Accra, Ghana, August 24, 2020//-Lying on a sickbed in a makeshift building in Teshie, a coastal town in the Ledzokuku Municipal District Assembly in the Greater Accra Region of Ghana, 65-year-old fisherman, Nii Tettey, is battling for his life.
In the last seven days, his family has been treating him with antibiotics bought under-the-counter from a nearby drugstore instead of taking him to the hospital for the fear of contracting the deadly novel Coronavirus Disease 2019 (COVID-19) pandemic.
Mr Tettey is not the only culprit who uses antibiotics to treat himself. Since the outbreak of the pandemic in Ghana on 12th March 2020, a number of people have refused to attend healthcare facilities for treatment for fear of getting the deadly virus.
But this practice of sick people taking antibiotics to treat themselves instead of attending the healthcare centres for the fear of contracting the COVID-19 could lead to antimicrobial resistance (AMR), according to Dr Ewura Adjoah Ahimah Nunoo, a medical doctor at the 37 Military Hospital in Accra.
“Some would even use antibiotics to treat themselves for COVID-19 pandemic when they haven’t done the test yet”, she told African Eye Report.
So, one of the impacts of the pandemic is the rise in antimicrobial resistance cases as alluded to by the experts.
Also resources that would have been used to support the country’s health financing systems would be rechanneled into fighting AMR and COVID-19 complications.
Their microbes which medical doctors described as organisms that are too small to be seen without using a microscope including bacteria are resisting all the medications due to the excessive intake of antibiotics.
A Medical Microbiologist at the University of Ghana, Dr Japhet Opintan, explained that irrational use of antimicrobials which are agents that kill microorganisms or stop their growth contributes to drug resistance among humans could lead to death.
As of the time of filing this report a distress call from a family member, which had Mr Tettey’s wife’s wailing voice in the background, said “he is dead.”
However, his death could have been averted if he was not abusing the antibiotics, the experts said.
Prof Kwame Ohene Buabeng, Head of Department of Pharmacy Practice at the Kwame Nkrumah University of Science and Technology (KNUST), also emphasised: “Irrational use of antimicrobials leads to antimicrobial resistance, which is rather a deadly phenomenon.
This is because when the bugs are resistant, they fail to respond to the antimicrobials, the patient ‘s condition worsens and the patient is likely to die if an alternative and effective antimicrobial is not found in time to treat the resistant infection”.
Antibiotics are drugs used for management of infections but their misuse has rather become toxic to humans, animals and the environment.
The World Health Organization (WHO) estimates that about 700,000 people die of antimicrobial resistance worldwide every year. About 10 million people will die every second by the year 2050 if nothing is done about the situation, according to the WHO.
With these complications and rising COVID-19 cases in Ghana, the health financing system which is one of the six elements of the health system is in difficult times.
The other five elements are health service delivery; the healthcare workforce; health information system, and access to essential medicines; financing family planning, vaccines and technologies; and leadership and governance.
The health financing system interacts with the other elements in order to improve health outcomes, to ensure financial protection, and respond to health consumers in an equitable, efficient and sustainable manner, the experts explained.
The financing of health systems according to the WHO are vital policy matter in Ghana and other developing and developed countries because of the key role they play in the delivery of healthcare for all.
Generally, the COVID-19 pandemic which spreads across the globe presents two most devastating crises to Ghana namely health crisis arising from its effect on public health and economic crisis emanating from the pandemic.
The initial restrictions implemented contained the virus and impacted the economy extensively. In addition to households and businesses, key sectors such as the hotel and health, hospitality industry, trade and industry, agriculture, transportation, manufacturing, real estates, financial as well as the education sectors have been negatively impacted, the country’s Ministry of Finance, said.
Gross domestic product (GDP) data from the Ghana Statistical Service (GSS) indicated that overall real GDP growth tumbled to 4.9% in the first quarter of 2020 compared to 6.7% over the same period in 2019.
Health financing system landscape before the pandemic
The health financing system according to experts is expected to coordinate with the other elements to have a deep improvement on health outcomes.
