Speech by Nana Addo Dankwa Akufo-Addo

17th October 2012

“SAVING OUR HEALTH SERVICE, KEEPING OUR PEOPLE HEALTHY”

Speech by Nana Addo Dankwa Akufo-Addo, 2012 Presidential Candidate of the New Patriotic Party, at the Sunyani Nurses Training College, Sunyani, on 17th October, 2012.

Good evening. I have just been told that NDC propagandists are at it again on FM stations in Accra. This time, the story is that I collapsed on a platform whilst touring the Kumawu constituency. I toured Kumawu some two weeks ago on 1st October and it is strange that this matter should come up now on the eve of my speech. It’s a total fabrication. I did not collapse; I have never felt stronger; and I am very fit to deliver a speech on health. I thank the authorities of this college for this opportunity to talk about a subject of utmost concern to all of us: good health, our individual health and the health of the nation.

When you meet somebody, family, friend or stranger, the greeting that is exchanged is an enquiry about each other’s health. You ask after each other’s state of health and you wish each other good health and you wish good health for their family. It is for good reason that we do this. We dread being sick and we know we have to be healthy to do life’s work and achieve our aspirations.

The wealth of the nation depends on the health of its people. We have to be healthy to transform Ghana, we have to be healthy to try to make a brighter future for Ghana, we have to be healthy to work for ourselves, never mind, try to work for you.

And to talk about this subject, I don’t think we could have a better place or audience than a Nurses Training College and an audience mostly of student nurses. When it comes to healthcare, you are at the front line and the policies that government adopts affect you directly and you are in a position to tell what works and what doesn’t.

In 50 days’ time, we will go to the polls to choose not just between candidates for president and Members of Parliament, but we will also decide between two profoundly different visions for the future of our country’s education and healthcare systems. This evening I intend to lay out the differences and hope it would help make your choice easier and you would choose the NPP vision for Ghana and for your future.

On December 7, the nation has a chance to make a decision on two major issues: (1) whether Ghanaians should have universal access to free quality education for every child under the age of 18, and (2) which party can be trusted to deliver access to affordable quality healthcare for every Ghanaian. The NPP believes that free quality education up to secondary level and affordable healthcare are essential for the healthy, educated workforce we need to transform the economy, create wealth and enhance the welfare and wellbeing of every Ghanaian.

Tonight’s talk is about the health of the nation but I want first to say a few words about the NPP education policy that seeks to provide free quality education to all our children from kindergarten to senior high school. Regardless of all the propaganda and distortions, the good people of this country know that this is something we should do, we can do, and we will do. The people of this region, I am told, know all too well that while our new caretaker President, the NDC presidential candidate, is going around the country struggling to convince parents that Ghana is not ready and cannot afford free secondary education, reports from the ground are that his party activists, sensing that this position will damage their electoral prospects, are going around rural communities with a picture of the NDC presidential candidate to lie and say he is the person promising free SHS. This is typical NDC duplicity. It appears that their capacity for deceit and double dealing is limitless.

The NDC adopted the same attitude when the NPP, under the leadership of President Kufuor, introduced the National Health Insurance Scheme. NDC MPs’ of the time, including their current presidential candidate, then MP for Bole Bamboi, walked out of Parliament and boycotted its proceedings dealing with the NHIS law because of their opposition to its passage. But, when the programme was successful, they claimed falsely it was their idea and that they had a pilot scheme at Nkoranza, near here. They don’t have the vision to deliver to the people of Ghana, so they try to rewrite history.

The NPP will go a step further to save our health system and keep our people healthy: we will offer all children free access to the NHIS. This means that parents no longer have to be a subscriber to the NHIS for a child to benefit. Millions more children will be covered by free healthcare.

The NHIS shows that the NPP believes in fairness as a principle of social action. We believe that access to social services should be on the basis of need, and that government has a duty to keep its people healthy. We are proud that we are helping to create a society of fairness and opportunities for everyone, including the most vulnerable. The NDC now admits that the NHIS is preferable to the cash and carry system they were operating, but if you look at their performance managing the system, you have to doubt their sincerity. We must save our health system, and keep our people healthy.

