway to UHC in Ghana
Ghana will not achieve the 2030 Sustainable Development Goals (SDGs) without proper funding and support from the government. The 17 SDGs focused on economic, social and environmental issues were proposed in September 2015 in an effort to promote global development and prosperity in the 193 member countries of the United Nations. Due to Ghana’s failure to achieve the health-related Millennium Development Goals (MDGs) from 2000 to 2015, a strong focus has been placed on the health-related SDG goal 3: “Ensure healthy lives and promote well-being for all at all ages.” Of the nine targets within goal 3 concerning maternal mortality, newborn deaths, epidemics, non-communicable disease, substance abuse, traffic accidents, sexual and reproductive health services and pollution, it is apparent that goal 3.8 of achieving universal health coverage is the key to achieving all other health targets.
Target 3.8 under SDG 3 states: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” To achieve this goal, government must focus on building a strong primary health care foundation that will pave the way for universal health care, abolish corruption and encourage widespread use of the National Health Insurance Scheme (NHIS) and continue to invest in building and staffing Community-based Health Planning and Services (CHPS) compounds.
Primary Health Care
Primary Health Care (PHC) allows citizens to receive affordable health care and adequate treatment for health crises regardless of restrictive financial circumstances by focusing on the equity, access and quality of services. A well-functioning PHC system can attend to 90% of a community’s health needs, as well as provide communities with education on clean water services, hygiene, nutrition, vaccination, family planning and common ailments. Unfortunately, although the 26 African Union countries passed the Abuja Declaration in 2001 and pledged to allocate at least 15% of their annual budget to improve health care, this pledge has not been upheld by Ghanaian government and policymakers; in 2015, the health sector budget was only 9.47%. Without proper funding and support, primary health care services still face numerous barriers including lack of quality health services, distance to the nearest health facility, cost, lack of information and lack of confidence in facilities and staff. The only way to combat these issues is to increase government funding to the promised 15% of the national budget and invest in infrastructure and medical training that will reach vulnerable groups and underserved communities.
National Health Insurance Scheme
The National Health Insurance Scheme can greatly aid in providing widespread, affordable health care coverage for all Ghanaians. Though the scheme has faced difficulties pertaining to corruption and late release of funds, the National Health Insurance Scheme Review Committee has been implemented in an effort to provide necessary reform and accountability. In addition, parliament has approved a 2.26 billion cedi budget to run the scheme in 2017, with 425.79 million dedicated to paying outstanding fees from the previous NDC government. With this new regulation and approval of the budget by parliament, the NHIS can be an effective and affordable health insurance provider, allowing access to comprehensive health care and advancing the country in achieving universal health care. Government must provide adequate funding for the NHIS to increase the number of people covered; current coverage stands at about half the population.
Community-based Health Planning and Services
Investment in Community-based Health Planning and Services (CHPS) is essential for the achievement of SDG 3. Community-based Health Planning Services compounds are designed to offer basic primary health care services such as clinical care, preventative and emergency services at the community level, allowing rural and impoverished communities to have increased access to professional nurses and health care. CHPS programs countrywide have faced challenges regarding changing intervention regulations and an inability to reach vulnerable populations. In a 2012 survey, the health sector estimated that only 5 percent of the population had been reached by CHPS services. Despite limited reach, communicable disease rates, access to immunization services and infant mortality rates have declined, implicating the CHPS program may garner impressive results with adequate support and funding.
Achieving the 2030 SDGs is possible if government prioritizes and utilizes PHC as a pathway to UHC. Adequate funding as promised by the Abuja Declaration must be effectively and equitably utilized to enhance health facilities and provide all communities with access to skilled health professionals. Achieving the ability to “ensure healthy lives and promote well-being for all at all ages” will allow Ghana to make incredible strides within numerous SDGs and will not only enrich, but save lives.