It also ensures financial protection, and responds to health consumers in an equitable, efficient, and sustainable manner.
The WHO which has been campaigning for the implementation of health financing system urges countries including Ghana to effectively carry on the three main functions of the health financing system: raising revenue; pooling risk; and purchasing services.
Significantly, the National Health Insurance Scheme (NHIS), government support, donor support, and the age-old out-of-pocket payments are the major sources of health financing system in Ghana, according to the Ghana Health Financing Strategy.
Data from the country’s national budgets indicated that the average contribution from the above-mentioned sources of health financing over the period, 2010–2017 showed a declining trend.
For instance, about 39% of total health expenditure in the country comes from government’s component of health financing which comprises direct and indirect tax revenue.
The data noted that the trend in transfers from government domestic revenue as a percentage of health expenditure during the period is also declining.
The donor support which includes contributions from donor partners accounts for 14% of the country’s health expenditure is declining since the country attained a middle income status in 2007, according to the data.
Additionally, the NHIS which makes up of premiums paid through the District Health Insurance Scheme by the informal sector and payroll deductions by Social Security and National Insurance Trust (SSNIT) represents a paltry 3% of total financing.
While the health consumers (people who use health services, as well as their family and carers) make out-of-pocket payments account for 1% of total health financing in Ghana.
Before the outbreak of the COVID-19 pandemic, the government was preparing to initiate reforms aimed at achieving the much-talk about Universal Health Coverage in the country, but funding challenge thwarted that effort.
COVID-19 pandemic’s impacts on Health Financing System
Besides, the country’s healthcare financing system is being impacted by the ongoing infectious COVID-19 pandemic.
One of the impacts of the COVID-19 crisis is the reduction of government spending on goods and services, transfers, and capital expenditure.
Government spending which refers to money spent by the public sector on the acquisition of goods and provision of services such as education, healthcare, social protection, and defence, is shifted towards fighting the pandemic to the neglect of goods and services, transfers, and capital expenditure, among others.
This situation according to economists has severe impacts on the Ghanaian economy as the contribution of the government as a source of financing health in general is plummeting.
The national budgets analysis conducted by African Eye Report further showed that the percentage of government financing of health expenditure has been declining since 2010.
Already, tax and other non-tax revenues are dwindling and with the increased expenditure to boost the economy in response to the pandemic, the fiscal deficit would widen even further, thus increasing debt burden, Monetary Policy Committee (MPC) reports released since the outbreak of the pandemic warned.
Similarly, the pandemic has had an impact on donor support to the country’s health financing system. Presently, a number of donors or development partners have responded to the pandemic by mobilising resources to finance global efforts at developing a COVID-19 vaccine, and research and development to enable them track the virus.
So, their attention has shifted towards fighting the pandemic rather than funding health facilities and other health projects in Ghana and other developing countries.
Also, the donors and development partners are expected to scale down on their contributions to health financing in Ghana and other developing countries after the COVID-19 crisis.
A classic example was the reduction in donor support to developing countries due to the 2008 global financial and economic crisis, according to Organization for Economic Cooperation and Development (OECD) reports.
Additionally, donor support in other areas such as HIV/AIDS, tuberculosis (TB), malaria, and neglected tropical diseases (NTDs) has been rechanneled to fighting the COVID-19 pandemic.
For instance, according to Global Fund (GF), the COVID-19 pandemic had a devastating impact on the fight against HIV, TB and malaria in 2020.
The GF, of which Ghana is a key beneficiary, revealed that the calamitous impact the COVID-19 pandemic had on the fight against TB worldwide.
“In 2020, the number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by a staggering 19%, with those on treatment for extensively drug-resistant TB registering an even bigger drop of 37%.
The number of HIV-positive TB patients on antiretroviral treatment as well as TB treatment dropped by 16%”, a recent report from the Fund added.
The report also acknowledged major declines in HIV testing and prevention services for key and vulnerable populations who were already disproportionately affected.
Compared with 2019, people reached with HIV prevention programs and services declined by 11% while young people reached with prevention services declined by 12%, it indicated.