If you look at their performance at managing the scheme these past four years, you have to conclude that either they do not really believe in a national health insurance system, and their advocacy of a one-time premium reinforces this perception; or they lack the competence to administer it. We must save the NHIS now from the incompetent hands of the NDC.

This election presents the people of Ghana with a clear choice between a well-thought out and comprehensive plan for education, health and the economy on the one hand, and on the other, a President who is offering four more years of visionless leadership from a government that pretends to be working for you. Four more years of the reckless borrowing this government have been doing will mean more of our money having to go to debt payments and even more excuses for why they won’t invest in our health and education.

The wealth of the nation depends on the health of its people. To transform Ghana, we have to be healthy, and our government has a duty to ensure that the most vulnerable have access to quality healthcare.The NPP has a record of care and achievement. The last NPP government introduced significant initiatives to expand health service coverage. The next NPP government, God willing, will introduce comprehensive measures to tackle the fundamental problem of too many Ghanaians dying because they can’t get proper care. I want to see ambulances carrying the sick to the hospital for treatment and not turned into hearses. We will continue the policy started under President Kufuor to establish an efficient ambulance service well-coordinated with emergency care in the hospitals and nationwide to be sure when patients get to you, you can still help them.

PRIMARY HEALTHCARE As I have gone round this country, I have heard enough to know that when it comes to health, what people want is more investment in the primary and community health sector. We need preventive care and regular access to doctors. An improved primary healthcare system is a vital component of saving our health system and keeping our people healthy. The NPP will focus on primary healthcare infrastructure and personnel because improving the health of all people will reduce visits to hospitals,

The environment and the physical conditions we live in to a large extent influence the state of public health. It is therefore in these areas of sanitation, proper ventilation, personal hygiene, good nutrition, provision of safe water and immunization to which we will pay the greatest attention. An Akufo-Addo government will concentrate efforts on the provision of good water for the people as this will eliminate at least 75% of the communicable and infectious diseases such as cholera, typhoid, guinea worm, billharzias and most diarrhoeas that plague our people. It is a great relief that we seem to be on the verge of eradicating guinea worm infestation from our country, (I hope nobody collects the 200 cedis on offer for the report of any new case) but we cannot say the same about the regular outbreaks of cholera that have been occurring in our cities. We must all see this as a disgrace to our nation and work on personal hygiene to eradicate such diseases from our society.

Our health education efforts will be increased to promote the total wellness of the body. Our diets are changing for the worse as our life styles become more sedentary and this is leading to new diseases and conditions that were unknown to us in the past.

As a people, we no longer exercise enough; we might know more about sports and support a wider variety of football teams than in the past, but sports participation and physical activity among the population have decreased. Our abysmal performance in recent Olympics games is a sad demonstration of this fact.

We shall seek to remedy this situation with a start in promoting school sports. The old saying of a sound mind in a sound body is as true today as it ever was.

Of course, this is the time and place for me to congratulate the great performance of the Black Maidens in the FIFA Under 17 competition, where they emerged as bronze medallists. They have brought joy to our hearts and they have set a good example to us all.

Better sanitation, personal hygiene, good nutrition, an active lifestyle and exercise will all help to keep us healthy, but being human, we shall fall ill and there will be accidents and we will need doctors and hospitals and nurses, and laboratory technicians and pharmacists and all the allied health workers that make health facilities work.

Trying to fashion the financing for a sustainable and effective healthcare system has proved challenging to virtually all countries and societies throughout the ages, but I think it is fair to say that there is universal agreement that a nation must have a healthcare system that ensures that the most vulnerable are assured of protection. The National Health Insurance Scheme introduced by the NPP in 2003 sought to do just that.

THE NHIS The NHIS is one of the greatest legacies of the NPP and a precious asset for the nation. It has been acclaimed as the most pro-poor healthcare system on the entire African continent.

