Sustainable Development Goals –Achieving Universal Health Coverage in Ghana through Primary Health Care

Sustainable Development Goals (SDGs)

In September 2015, 193 member countries of the United Nations (UN) met at the General Assembly to officially adopt the 2030 Agenda for Sustainable Development.

Along with a set of bold new Global Goals, the SDGs as they are known ushered in hope for a better world. It also promised a new era of transformation in global development.

The euphoria which greeted this declaration was summed up in the words of the United Nations Secretary-General Ban Ki-moon who hailed this transition as a universal, integrated and transformative vision for a better world.

Spanning a period of 15 years (2016-2030), the SDGs comprise 17 goals and involve 169 targets and 1,063 indicators which will serve as metrics for measuring achievements.

Millennium Development Goals (MDGs)

Rewind to the year 2000, Ghana’s Kofi Annan, then the UN Secretary General rallied 189 countries to adopt the Millennium Development Goals (MDGs). The MDGs as they were popularly known originated from the United Nations Millennium Declaration. The UN Millennium Declaration asserted that every individual had dignity; and hence, the right to freedom, equality, a basic standard of living that includes freedom from hunger and violence and encourages tolerance and solidarity.

With 8 goals set and indicators to track progress, many were optimistic of the progress the world would make in the twenty-first century as these goals sought to improve the livelihood of people all over the world.

While, the MDGs led to significant national development and improvement in livelihoods among the poor in some countries, many more, particularly, countries considered as developing economies by the International Monetary Fund (IMF) were unable to meet some of their MDGs targets.

Critics of the MDGs indicated that these developing economies were unable to meet the targets because the chosen objectives lacked analytical power and justification.[1] The MDGs were also thought to lack indicators for within-country equality.[2]

On the health front, Garrett Laurie[3] (2015) offered further insight when she contended that “a key criticism of the health-oriented MDGs is that they have fostered a silo approach to the funding, human resources development, and structure of health delivery that is disease-focused on malaria, HIV/AIDS, tuberculosis, infant mortality, and pediatric care”.

The Transition

Ghana, a developing country, made significant progress in achieving some of its MDGs targets.

Unable to achieve its health MDGs (4, 5 and 6) targets, Ghana’s current maternal mortality rate of 350 deaths per 100,000 live births is considered a far cry from the 2015 MDG 5 target of 185 deaths per 100,000 live births.

Similarly, its infant mortality rate of 41 deaths per 1,000 live births and under-five mortality rate of 60 deaths per 1,000 live births were also distant of their MDG 4 targets of 26 deaths per 1,000 live births and 39.9 deaths per 1,000 live births respectively.

Among factors cited for Ghana’s inability to achieve its health MDGs targets included poor road and communication networks, lack of transport and health infrastructure; inaccessible health facilities, cultural beliefs and practices, weak referral system between health facilities, lack of blood products, inadequate number of midwives and other health professionals, weak implementation of health interventions and inadequate funding for the health sector to mention just a few.

Like many people around the world, Ghanaians are excited at the transition from MDGs to SDGs. The prospect and promise of seeing progress in national development over the next 15 years, particularly, as far as the health goals are concerned provides opportunity to address the challenges mentioned above that impeded Ghana’s progress in achieving its health MDGs.

Universal Health Coverage

Achieving the health SDGs (goal 3) requires a multiplicity of approaches that will not only strengthen health systems but also address social-cultural and economic challenges usually eminent and prevalent in developing countries. Seemingly over ambitious, the nine (9) health targets under SDG 3 are expected to “ensure healthy lives and promote well-being for all at all ages.” Garrett Laurie (2015) contends that, achieving universal health coverage (UHC), 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 is essential to the fulfilment of all of the other health targets.

According to the World Health Organisation (WHO) Universal Health Coverage (UHC) “means that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”. [4]

UHC is a strategy to ensure that all essential health services such as HIV, tuberculosis, malaria, non-communicable diseases and mental health, sexual, reproductive, newborn and child health are available, accessible and affordable to all who require them.

Universal Health Coverage however, cannot be achieved in Ghana without revamping and strengthening the health system. The fragmentation of the health system which in other words refers to the current vertical implementation of programmes means that while some health thematic areas are likely to see improvement, others are likely to be stagnant or witness little progress.

