Not too deep a cut?

On the 19th November 2013, the Finance Minister, Hon Seth Terkper read to the nation the 2014 budget statement themed “Rising to the Challenge: Re-aligning the Budget to meet Key National Priorities”.
As expected there have been two distinct voices, the first group calling the budget a ‘transformational budget’; a timely one that reflects the sensitiveness and clear vision of the government. On the flip side is the group that calls it a visionless, retrogressive and uninspiring budget statement
A highlight that got most of us talking was on the 10% Executive salary cut. The Finance Minister stated: “In the spirit of the emerging partnership among the social partners from the Ho forum, H.E. President John Dramani Mahama, his Vice President, Ministers and Appointees have decided to take a voluntary 10 percent pay cut for 2014. The amount to be deducted by the Controller and Accountant-General will be paid into a fund to be dedicated to special purpose CHPS compounds focusing on maternal and neonatal health.”
In reaction to that, the Member of Parliament for Wenchi, Professor George Gyang-Baffuor, is quoted as saying the decrease of 10 per cent of the salary cut of the Executive “is a gimmick which will have no effect on salary expenditure of the country.
However, addressing the people of Wa in the Upper West as part of his visit to the region, President Mahama said “all of us have taken a 10% cut in our remuneration in order to show to the nation that we are willing to sacrifice along with you”. The President indicated, “I have told my Ministers that we have to lead by example, we have to show the rest of the country that we are willing to make sacrifices”.
I am inclined to side with the President, if for nothing at all, the symbolic effect of the salary cut should not be lost on us. Through ace journalist Kweku Baako, we are reminded that Prime Minister Busia did similar cut for rural development, and Nkrumah also did same. I am particularly excited that the amount to be generated is targeted to achieve a certain goal of improving maternal and neonatal health.
Our dear nation has a staggering maternal mortality rate of 350 per 100,000 live births (2010) and the UNICEF estimates Ghana’s neonatal mortality as 29.50 per 1,000 live births (2011) (Source:http://www.indexmundi.com/facts/ghana/mortality-rate). With such figures it comes as welcome news that the president and his executives have decided to channel their pay cut towards improving the health of our mothers and babies through the CHPS initiative.
The Community-Based Health Planning and Services (CHPS) initiative is a national programme seeking to reorient and relocate primary health care from sub-district health centres to convenient community locations. CHPS is an essential health care initiative based on practical, scientifically sound and socially acceptable methods and technology; made universally accessible to individuals and families in the community through their full participation; and at a cost that the community could afford to maintain in the spirit of self-determination.
Laudable as the CHPS initiative is, there have been several challenges at its implementation. In a recent stakeholders summit Dr Alex Korshie Nazzer, Chief Executive Officer of Health and Wellness Consult listed the challenges of the CHPS initiative as, poor or lack of accommodation in the community, lack of transportation for house to house visits, heavy work load, lack of motivation, incentives or compensation for officers in deprived areas and the inadequate or no finances for outreach work. He noted that some of the facilities lacked logistics and machines for testing blood pressure and blood sugar levels of pregnant women. And that the relationship between CHPS compounds and their respective sub-districts was sometimes hostile and unprofessional and this does not allow for collaboration for effective service delivery. (See: http://www.ghana.gov.gh/index.php/2012-02-08-08-32-47/general-news/2811-stakeholders-review-chps-initiative)
These are major challenges that any reform to the initiative must tackle. For this executive sacrifice to be worthwhile these challenges must be tackled head on. Then again there should be clear outcome measures to assess the impact of this initiative.
Fortunately the Minister of Finance has assured us that the monies from the cut will be used judiciously. In my opinion, particular emphasis should be laid on skills training and knowledge acquisition on the part of the community health officers to embark on effective maternal health promotion, recognition of danger signs in pregnancy and early referrals. This will go a long way to help reduce maternal mortality.
Strengthening the CHPS initiative and reforming it to focus on maternal and neonatal health together with the already existing NHIS free maternal health care policy is surely going to improve maternal health tremendously in rural Ghana.
But critics of this sacrifice and laudable initiative may be proved right if the inherent challenges of the CHPS initiative are not critically looked into and monies just get pumped into this already weak structure.
Government must ensure that this initiative works. Maternal and child health should be our collective concern, the current statistics is a scar on our collective conscience and as such what should concern us most is whether this said amount will be used for the betterment of our mothers and children. For those who think the sacrifice is small, we can always ask for more, but let us not underestimate the benefits likely to accrue if this money will be put into good use.
God bless our homeland Ghana!

Dr Nathanael Adjei-Kyeremeh
[email protected]