Fighting epidemics: Need for reliable source of funding

Mr Thomas Naporo has been working as a Community-Based Surveillance Volunteer under the Ghana Health Service (GHS) for 14 years now. He oversees four suburbs of Tamale, namely Kotingli, Tuwa, Baliga, and Dakpemyili, which are several kilometres apart. His work involves visiting the four communities to pick information on disease incidents and reporting them to the nurse in charge of the Kotingli CHPS Compound for verification and possible public health actions to prevent the spread of the disease.

He relies on his old bicycle to cover the four communities every week. He told the Ghana News Agency that, “It is not easy visiting the four communities on a bicycle. Sometimes, I get tired. The bicycle even breaks down at times.

Apart from my GH¢200.00 monthly allowance, which is paid quarterly or sometimes semi-annually, I do not receive anything to help repair my bicycle. Looking at the distance I cover, I will prefer a motorbike and some additional money for maintenance to help improve my work.” Mr Naporo’s experience illustrates what many other Community-Based Surveillance Volunteers across the country go through as part of efforts in dealing with disease outbreaks.

The Community-Based Surveillance Volunteer is an important layer in the GHS’ Integrated Disease Surveillance and Response System (IDSR) for dealing with disease outbreaks, in the sense that if they do not do their work effectively, the community could be plunged into an epidemic; an outbreak of a disease that has the potential of spreading across various communities, districts, regions and the entire country.

Mr Naporo’s experience shows that what is lacking in funds to support the IDSR to function effectively to track down diseases before they degenerate into epidemics.

Presently, only thirty districts in Ghana are operating the Community Based Surveillance system due to a funding gap.

GHS’ system for dealing with disease outbreaks

The country, and for that matter, the GHS recognises the fact that it will be more appropriate to quickly deal with diseases at their initial stages to possibly prevent them from spreading or degenerating into epidemics. In view of this, the GHS operates the IDSR. The structured system starts from the community level. The Community-Based Surveillance Volunteers are in almost every community to identify public health events and then report their findings to a health facility under their jurisdictions.

Currently, the country is supposed to have a CHPS Zone in every electoral area where there will be a CHPS Compound manned by a nurse, who will receive the report of disease incidents in the communities from the Community-Based Surveillance Volunteers. The nurse then verifies the information and if it is authentic or confirmed, he or she informs the sub-district level about the situation. The chain of reporting continues to the district, regional, and even national levels.

Even if there is no outbreak, every week, the GHS is supposed to have public health events that come up and happen in every community being reported to its IDSR. Also, diseases reported by patients at health facilities are compiled each week. So, at the end of every week, surveillance officers at the GHS analyse the data to know disease trends each week to inform public health action and how to deploy resources to handle the situation.

At the regional level too, there is also a weekly epidemiological bulletin, which is an analysis of diseases that have the potential to degenerate into epidemics.

Structured system without funds to implement?

As far as systems are concerned, the GHS has a solid structured system in place and if strengthened through adequate government financing, can prepare the country to pick any epidemic-prone diseases that may come up. However, the issue has to do with the routine financing of the structured system.

It takes resources and funds to deploy all actors along the chain from the Community-Based Surveillance Volunteer through to the public health officers at the national level to effectively discharge their duties. For established outbreaks such as the COVID-19 pandemic, it is easy to mobilise resources from the central government and donor partners to respond to them. However, the everyday detection, reporting, and confirmation of public health events to determine whether or not there is an outbreak are where the GHS does not have a regular flow of finances to be able to carry out.

Over the past couple of years, funding for routine activities has dwindled. Budgetary allocations to the health sector go into remuneration for health staff, and construction of health facilities leaving significantly less resources available to run the public health system routinely.

This implies that diseases that could be detected and managed on time will be left to degenerate into epidemic levels with their devastating consequences on the population.

Need for epidemic preparedness financing

Epidemics have devastating consequences on populations, a country’s economy amongst others. For instance, the COVID-19 pandemic has led to pressure on the country’s health facilities, job losses, low productivity, reduced government revenues amongst others, which have implications on national development.

This is why there is an urgent need for a reliable source of funds to support the effective implementation of the GHS’ IDSR for dealing with disease outbreaks. This is because a very good preparedness and surveillance system will be able to pick up information when a disease comes up and quickly be able to intervene so that it does not spread.

In terms of rapid response, when the system is very sensitive to detecting any possible disease that enters it, then, the country can be in a position to prevent epidemics in terms of the spread of the diseases.

At a recent regional forum in Tamale to collate citizens’ inputs for consideration into the national budget, Mr Mohammed Mumuni, Northern Regional Programme Manager of SEND GHANA expressed the need for a national strategy with a reliable source of funding to avert a major disaster or epidemic in the near future.

The forum was organised as part of the Advocacy for Epidemic Preparedness Financing project being implemented by SEND GHANA in partnership with the Global Health Advocacy Incubator.

Mr Mumuni said, “The National Action Plan for Health Securities (NAPHS), which is Ghana’s Epidemic Preparedness Plan exists by name because of the lack of commitment by the government to implement it. That is why we had to spend left, right, center; mobilising resources when COVID-19 came. So, we think that moving forward, as a country, we need to prioritise the implementation of NAPHS by making funds available through a dedicated funding source to make sure that when we find ourselves in situations like these, at least, we will be able to resist or absorb some of the shocks as a result of this pandemic. So, we are hoping that, in the 2022 budget and beyond, government will make adequate allocations for the implementation of NAPHS to enable the GHS to adequately prepare for future pandemics”

Dr Hilarious Abiwu, Deputy Northern Regional Director of GHS in-charge of Public Health, who made a presentation on epidemic preparedness financing at the forum, spoke about the funding regime for routine surveillance activities saying, “You get a lot more resources coming in if there is a problem but on everyday basis, we do not have regular inflows to be able to strengthen this system.”

Dr Abiwu suggested that, “If we can have some form of dedicated funding for some of these public health activities, which do not bring money in, then the system can only get better. The same way we have a health insurance fund, we may have to be thinking through the possibility of looking at a fund dedicated to public health interventions. That will be a good thing to protect all of us.”

The way forward

Diseases will continue to come. Therefore, the country needs to continue to be prepared by strengthening her system for dealing with epidemics through ensuring the availability of funds to continue to have drills to be ready so that in case there is an outbreak, she will be able to pick it up early.

Just as efforts were made to create the National Health Insurance Scheme to ensure the availability of funds to handle the clinical aspect of the country’s health care system, the country must also consider an option to create a fund and allocate annual national budgets to ensure availability of resources to effectively support the public health aspect of the health care sector as well.

This will strengthen the public health sector to undertake its routine operations to detect diseases right from the community level and take necessary actions to prevent them from degenerating into epidemics.