Achieving universal health coverage calls for a robust health and financial system that does not exploit the poor but provides affordable health care for all irrespective of status in society.

Essentially, this means that everyone must have access to affordable quality health services – well equipped health infrastructure with essential equipment, medicine and drugs and trained and skilled human resource for health.

Primary Health Care

While Ghana cannot achieve Universal Health Coverage (UHC) in a day, its adoption of a Primary Health Care (PHC) approach will facilitate achieving UHC under the SDGs 3.

Touted as the most dynamic, efficient and effective mechanism to achieve UHC, the WHO in 1978 referred to PHC as ” essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”[5]

In order words, “PHC is the foundation of every health care system: the first contact and ongoing link between people and their health providers. It is how individuals and families connect with the health care system throughout their lives, from prenatal checkups and routine immunizations to the treatment of illness, rehabilitation and the management of chronic conditions”. [6]

Universal Health Coverage through Primary Health Care

As recently as 2008, Ghana reaffirmed its commitment to PHC at the Ouagadougou Declaration on PHC and Health Systems in Africa. The National Health Insurance Scheme (NHIS) and Community-based Health Planning and Services (CHPS) which seek to make health services easily available to communities are some strategies Ghana has adopted to ensure universal health coverage under its primary health care approach. Though laudable, these strategies are beset with many challenges including inadequate skilled staff and lack of logistics.

For instance, the NHIS which is essential in promoting universal health coverage, equity in health service delivery and addressing poverty and financial challenges is beleaguered with challenges such as cash flow bottlenecks. Delays in reimbursing health facilities for services delivered, inadequate logistics and human resources, limited space within health facilities to cope with the increasing number of clients are also some challenges that affect ability to effectively implement PHC.

More so, Ghana continues to invest heavily in tertiary and secondary care while little stride has been made to change the strategy of vertical disease programming.

The lack of population or citizenry demand for PHC and the existing of socio-cultural practices such male decision-making processes in health seeking behaviour among poor and underserved women and young people also continue to affect efforts to make PHC effective in Ghana.

Proposed Solutions to Make PHC Effective

For Ghana to achieve UHC and essentially the health SDGs, it will have to review its current PHC strategies and road maps while ensuring that best PHC approaches are enforced nationally and particularly at the district and community levels.

This requires supporting the health system infrastructure with health facilities, capable, motivated, well trained and skilled health personnel and essential equipment and drugs at all levels.

Ghana will also have to consistently allocate a minimum of 15% of its annual budget to the health sector as part of its commitment to the Abuja Declaration. Harnessing resources from the private sector is also vital and will ensure sustainability of the health system and reduce the over dependence on foreign resources and expertise.

Additionally, emphasis has to be placed on coordination and integration of vertical programmes to ensure more equitable allocation of resources.

Further, the involvement and participation of communities in health service delivery must be intensified. This will strengthen PHC as a strategy for achieving UHC and inadvertently the health SDGs.

Last but not least, inter-sectoral collaboration between the health sector and government ministries, departments and agencies – roads, transport, power, water, education etc. should be strengthened to make PHC work.

For PHC to be effective, it is also important to further the decentralisation process. This will ensure synergy between local government and local health administrators.

In summary, while Ghana’s efforts to achieve UHC is laudable, PHC remains a key strategy for effective health systems            strengthening, community participation in health service delivery and the provision of equitable, accessible and quality health services that focus on people’s needs and expectations. Primary Health Care thus remains a cost effective strategy to ensure Universal Health Coverage.

Written By: Nii Sarpei

[1]  Deneulin, Séverine; Shahani, Lila (2009). An introduction to the human development and capability approach freedom and agency. Sterling, Virginia Ottawa, Ontario: Earthscan International Development Research Centre. ISBN 9781844078066.

[2] Can the MDGs provide a pathway to social justice?: The challenge of intersecting inequalities. 2010. Naila Kabeer for Institute of Development Studies

[3] http://www.cfr.org/health/universal-health-care-attainable-goal/p36998

[4] http://www.who.int/health_financing/universal_coverage_definition/en/

[5] http://www1.paho.org/English/DD/PIN/alma-ata_declaration.htm

[6] http://pai.org/wp-content/uploads/2016/05/PAI-2849-PHC-FSr4.pdf