Calls for the establishment of PHEF, how accountable can it be?

Accra, May 30, Since the re-emergence of infectious diseases like cholera, polio, and meningitis in the 1970s, Ghana has suffered several outbreaks which have become annual. In recent times, the emergence of communicable diseases of public health concern like Ebola, Murburg Virus, Monkeypox, Lassa fever and COVID-19 has awakened the world to the need to prepare and respond to public health emergencies adequately. The World Health Organisation (WHO) for instance, has entreated African countries to include activities of health emergency preparedness in their national budget and health system financing plans. In Ghana, stakeholders in the health sector and sections of Ghanaians are calling for the establishment of a Public Health Emergency Fund (PHEF) to ensure timely response to outbreaks and other public health emergencies. Public Health experts say, most often, districts and communities in Ghana experience public health emergencies without a warning. The longer it takes to respond to the emergency, the greater the toll on lives, the economy, and the nation. While the health authorities agree to the need to set up a PHEF, issues of accountability and accessibility of the fund have been of concern. The Ghana Association of Medical Laboratory Scientists (GAMLS) says the proposed PHEF must be separated from the Consolidated Fund, controlled by the government to ensure accountability and its availability. To them, the fund must be established in a well-structured manner to ensure transparency and accessibility, stating that the proposed PHEF must be managed by an authority with an oversight responsibility from the government. ‘We have observed clearly that when there is a fund added to the consolidated fund, its uses become much of a problem. If it is in the consolidated fund, it is like free money for the country and becomes difficult to access for its main purpose. Dr Abu Abudu Rahamani, President of GAMLS says the establishment of a Public Health Emergency Fund in Ghana is long overdue, and its urgently needed to ensure that health institutions are well prepared in their response to health emergencies. ‘We need a permanent PHEF because we are all not immune to diseases and this fund must be set up with specific and clearly defined roles to protect us all,’ he said. The President of GAMLS said the proposed PHEF is not expected to be used for routine public health concerns, like malaria cases, typhoid, and HIV, he said as an emergency fund, its usage must be classified under what constitutes a health emergency. He said the WHO is calling for the establishment of a Public Health Emergency Fund in African countries and setting it up in Ghana only means that the nation is doing what is right. Dr Rahamani said when the PHEF is established and well structured, the international community will be willing to invest in or contribute to it. Emergency preparedness according to him means there are logistics, skilled manpower, and health structures that are well-placed. ‘Before an emergency sets in, it is important to prepare before the action,’ he said. Dr Anthony Adofo Ofosu, Deputy Director General of the Ghana Health Service (GHS), who is also a Public Health Physician says the accountability of the PHEF, should not undermine the need to establish the fund, because well-structured funds have processes on access and auditing. He said there are systems of accountability with established funds, and the problem of mismanagement sets in when the funds are ad hoc. The GHS, Deputy Director General said the absence of a dedicated fund for public health emergencies poses threats, especially at the district health directorates which are not well-resourced and struggle to respond to health emergencies. ‘Having a PHEF is not something new, we have done it before, in the era of donor funding, we had it, we called it Donor Pull Fund (DPF) where the donors provided funds basically for public health activities like training, capacity building of health works, supervision and monitoring of disease surveillance and emergencies at the district level,’ he said. Dr Ofosu said funding public health incidents has been a challenge because Ghana always relies on partners for funding when the need arises. He said a dedicated fund for public health emergencies was necessary as the government’s support for public health emergencies had an implication on the overall health sector budget while other services suffer. ‘Now the challenge we have is that the Government of Ghana (GOG) funding for health has gone up and public health activities have been deprived, when surveillance suffers, possibilities of disease outbreaks are high,’ Dr Ofosu said. He called for improved financing of health emergencies at the district level to ensure safer communities for all during outbreaks, stressing that the districts must also have some funding for public health emergencies. Imagine a small community with one Hospital in the Eastern Region is hit by a cholera outbreak, the Hospital overruns with patients, there are not enough medications to administer to patients and the disease begins to spread to all parts of the country with no adequate resources to curb the situation, what will befall the nation? Public health conditions cause a lot of harm to the population and health professionals also risk their lives amidst lots of challenges to help the situation. Ghana may not know when it will be hit by a health emergency and it is in the nation’s best interest to prepare, by establishing a PHEF, making logistics available and improving the capacity of health workers to man all public health emergencies when the need arises.