However, the report observed that interventions to combat malaria appear to have been less badly affected by COVID-19 than the other two diseases.
Ghana’s NHIS as another source of financing healthcare in the country is being hampered by the outbreak of the pandemic because many people are shying away from seeking healthcare at the various hospitals due to the fear of contracting the virus.
To add up, many of these hospitals, particularly the public ones are being used as isolation centres which scare non-coronavirus patients from visiting these facilities.
Many people also prefer engaging in self-medication at home for some illnesses to visiting the health facilities for fear of getting infected with the COVID-19 disease.
This would negatively affect the number of NHIS’ subscribers because many would not see the need to renew their NHIS memberships as they are not going to visit the health facilities but would continue to engage in home treatment(s).
Furthermore, the out-of-pocket payment which constitutes internally generated funds (IGFs) of the hospitals would be affected adversely.
As people start to opt for self-medication or home treatment(s), they would avoid paying for some critical health services including elective surgeries, and reproductive health services, which they would have received should they visit the health facilities.
This implies that the non-attendance to hospitals would affect the hospitals’ IGFs, so out-of-pocket payment as a source of health financing in the country would suffer a huge blow.
Also, the devastating COVID-19 pandemic has had an impact on employment in all sectors of the Ghanaian economy, which in turn has affected individual and household incomes.
Clearly, this would drastically affect people’s ability to afford to pay for healthcare, consequently reducing IGFs of healthcare facilities in the West African country.
Indeed, a reduction in the IGFs of these healthcare facilities would certainly affect their ability to buy consumables, and equipment for their operations.
Response and resilience measures
The government’s swift response to the pandemic was largely influenced by lessons learnt from some of the countries, which were earlier affected by COVID-19, notably countries in Asia and Europe.
While developed countries such as the United States, Spain and Italy were heavily hit by the pandemic due to their earlier delays in responding to the outbreak of the virus.
Similarly, key policy actions taken by the Ghanaian government included: the closure of all the country’s borders; mandatory quarantine and testing of all travelers coming into the country; and the partial lockdown of specific areas recognised as hotspots- Greater Accra and Greater Kumasi.
Additionally, the government set out five key objectives to fight the COVID-19 pandemic. These are: limiting and stopping the importation of the virus; containing the spread of the virus; providing adequate healthcare for those who are sick; limiting the social and economic impact of the virus; and inspiring the expansion of the country’s domestic capability and deepening self-reliance.
Also, plans were at foot for the government to procure COVID-19 vaccines to vaccinate about 20% of the Ghanaian population.
In the bid to respond to the economic and social impacts of the pandemic, the government has had to commit resources to support preparedness and response as well as establish the Coronavirus Alleviation Programme (CAP) to be used to promote selected industries such as pharmaceutical sector supplying COVID-19 drugs and equipment, support of micro, small and medium enterprises (MSMEs) and employment.
The programme which had been approved by Parliament also seeks to protect households and livelihoods, support micro, small, and medium-sized businesses, minimise job losses, and source additional funding for promotion of industries to shore up and expand industrial output for domestic consumption and exports.
Also, the government, in collaboration with the National Board for Small Scale Industries (NBSSI), business & trade associations and selected commercial and rural banks rolled out a soft loan scheme up to a total of GH¢600 million, which have a one-year moratorium and two-year repayment period for micro, small and medium scale businesses.
Ghana’s President Nana Addo Dankwa Akufo-Addo assured that besides the GH¢600 million stimulus package, the government was working to secure bigger funds to support other industries including tourism in the face of the pandemic.
He said aside from GH¢3 billion from the commercial banks and the recovery funds secured from the International Monetary Fund (IMF), the government was also negotiating with the World Bank for funds, while at the same time planning to pump larger sums into the economy to support and empower the production sectors.
In conclusion, though the resilience of the country’s health financing system is tested by the COVID-19 pandemic, with proper management, the country can sail through the pandemic crisis smoothly.
By Masahudu Ankiilu Kunateh, African Eye Report
