President Nana Addo Dankwa Akufo-Addo recently performed a symbolic ceremony at Trede in the Atwima-Kwanwoma District, for the official commencement of the 'Agenda 111', which has the objective of increasing access to healthcare delivery across the country.
The underlying factor, he said, was to build and equip as many hospitals as possible to advance Ghana's agenda of becoming a 'Centre of Excellence' in medical care in the West African sub-Region.In all, a total of 111 hospitals are expected to be constructed nationwide, each costing about US$16.88 million, and scheduled to be executed within 18 months by a team of local contractors.Facilities to be provided include; Out-Patient-Departments (OPD), Maternity, Obstetrics and Gynaecology Units, Accident and Emergency Units, Male, Female, Paediatric and Isolation Units.
The rest are Ophthalmology, Dental, Physiotherapy and Imaging Units, as well as Surgical and Consultation Units.Provision is also being made for support facilities such as kitchen, laundry, sterilization and energy centers, with plans to construct a mortuary, staff accommodation for doctors, nurses and other health workers.
"Agenda 111 is the biggest investment in healthcare in Ghana's history," President Nana Akufo-Addo noted, saying the projects would provide about 25, 000 jobs for the people in the course of construction.Additionally, 20,000 health professionals, including; medical doctors, nurses and pharmacists, are billed to be employed to work in the health facilities when completed.
According to the President, the emergence of the COVID-19 pandemic has revealed the unequal distribution of health facilities in the country, a challenge which his administration is committed to resolving."These projects are carefully being executed to impact positively on the lives of the people," he stated. President Nana Akufo-Addo, highlighting the benefits of the 'Agenda 111', emphasized that the government had resolved to expand the base of healthcare coverage for the wellbeing of the people.The implementation of the project would in the longterm contribute significantly to expanding the training of medical and other health professionals, he argued.He said the vision to make Ghana a medical travel destination would also come with its own advantages of growing the economy to an appreciable level, while offering jobs to the people.
Our Concerns as Healthcare Policy Researchers
Though Agenda 111 is a laudable government project to expand the healthcare industry,it is quiteunfortunate that Herbal, Naturopathic and other Complementary Alternative Medicine facilities were not included in the list of health facilities to be established. Herbal services were not given considerations neither were trained herbal medicine professionals. Naturopathic and Herbal Medicine services are used by about 80% Ghanaians according to World Health Organization(WHO). Several other researches have revealed that Naturopathic and Herbal Medicine is an important component of Ghana's primary healthcare delivery. It is an undisputable fact, backed by data, that a large proportion of Ghanaians resort to the use of herbal remedies at one point or the other. Studies have also revealed that if given the option, many indigenous Ghanaians will opt for naturopathic and herbal therapies as compared to conventional therapies.Even with the emergence of the Covid-19pandemic,empirical evidence suggests that many Ghanaians resorted to the use of herbal remedies such as hibiscus and neem, with His Excellency the President of the Republic of Ghana even calling on Ghanaians to use some local remedies in one of his televised addresses on measures taken to address the Covid-19 pandemic.
This is the reality at stake: whether we like it or not, Ghanaians use herbal and naturopathic remedies as a source of primary healthcare. However, majority of these remedies are unregulated, unstandardized and have little to no scientific basis. Also, whether we like it or not, people are practicing herbal medicine and naturopathy with little or no scientific background, with majority of such practitioners being trained through the apprentice system. As stakeholders of the health system, it beholds on us the duty to provide safe, regulated and science based naturopathic and herbal alternatives to the Ghanaian populace, by giving formal science based education, standardization and regulation to these people, and establishing stand-alone facilities for them to practice in, so as to save lives and afford all Ghanaians a better shot at their right to quality healthcare. Hence, we believe that it is about time government and policy makers consider the herbal and naturopathic industry when making policy decisions, rather than relegating this industry into the background.
Our Proposal for establishment of government Herbal and Naturopathic hospitals
As healthcare policy researchers, we find the government Agenda 111 as a good policy to enhance our healthcare delivery. As a country, however, we need to acknowledge the fact that healthcare in Ghana is shredded with equity challenges. Though there has been some effort by the current and past governments to integrate herbal medicine in some selected government hospitals, this project has been saddled with numerous challenges. For instance, in one facility we visited, the Medical Herbalist in chargebemoaned the decline in patients patronizing their services. We realized that though the herbal department was in a government hospital, patients were of the view that they had to share the same services with those seeking conventional therapies, thus, causing some level of discomfort among them as some conventional providers consider Complementary and Alternative therapies as inferior. For instance, a patient who intends to seek for herbal services will have to use the same laboratory department and other imaging services being utilized by those seeking conventional care. This also creates huge delays for patients seeking herbal services. Further, placing herbal and naturopathic medicine departments under the management of healthcare managers such as Medical Superintendents and Nurse Managers who have little or no training in Complementary and Alternative Medicine is a recipe for disaster. These healthcare managers have had almost all their training and practice in conventional medicine and as such, do not understand and appreciate the needs and elements that are required for a Complementary and Alternative Medicine unit to function at optimal level.
This is one of the major reasons for which integration of herbal medicine into the primary healthcare system has not been as effective.
