Poor health performance prompts policy rethink

Stubborn levels of malaria and guinea worm mean the government needs to rethink its tactics, homing in on mothers and children and putting more emphasis on prevention at the local level, Health Minister Kwaku Afriyie told IRIN. “We are calling for a change in strategy because the old strategies have worn out. Our key health performance indicators have either dipped or are showing no signs of improvements,” Afriyie said in an interview last week. His call came just weeks after a May summit between the Health Ministry and donors to review Ghana’s health targets and budget for 2005. Afriyie said the economy, conflicts in the northern reaches of the West African country, delayed financial support and a brain drain of professionals to overseas had all affected the health sector’s performance. “We make no excuses. It simply means that we have to back up and step up efforts to improve on the implementation of our strategies at the district and sub-district levels,” he told IRIN. “Strategies will have to be refigured to give priorities to maternal and child healthcare first,” he added. Health ministry officials say new policy documents are currently being drafted and will be published in November at a funding meeting with development partners. For now specifics about the strategy changes remain secret but fighting malaria will be high on the agenda. Government statistics show the potentially-fatal mosquito-borne disease accounts for 40 percent of cases at outpatient departments around the country, hitting pregnant women and children under five the hardest. MALARIA A TOP PRIORITY A survey by Ghana’s National Malaria Control Programme of some 60 hospitals nationwide showed the number of pregnant women with malaria jumped 33 percent between 2000 and 2002 to reach 16,908 cases. Among children under five there was also an increase, albeit more muted, with the prevalence rate rising four percent to 279,967. On a positive note, the number of malarial deaths in this age group dipped slightly, with 1,917 deaths in 2002, 35 fewer than in 2000. “There is no one magic bullet for tackling malaria,” Afriyie said. “We have to marshal all the arsenal that we have -- education, an increased use of ITNs [insecticide treated nets], early treatment and environmental sanitation.” The use of ITNs in Ghana falls far short of pan-African targets. A summit in Nigeria two years ago called for 60 percent of pregnant women and the under fives to sleep under the treated mosquito nets by 2005. But Ghana has a mountain to climb to reach that figure, with just 3.5 percent of children under five using the nets in 2003, and the figure for pregnant women even lower at 2.2 percent. The World Health Organisation says sleeping under an ITN net is one of the best ways to avoid getting malaria and while the Ghanaian government tries to make the nets more popular, it is also taking steps to improve treatment for those who have already contracted the disease. The government is switching drugs to the more expensive drug artesunate-amodiaquine because malaria parasites are becoming increasingly resistant to chloroquine. “From 2005, artesunate-amodiaquine will be supplied to all public health institutions as the alternative treatment for malaria instead of chloroquine. The Health Ministry will stop procuring chloroquine and phase out existing stocks over a period of time,” Emmanuel Twumasi of the National Malaria Control Programme told IRIN. Figures provided by the Health Ministry show a single treatment using artesunate-amodiaquine will cost US $2.40. With three million Ghanaians affected by malaria each year, the budget for the new drugs is estimated at US $7.2 million and the government is expected to have substantial assistance from donors. GUINEA WORM ALSO PROBLEM Aside from malaria, guinea worm remains a frustration, with the number of cases rising and falling as conflicts bubble up and then fade away in northern Ghana. “These conflicts greatly eroded our performances. If the community health nurses and other health personnel cannot go out and do their job or if people cannot get health care, how do you expect us to make an assault on guinea worm or on maternal mortality?” Afriyie asked. While the complete eradication of guinea worm was targeted by 2003, ministry statistics show there were 8,283 cases in Ghana last year, with a new increasing prevalence rate recorded in the northern Volta Region, due to the movement of displaced populations from the Dagbon conflict that erupted at the beginning of 2002. “We can make a huge impact on the prevalence of guinea worm by using filters, public education and confining people infested with the worm without depending solely on the provision of safe water, which is very expensive,” Afriyie said. To improve health services, money is needed. Donor agencies like the World Bank, the Danish International Development Agency, the Department for International Development, the European Union and the Royal Netherlands Government pooled US $281 million to support a five-year Programme of Work until 2006. Donor contributions of US $61.5 million accounted for about half of Ghana’s health expenditure last year and Afriyie said he expected this year’s donations to match that. “We are expecting quite substantial financial contributions in the coming year from our health partners, some of whom are yet to sign on. We are still tallying the figures but it will definitely not be lower than what we had last year.”