An insurance scheme only works when clients and the service providers are confident in the stability of the system. The NDC government has created so much instability in the system, no one has confidence in it. As is their usual practice, they think they can use propaganda to cover their failure in the health sector as well. Unfortunately for the NDC, the human body cannot be lied to.

The government would have us believe that there is a significant increase in usage of the NHIS, which they offer as proof of their commitment to widening access to healthcare. But, their own annual reports show up this claim to be false. There is a decline in membership in the NHIS and a corresponding increase in visits to the hospital by NHIS cardholders. The NHIA’s own annual reports indicate that active membership dropped from 9,914,256 at the end of December, 2008, to 8,204,116 by the end of 2011 and according to the NDC Manifesto, there have been 25 million visits to hospitals by NHIS cardholders in the past year. This means that we have a decline in membership and a corresponding rapid increase in visits to hospital by NHIS cardholders. There is something quite unnatural about this and the only explanation there can be is that we are getting sicker than before. Compare this to the constant growth in membership of the scheme under the NPP, with NHIS membership increasing from 6.6 million in 2007 to 9.9 million in 2008, for example.

The most worrying indicator of loss of confidence is the decline in renewal rates of membership in the scheme. I suspect that many people were holding out on their renewal as they waited for the NDC promise of a one-time premium payment to materialise. If the consequences of this farcical NDC promise were not so tragic, it would be a source of great joy. Four years down the road they have not been able to implement their one-time premium policy. We can only assume that it was made to deceive Ghanaians just to get their votes.

As if it wasn’t bad enough that they dangled the one-time premium payment promise, they introduced a form of payment that has brought a lot of confusion and instability to the scheme.

NHIS CAPITATION The chaos that followed the decision by this NDC government to introduce the capitation method of payment in the Ashanti Region has been well documented and is fresh in all our minds. This most populous region was a poor choice for a pilot program, and it shows in the results. Subscriber confidence has been reduced. There is reduction in active membership in all schemes and in some schemes, as much as 80% in the first 3 months of implementation. Premiums collected from subscribers were reduced by as much as 35.5% for the period January –July 2012 as compared to the same period for 2011.

The private health providers, who form the bulk of the health service delivery in the region, withdrew from the scheme. Some re-joined in April when some of their concerns were addressed, making it clear that there had not been enough stakeholder consultation and education throughout the process. This brought unnecessary hardship and confusion to the subscribers and providers. It impacted the health of the people of the region. Most health institutions in the Ashanti Region have been forced to introduce what is called a Co-Payment -- or to call it by its real name, Cash & Carry -- through the back door.

Capitation, as the pilot project in the Ashanti Region has shown clearly to all Ghanaians, has failed. But we discover the NDC is not quite finished- they are promising more chaos and more suffering for subscribers to the scheme instead of quietly withdrawing capitation. The NDC Manifesto calls for the expansion of capitation! Yes, you heard right. At page 23 of their 2012 Manifesto, they are threatening to bring it back in a big way. It reads “In the next four years, the NDC government will… roll out capitation nationwide.” Yes, that is what the NDC is promising. Fellow citizens, the NDC intends to spread the ills of capitation to every corner of the country if re-elected into office. Call it a timely warning because we cannot claim we have not been warned. The ruling party is sending out a clear message to the Ghanaian voter: ‘The NDC Can Be Dangerous to Your Health’. Vote for NDC and pray you don’t fall sick for another 4 years. Ladies and gentlemen, this is too high a risk to take, if you ask me. The NHIS is not safe in NDC hands.

The NDC either does not believe in national health insurance, or they are incapable of operating the scheme successfully. Both of them are unacceptable. Today, the scheme is to all intents and purposes bankrupt. In 2008, under the NPP, the NHIS was a net lender to Ghanaian banks. Now it is a net borrower; and as at December 31, 2011, the scheme owed the banks GHC105 million. They have had four years to operate the one-time premium policy, and have been unable to implement it. The Capitation system of payment has been shown to be a disaster and will collapse the scheme. Ladies and Gentlemen, when the NPP is voted into office on December 7, God willing, we will inject new life into the scheme and rebuild the confidence of the service providers and the clients. We believe in it and we will make it work. We must save our health system to keep our people healthy.