There are numerous reasons for which many people forgo conventional government hospitals for their medical care and opt for herbal or even private facilities. Results from an empirical study we conducted to examine the push factors driving Ghanaian healthcare consumers from mainstream medicinerevealed that long queues and extended waiting times at the government hospitals, frequent strikes of conventional medical practitioners, perceived side effects of conventional drugs and inaccessibility of such services are some of the reasons for which people are opting for herbal and other naturopathic facilities.Due to this, we are of the opinion that it is time for the government to also set up standalone government Naturopathic hospitals in the country as part of their agenda 111. These hospitals should be autonomous and separated from any conventional facilities. This move is likely to generate a huge revenue for the government in the country as it will build public trust and allow patients to seek Naturopathic services from these government centers. It will further prevent more people from seeking private services from herbal and Naturopathic facilities which do not have qualified personnel and are highly unregulated. This will go a long way to prevent unnecessary deaths and disability which occur as a result of people patronizing quack herbal practitioners. The government Herbal and Naturopathic hospitals should be built with state-of-the-artand ultramodern equipment. This will place Ghana's health system on a pedestal such that it can compete with other countries, and reduce the rate at which people leave the shores of Ghana to access healthcare, causing the country to lose revenue. China, India and other advanced countries have such unique stand-alone government Naturopathic Hospitals where people seek quality medical services from.If this concept is adopted by the Ghanaian government, there will be a huge boost in the practice of alternative complementary medicine in Ghana and in effect,reduce the burden of non-communicable diseases like diabetes, hypertension, due to the naturopathic principles which are applied in delivery of such services.
Equity in Healthcare and Training
As healthcare policy researchers, we hold the view thataddressing and resolving diversity, equity and inclusion issues pertaining to deliveringherbal and naturopathic services to the general public is vital to the short and long-term viability of our health training institutions and naturopathic-wide professional health. We have further realized that our healthcare system is builton systemicdiscrimination, and conscious or unconscious bias from the healthcare communitywhich ultimately negatively impacts the quality of patient care all doctors provide.Many of these health inequalities result from a broad set of social, economic, and political conditions which influence the level and distribution of health within a population.
It is incumbent upon us all to address the root of healthcare and clinical bias, and to vow to commit to ongoing activities and policies that foster healthcare policies that are safe and inclusive for all.
It is in this spirit that the we convened the Diversity, Equity and Inclusion Committee (DEI), with goals to drive a collective effort across the herbal naturopathic community, and to help share best practices that will solidify the infrastructure needed to ensure lasting change. We believe that it is time for the government and healthcare policy makers to start thinking of setting up stand-alone government Herbal and Naturopathic hospitals in the country to be managed by healthcare professionals who have the requisite training in the Herbal and Naturopathic community. This move is long overdue and deserves maximum attention from the government and all other stakeholders in Ghana's Health System. It is high time we detached herbal services from the conventional government hospitals and make them autonomous in the country.
In addition to providing safe, regulated and science-based natural healthcare to the populace, the revenue boost to Ghana's economy is likely to be higher than what is accrued from the conventional facilities, due to the high prevalence of herbal therapies among Ghanaians.
Further, we need to appreciate the fact that the healthcare dynamics are gradually changing. The world at large has embraced Herbal and Naturopathic Medicine. Ghana must not be left behind. Also, training of healthcare professionals in the fields of naturopathy, herbal medicine, Ayurveda, Acupuncture and other Complementary and alternative medicine fields is currently ongoing in Ghana. Occupational standards are currently being developed with the aim of providing the country with top notch practitioners who are comparable to any conventional medicine practitioner. All these factors need to be considered when making major health policy decisions such as Agenda 111.
The Indian Model
In India, there are many separate government naturopathic hospitals operating distinctively from the mainstream hospitals being managed by the Naturopathic or what they term AYUSH professionals. AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha &Homoeopathy) professionals are on par with mainstream doctors.
A typical example is Varkala, a small town in the south Indian state of Kerala. This townhas made a solid imprint in the area of health tourism with its government owned Naturopathic Hospital. Established in the year 1978, the hospital is well furnished with 60 beds and other requisite facilities. The proximity to the beach further makes it a favorite among the tourists from all over the world. Over these years the hospital has become one of the popular health tourism centers of Kerala.Other states have more than 200 bedded Nature Cure Hospital and Research Centre in Karnataka.
Naturopathy is one of the oldest sciences of healing and art of living. It involves a system of therapeutics which relies completely on the innate boons and benefits of nature to maintain the health of our body. It avoids surgery and prescribed medicines. Natural remedies like sunlight, air, water, and mud supplemented with diet, exercise, massage, acupuncture and physiotherapy replaces antibiotics, tonics and other medicines. Preparations such as vitamins, nutritional supplements, and herbs are used to treat and prevent disease. References on nature cure can be found in the Vedas and other scriptures. The heart and soul of the system is the belief that our body is self-healing and is able to repair itself and recover from sickness spontaneously. The system also stresses the need for a healthy environment for the proper functioning of the body.
We believe that the government's Agenda 111 should have another model for government Herbal and Naturopathic hospitals in the country as done in India and other advanced countries. The herbal and Naturopathic hospitals should be autonomous and distinct from any government conventional facility. This, we believe will create equality in healthcare delivery in the country. We believe that if it must be done, it must be done well! For Agenda 111 to achieve its ultimate goal of making Ghana a "Centre of Excellence' in medical care in the West African sub-Region",it must cover all aspects of the health service delivery spectrum and in addition to conventional medicine, make room for Complementary and Alternative Medicine including Herbal Medicine and Naturopathic facilities.
Moving forward as a nation in healthcare delivery, we call on the government to always think about the Herbal and Naturopathic community in their policies.
About the Authors
Noble Prof. Raphael Nyarkotey Obu, is the president of Nyarkotey college of Holistic Medicine and currently entering his final year of the LLB Law program at the Kings University College. He is also the author of the book" The Law and Naturopathic Medicine Practice in Ghana". LawrenciaAggrey-Bluwey, is the coauthor, a Clinical Nurse, Health Services Manager and an Assistant Lecturer with the Department of Health Administration and Education, University of Education, Winneba. She is also a PhD student in Health Policy and Management, at the University of Ghana, Legon.