Research Fellow at Ghana Centre for Democratic Development and Pharmacist, Dr Kwame Sarpong Asiedu

Pharmacist Kwame Sarpong Asiedu says Ghana’s health outcome indicators under the Fourth Republic have been underwhelming, especially when compared to other countries with similar Gross Domestic Products as Ghana.

Speaking at a lecture delivered at the British Council Hall on the theme “Down Memory Lane: From 1993 to the Present,” where the focus was on Ghana’s democracy and its consequential impact on public health, he stated that the country’s health system has not delivered as much as it could based on the inputs successive governments have made.

“Under this democracy, our health system comparatively seems not to improve the longevity of the population as a whole, can’t protect our women adequately during childbirth, and is failing the most vulnerable (the very young),” he said.

His assertion was based on data drawn from the World Health Organisation and government statistics.

Using four key indicators – life expectancy, maternal mortality ratio, infant and under-five mortality and percentage of population above 65 years – to measure Ghana’s health sector performance against countries like Rwanda, Sudan and Liberia, he realised that while these countries experienced a better improvement in their health indicators despite their relatively lower investment in the health sector, Ghana with much more investment in the sector was getting little value for money.

“The key input of any health system after a democratic mandate has been handed to a President is money. The easiest way to compare the funds allocated to health is to determine how much money is invested per person per year (health expenditure per capita).

“Ghana’s health expenditure per capita in 2022 was US$84.98. This was an increase of approximately 454% of the figure in the year 2000. In comparison, Rwanda increased its figure by 422% over the same period to the current figure of US$57.50.

“Over that same period, Liberia and Sudan increased their figures by 306% and 53.6% to US$52.09 and US$23.39 respectively. How do the health outcomes of these countries compare? The following selected health outcomes will perhaps give us insight,” he said.

Comparing life expectancy, he revealed that Ghana over the years has failed to drastically improve the longevity of its citizens in the country despite the huge sums of money invested in the sector.

“In 1993, life expectancy in both Rwanda and Liberia was 42.17 years whilst Sudan was 46.58 years. At that time life expectancy in Ghana was 56.42 years well ahead of all three countries. By the year 2000, a child born in Rwanda was expected to live to 47.13 years, Liberia 51.36 years, and Sudan and Ghana 58.20 years.

“Therefore, seven years after the commencement of the Fourth Republic Sudan had increased the life expectancy of its citizens by 11.62 years whilst Ghana had increased ours by 1.78 years.

“All three countries had shown better improvements in their citizens’ health and well-being compared to Ghana. This moved Ghana from 155th on the global ranking of 193 countries and states to 154th and Sudan from 170th to 153,” he said.

He added that comparing recent data even shows a worrying graph.

“A look at the life expectancy data for 2022 and comparing it to the figures in 2000 is even more intriguing. Rwanda surged ahead and improved the health and well-being of its citizens by 40.18% moving life expectancy from 47.13 years to the current 66.07 years. Liberia had an improvement of 18.28%, Sudan 12.14% and Ghana 9.60%.

“Looking at investments each country made in health per capita over the same period, how is it possible that Ghana had the highest improvement (454%) but attained the lowest improvement in the health and well-being of its citizens? Is this the democratic dividend in health the framers of the Fourth Republican Constitution envisaged?”

Comparing the maternal mortality ratio he noted that Ghana had failed to adequately protect and preserve the lives of mothers during childbirth.

“For a democracy to be delivering a health dividend this right of women should be a priority…Between the years 2000 and 2020, maternal mortality rates dropped by 47.3%. In comparison over the same period Rwanda saw a fall of 72.12%, Sudan 57.94% and Liberia 16.07%.

“Hence apart from Liberia, the comparator countries saw a higher decrease in the risk women faced during childbirth compared to Ghana with less investments in health. Did our democracy promise a lower value for money to our wives at the outset? If not can it be said to be yielding the right dividends for the Ghanaian?”

In the area of infant mortality, once again, Ghana was lagging behind.

“We can all accept that a democracy cannot be said to be yielding dividends if health outcomes are such that the most vulnerable are not protected,” he said.

Comparing figures, he revealed that “Between 2000 and 2020, the percentage decrease in infant mortality for the comparator countries was as follows, Ghana at 48.09%, Sudan at 40.60%, Liberia at 58.20% and Rwanda at 72.27%. Yet again how is Rwanda achieving these significant health outcomes with less monetary input?

“Between 2000 and 2020 the risk of children dying by their fifth birthday was decreased by the following percentages, Rwanda at 78.73%, Liberia at 59.80%, Ghana at 56.08% and Sudan at 54.90%. Yet again with the highest percentage change in health input, Ghana is not achieving the best outcome.”

And finally, in comparing old age indicators i.e. percentage of the population reaching age 65 or above, Ghana once again was performing abysmally.

“Based on available data between 2000 and 2020, Ghana increased the percentage of its population above 65 years by 6.89% (from 3.19% of the total population to 3.41%). Comparatively, Sudan saw an increase of 33.07%, Rwanda 29.17% and Liberia 5.96%,” he said.

“It is clear from the selected health outcome indicators that under the Fourth Republic, our health system has not delivered as much as it could based on the inputs successive governments have made,” he averred.

In total, Ghana between the years 2000 and 2020 has managed to decrease its crude death rate number of deaths occurring during the year, per 1,000 population) by 23.72%, Sudan by 30.93%, Liberia by 43.60% and Rwanda by 63.24%.

“This indicates that even though Ghana has had the highest increase in financial investment in health we have shown the least improvement in the ability of our health system to keep the population alive.

“Is it any wonder that we have the slowest improvement in our life expectancy at birth? Why then have politicians over the last three decades managed to use slogans in health as a vote driver?” he quizzed.

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