HEALTH WORKERS But, in order for the NHIS to deliver, we must have well trained nurses, midwives, health technicians, pharmacists, doctors and other allied health workers in sufficient numbers serving with job satisfaction. We shall increase the capacity of the institutions that train health workers; we have done it before. Under President J A Kufour, all the existing health training institutions were expanded and new ones established across the country. Some private health training institutions were also established. Intake for Diploma Nurses, for example, was increased from 968 in 2000 to 7,068 in 2008. Community Health Nursing intake increased from 500 to 2,214 in 2008. To improve skills in the nursing profession, the health care assistant training program was established and a number of Health Assistant Training Institutions were also put up across the country. Intake into such institutions increased from 477 in 2006 to 2,541 in 2008. This did not happen by accident. We will expand health facilities and train more of our health workers to attend to the sick. There are lots and lots of young people who want to become nurses, we need lots and lots of nurses, we will make it possible for them to train as nurses. Our priority will be to train our doctors locally. We will expand existing medical schools and establish a National Institute for Biomedical Sciences, where medical students will have their basic sciences and this will make it possible to increase the intake of the medical schools.

At a time when Ghanaian students on government scholarships across the world are crying for their fees and allowances to be paid, and at a time when students at our nursing training colleges are crying against the sudden 100% hikes in fees, the NDC government, under an opaque scheme, operated by then Vice President Mahama, found GH¢160 million to send people to Cuba to be trained as doctors. The Cubans still insist it was a scholarship scheme. If so, then it is most expensive. The cost of this translates into GH¢106,000 per year for each of the 250 Ghanaians sent to Cuba. On the other hand, the cost of training a Ghanaian doctor in Ghana is a fraction of that, at just GH¢30,000 annually, according to the Ghana Medical Association. Can you imagine what the UDS Medical School, for example, would have done with just a third of this GH¢160 million investment over the next five years? We shall invest in our own medical schools to train more doctors locally.

COMMUNITY HEALTH NURSE In line with our primary healthcare policy, the NPP will ensure that every village or deprived community has access to a Community Nurse to provide the primary healthcare that often makes the difference between life and death. These Community Nurses, with a small and basic surgery, will be responsible for basic public health education and primary healthcare.

MOBILE THEATRES There are simply not enough specialists and facilities to serve patients, especially in rural and remote communities. To solve this problem, we need to think outside the box. The next NPP government will, therefore, revolutionise the concept of taking healthcare closer to patients’ homes with the use of mobile theatres and mobile clinics. The use of mobile units will mean we can, through a shift system, send the best of our medical personnel and the state-of-the-art facilities to patients in a way that mitigates the need for capital spending, whilst allowing the best of medical care, including surgical operations, to be deployed across the nation in a way that is responsive to local needs. With mobile theatres, the next NPP government will seek to deliver thousands of cataract operations and other such treatments nationwide.

REFERRAL HOSPITALS It is time that we took the bold step of establishing a number of world-class referral hospitals and medical centres of excellence in our country. Prof Frimpong Boateng, with the successful Cardio-Thoracic Centre in Korle Bu, has taught us that these can become income-generation ventures, as well. The next NPP government will introduce policies to promote Ghana as a centre of medical tourism in Africa. We will assist those already doing so in the private sector to do more. This would not only help to provide a satisfactory working atmosphere for our specialist doctors, it would attract many doctors to come and work in Ghana, and would help turn our country into an attractive health tourism destination.

