Wanted!!! Prevention, Not Explanations and Reactions
Our dear country is in the midst of yet another public health crisis. The perennial and seasonal outbreak of meningitis is upon us again. Coming in the wake of last year’s outbreak of cholera and the frequent return of buruli ulcer to our major cities, it is very clear that public health management in Ghana has irrecoverably broken down.
According to a statement, read by the Head of the Surveillance Unit of the Ghana Health Service, on Monday 25 January 205; there were 153 reported cases and 33 deaths with cases currently in seven districts in Brong Ahafo Region and two in Northern Region with the highest case loads are in Wenchi, Tain, Techiman Municipal and Techiman North. A week on the number of deaths has passed 50 and the outbreak has spread to many more regions
For me, the more interesting part of the statement was the revelation that “the recurrent meningitis outbreaks in Ghana particularly in the northern regions, led to the conduct of a mass preventive immunization campaign in the country in 2012 to address the burden of Group A meningococcus.”
Please note that the exercise took place in 2012, nearly 4 years ago; juxtaposed with the admission that the problem was recurrent. The obvious question being ‘If the problem is recurrent, why not carry out the prevention efforts in a recurrent manner, rather than periodically? ’
The statement also provides the answer, “Following the successful conduct of the mass preventive campaign in the three northern regions, the proportion of meningococcus serogroup A has declined dramatically and the occurrence of meningitis outbreaks due to other Nm serogroups as well as other bacteria are rather a new concern. Additionally, outbreaks due to Streptococcus pneumoniae have also become more pronounced and a public health threat which demands effective preparedness and response strategies”
In other words, our public health management strategy is founded largely on responding to outbreaks, rather than preventing the outbreaks of the diseases. This approach is indeed at loggerheads with the very principle and purpose of public health management, which is defined as “the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention”
The operative action is “prevention”. It is not explanation nor is it reaction. And yet, public health practice has been reduced exclusively to the latter two since the days of my youth when the town council inspector paid unscheduled visit to dip his stick into our “ankwor3”(drum) and examined the cleanliness of the gutters outside our homes
The statement admits to “seasonal reports of meningitis in Ghana normally during the dry periods of October to March”. So are we right to ask why the last serous effort at prevention took place four years ago and has not happened again since? Are further entitled to ask why no preventive actions on the strains of the disease that are have “become more pronounced and a public health threat now”
The Head of Surveillance’s answer is both inadvertently revealing and frighteningly alarming.
“Demands effective preparedness and response strategies”, one may well ask of the good doctor, ‘What has Ghana’s Public Health Service been doing all these to heed your own advice?’ And indeed, what kind of surveillance have you and your unit been concerning itself with? Is it of counting the affected and the dead from outbreaks or looking out for signs of imminent outbreaks so you can effect preventive actions?’
Just last Friday, Dr Fred Adomako Boateng, Deputy Head in charge of Clinical Care at the GHS briefed the media on the health situation in the Ashanti \region where the first vase of CSM had broken out, He said “People have been asked to avoid crowded areas, drink a lot of water, improve ventilation in rooms and report to the nearest facility as soon as possible with any malaria-like symptoms.” A veritable case of ‘shutting the stable door when the horse has bolted”
Knowing when the disease occurs every season, our public health managers should be mounting preventive campaigns every season ahead of the expected period of outbreak. Why this was not done but we are now being bombarded with copious explanations of why the outbreak occurred? is beyond my comprehension and probably that of most Ghanaians
The most pathetic aspect of all is the reason given for not mounting preventive initiatives. “The World Health Organization (WHO) has stepped in to provide technical support for Ghana to contain pneumococcal meningitis. The Centers for Disease Prevention and Control (CDC) in Atlanta, Georgia, USA, is also providing support for the confirmatory testing of samples.”
In otherwise, the near 60 year old Oman Ghana will spend a lot of money to set up a Public Health Service, man it with various big shots who earn big salaries and attract big allowances; and does not devote any resources to do the work that it has been set up to do? That essential of tasks is left to the mercy of some benefactor or donor partner coming along with money.
So it is that the purpose of establishing our public services is to create jobs for over-certificated in our midst, rather than render service to improve the lives of the majority underclass of our population. Is it any wonder that all they do is to explain why things went wrong and wait for donors to bring technical assistance for them to react??
Today, we allow dirt and filth to pile up and choke our gutters before we organise periodic sanitation days to clear the gutters and dump the contents by the roadside only for them to refill the gutters because no one clears them. And every household and business pays property and business rates to their local authorities. That money is supposed to enable that which we wait for donors to provide when we are engulfed by the seasonal crises.
Alas poor Ghana, the situation is not peculiar to our public health service. It afflicts every single one of our public services. And ironically, we will soon ne spending the money we don’t have making feverish preparation to celebrate the Diamond jubilee of our singular achievement as Black Africa’s first independent country
I want to recommend that we adopt the theme “Ghana Reset” for the celebrations
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