Dr. Joan Awunyo-Akaba, Executive Director, Future Generations International, and Gavi (The Vaccine Alliance) CSO Board Member, discusses the critical role of civil society in holding governments accountable for the provision and delivery of health care, as Ghana finds itself poised to ‘graduate’ to middle-income status. Joan Awunyo-Akaba was a panellist at an Action for Global Health civil society event at the UNGA in September.
When people ask what civil society does, I say we are the voice of the voiceless. The women who have to carry their own water to the delivery room; the children who are unaware that vaccines are not reaching them; for the frontline health workers who are too afraid to talk about a lack of equipment and dysfunctional supply chain systems. We speak for them.
At the United Nations (UN) General Assembly in September, I heard the eagerness of governments wishing to improve the healthy development of their people. The political will appears to be there but governments were focused only on the money when they discussed ‘domestic resource mobilization’ to achieve Universal Health Coverage. What they seem to have forgotten, or not even considered, is civil society; a critical human resource that could be mobilized for the healthy development of our people.
Being a Ghanaian, I appreciate that it is communities, particularly children and the most vulnerable, who suffer the most. This is especially pressing with Ghana’s imminent ‘graduation’ to middle-income status. Donors are pulling out before we have had the chance to consolidate our economic gains. All sectors are feeling the pinch, and the government is stressed. Labour unrest is palpable.
We need to find additional sustainable funding to continue with the gains made in immunisation through Gavi support. Ghana had not even been able to pay the full 2% of its co-financing contribution to Gavi this year – and this is increasing to 20% in 2015 when Ghana begins its ‘graduation’ process. Moreover, the new vaccines (pneumo and rotavirus introduced in 2012) have doubled in price. However, we should not just focus on the money, we should also look at human resources, materials and time. We need to consider all these parameters when we talk about mobilizing domestic resources for Universal Health Coverage.
When we have recognition, we have impact
Civil society can be truly involved when we are able to serve our communities, and articulate the needs of these communities to our governments. This means governments need to build the capacity of civil society organisations (CSOs), and empower them to have the recognition to advocate. Only then will decision-makers ask what we can do together, and involve us in the design and implementation of their policies.
In my country, the health ministry is in the initial stages of formalising the engagement of our CSO health platform, ‘The Ghana Coalition of NGOs in Health’, through a Memorandum of Understanding (MOU). This is a huge step towards the meaningful participation and accountability of civil society. But this should crucially be supported by a budget. Financial and technical support from the Dutch government and Gavi has strengthened our platform, giving it greater recognition. We now sit at the same table as our ministry of health, and big development players such as the World Bank and World Health Organisation. This model is now being shared with other Gavi-eligible countries.
Unless we tackle the root causes, what lessons have we learnt?
Professor Lawrence Summers speaks of being on the cusp of a ‘grand convergence’ in global health within a generation. Our leaders must look at the interventions made to improve the health of citizens in countries like Sweden and China. We don’t have a long way to go. We simply need to invest in health services and human resources; and improve the shockingly-poor ‘social determinants’ of health staring us in the face.
It is unacceptable that we are building hospitals, with no running water, only to see our people come there to die from preventable diseases. How can we build houses and hospitals without sanitation facilities and no drinking water? Why are children defecating on refuse dumps? We can, at the very least, develop our rain-catchment system to ensure adequate water supply in our communities, and at our health facilities.
How many more children must die from pneumonia and preventable diseases? It’s our right to demand, insist, ask for the interventions that make our children healthy.
Community leaders (the traditional Chiefs, ‘Queenmothers’ and elders) hold so much weight and power that they have the potential to be critical stakeholders in Ghana’s development. Indeed, a district director of health services was recently compelled to attend a community health meeting, only after the local ‘chief’ demanded his presence. But they are like sleeping elephants: we need to wake them up and make them aware that they have the capacity and legitimacy to demand, insist, ask… only then will the government sit up and take notice.
We can easily improve the health of our people if, in turn, our leaders improve the social determinants of health. With the right mechanisms we can enforce the laws that promote environmental sanitation to curb malaria, our number-one killer, and ensure households have toilets.
Health starts in the communities and ends in the hospitals. When you go to hospital – you go there to get better or to die. Health promotion must take place at the community level. Universal Health Coverage means everyone can access the quality health services they need without financial hardship. But Universal Health Coverage will not fly if communities and civil society do not take a central role.