PHARMACEUTICAL INDUSTRY Ghana has a successful local pharmaceutical industry, which deserves special attention from government. My government would help them to serve our people well and become more competitive in the international market. We will borrow from the experiences of India and elsewhere to become the masters of this lucrative industry. Under the NDC, what we have seen in recent years are measures that are counterproductive to the growth of the local industry, with Facility Audit Fees, for example, going up from $7,000 in 2008 to $15,000. At the same time, the Food & Drugs Board has seen its share of the national budget decreasing in real terms. We will change this as part of our policy to focus more on preventive and primary health care.

HEALTH OMBUDSMAN In our efforts to enhance the quality of care, the NPP will create an ombudsman with the power to investigate and support complaints from patients in both public and private hospitals.

PERSONS WITH DISABILITY As part of our efforts to build a society of opportunities for all, we shall actively promote the provision of facilities for persons with disabilities and invest more public funds to ensure their proper integration to enable them achieve their potential in life. I will ensure that the provisions in the Persons With Disability Act, 2006, Act 715 are implemented. I must here declare a personal interest; this is one of the laws that I feel a personal attachment to, having started work on it as Attorney General. Ghana cannot afford to ignore the contributions of the many talented people in the society simply because they are disabled. The likes of Prof Bashirudeen Koray of the Ministry of Justice, a blind lawyer, whose appointment I had the honour of approving as Attorney General, bear testimony to what persons with disability can do in a society where all have an equal opportunity of exploiting existing opportunities and contributing to the creation of new, exciting ones.

MENTAL HEALTH One of the greatest challenges we have in the health sector is in the area of mental health. There is an alarming shortage of psychiatrists and mental health practitioners in general. There are said to be only five specialist psychiatrists in the public health system and this means that every mental health problem rapidly deteriorates into a full scale crisis. We shall offer incentives to make it attractive for young doctors to specialize in psychiatry and we shall tackle the long standing problem of the disgraceful state of the Psychiatric Hospital in the middle of Accra.

CARING FOR THE ELDERLY Ladies and gentlemen, we all continue to tell ourselves that we have a society in which the elderly are respected and taken care of. The truth, the reality, ladies and gentlemen, is very far from this. In villages and cities around the country, we are leaving our elders in pitiful conditions. There are many elderly people who have been left by themselves, who have no one to care for them.

We will introduce policies that will compel District Assemblies to take a more responsible role in catering for the needs of the elderly in our communities. Beyond that, my government will offer incentives to the private sector to provide the elderly with proper care homes. I know this will require a major cultural jump but I believe it is time we brought this silent and hidden problem out into the open and find solutions. Those who have served their families and Ghana deserve some dignity at the end of their lives.

Some of the other measures the next NPP government will introduce to improve healthcare delivery in Ghana will include:- • Making dental care accessible to the poor and vulnerable • Cutting down on red tape at both the NHIA and our hospitals to invest the millions saved in frontline health service delivery • Refocusing capital investment on primary and community services • Increasing health spending in real terms every year • Making sure the Public Procurement Act works in the supply of pharmaceuticals and other health facilities • Introducing eHealth policy to make access to healthcare and health tips easily accessible to consumers via the internet and mobile phones

We need to move away from management by crisis. The health sector needs a management culture that is proactive and not reactive. The Ghana Health Service will be helped to acquire a more efficient Medical Information Management Systems designed to better track performance across the delivery chain, and provide the data needed to make excellent health care decisions and save lives and keep Ghanaians healthy.

We will sit down with the private providers of health services to work out how to attract greater investments and offer lucrative incentives with the objective of creating a competitive, consumer-driven healthcare service delivery system.

Ladies and Gentlemen, we have it in our power to transform our country and its economy. We will do it with the support of people like you. Every day nurses and health workers around this country perform little miracles. They bring care and comfort to the sick and the distressed, they do it under trying conditions. Under an NPP government, you will have support from the top and together we will build a healthy and prosperous Ghana. We shall not go back to a failed government that is failing you, failing your health, failing your jobs, failing your education, failing your future. Let us move forward with the NPP.

God bless you God bless Ghana.