Prof. Alfred Edwin Yawson Urges Policymakers to Strengthen the Primary Health Care System

“Ghana’s health system has demonstrated some resilience and provided essential health services as other tertiary care services suffered in the face of the COVID-19 Pandemic”. Prof. Alfred Edwin Yawson, Head, Department of Community Health, and incoming Dean, University of Ghana Medical School made this remark as he delivered his inaugural lecture on the topic: “In the Eyes of the Beholder: Dissecting Ghana’s Health System towards 2030 and beyond”.

Examining the health system financing in Ghana since independence, Prof. Yawson disclosed that in the 1970s, the inequities in the national health budget led to the 10/90 Gap in Health Financing. Prof. Yawson noted that about 90% of the health care budget was spent on 10% of the urban-based population and the rest of the population had to contend with the remaining 10% of the budget. To cater for the inequities of the 10/90 Gap, the Cash and Carry System and later the National Health Insurance Scheme (NHIS) were introduced.  Expanding on the close to 20 years implementation of the NHIS, Prof. Yawson said “being a social type of insurance in a low-income setting, the NHIS has peculiar challenges because generally, income levels are low in our setting”.  He added that, “We have a predominant portion of the population being the informal sector as well and this contributes to low levels of premium. The contribution from premiums constitutes less than 5% of the NHIS budget…we need to be innovative about how the Health Insurance functions”. 

Prof. Yawson stated that in the 2021 fiscal year, 74% of consolidated funding for the health sector came from the central budget of the government of Ghana, while 26% was complemented by development partners. He revealed that, the contributions of the developing partners are dwindling and over 60% of government resources in the health sector goes into payment of salaries and emoluments of health workers.

Prof. Alfred Edwin Yawson delivering his inaugural lecture

Touching on governance and key leadership, the lecturer highlighted the Ghanaian health system’s resilience for its capability to function and provide vital services in the face of shock such as COVID-19, without any impediment. He cited those essential services as immunisation, antenatal attendances, deliveries and basic services at the end of 2020 did not show any difference when compared to 2018 and 2019, implying that the outstanding systems put in place worked perfectly. He enumerated numerous agencies where health system planning and budgeting tools were used to develop strategic and operational plans from the low levels of the health system. However, there are challenges in translating national policies into implementable actions at sub-national levels. An example is the lack of awareness at some healthcare facilities. 

Speaking on human resource for health, Prof. Yawson indicated that the health system can train most of the specialists and the health care staff needed through the establishment of postgraduate colleges. Prof. Yawson also cited and acknowledged agencies such as Food and Drugs Authority (FDA) as strong regulatory agencies in sub-Saharan Africa. He disclosed that Korle-Bu Teaching Hospital was accredited by the Health Facilities Regulatory Authority (HeFRA) as a facility that can provide services to the citizenry in 2019, showing that even the renowned health institutions are being monitored.

Moving towards 2030, the lecturer signaled the need for examination of health systems to ensure the provision and expansion of essential health services, tertiary level care and capital infrastructure.

Drawing attention to health service delivery and access, Prof. Yawson indicated that government provides approximately 60% for outpatient services, whilst the Private sectors including faith-based organisations contribute close to 40%. He urged the nation to pay attention to contributions of the private sector to the improvement of the health system. Prof. Yawson further recommended that the potential of the private sector be harnessed to boost the health system. 

Additionally, the lecturer pointed to obesity and overweight as risk factors for most of the non-communicable diseases, especially the cardiovascular related conditions. He emphasised that between 2007 and 2014, there was an increase in obesity and overweight of 3% at the population level. He cited females, urban residents, older persons, those with higher education and those with higher incomes as groups with higher risks of obesity.

A cross-section of participants at the lecture

Prof. Alfred Yawson stated that a population level survey conducted in 2007 revealed that 71% of older persons who wanted access to health care received it, however, 2014 saw a reduction of 42.3% older persons receiving care. He pointed out that plans are underway to collect data in the current year to reveal the latest trends. Highlighting population level risks, he said “Ghana’s ageing population rate of 60 and above is rising and Ghana in terms of proportion has one of the highest proportions of the aged in sub-Saharan Africa. As people age, chronic degenerative conditions will increase”. He disclosed that the population of the aged in Ghana is projected to increase from 6.5% in 2010 to 11.9% in 2050. Therefore, Ghana must prepare itself for geriatric and palliative care through training.

He reiterated that high risk of ageing and non-communicable diseases were increasing and health and social policies were adequately needed to address the issue. Prof. Yawson observed that rural residents have challenges accessing health care; urban residents suffer more chronic health conditions and older women who are poorer suffer more chronic health conditions and usually have lower health score. Prof. Yawson advocated for interventions for areas and population groups that are at most risk and need assistance.

He commended the Ministry of Health and Ghana Health Services for developing the Universal Health Coverage (UHC) roadmap and called on policymakers to operationalise it to strengthen the primary healthcare system since it targets areas and population groups that are in the most need.

Prof. Alfred Edwin Yawson also advocated for the restructuring of the package of health services at the lower level to improve access for the ordinary Ghanaian; increase in domestic funding for the health sector to ensure health reliance; demand-driven training of specialist physicians, nurses in areas of special need, and inclusion of the private sector, academia and civil society in the planning process to generate the awareness of change.

He indicated that within the context of economic constraints, there was a need to make the Ghana Beyond Aid programme count since it was needed to achieve universal health coverage by 2030.

In her closing remarks, the Vice-Chancellor and Chairperson of the occasion, Prof. Nana Aba Appiah Amfo, commended and congratulated Prof. Yawson on his insightful delivery. She lauded his collaborations with policymakers and acknowledged the impact of the lecturer’s mentors in shaping him into a brilliant academic. Prof. Amfo succinctly summarized the lecture and expressed anticipation of the lecture generating good discussions, leading to the successful implementation of Prof. Yawson’s recommendations.

Prior to the lecture, the Registrar, Mrs. Emelia Agyei-Mensah, welcomed all present and said, “Inaugural lectures form an essential component of the University’s programme for an academic year and every academic who rises to the rank of a professor in his or her career in the University of Ghana is expected to deliver an inaugural lecture”. Mrs. Agyei-Mensah added that inaugural lectures offer the University an opportunity to recognise and showcase the achievements of faculty as they share their research with colleagues within and outside the University.

The Ghana Dance Ensemble graced the occasion with cultural performances as well as seperewa appellation to herald the lecturer. 

Several presentations were made to Prof. Alfred Edwin Yawson to congratulate him on his achievement.

As a prelude to Prof. Alfred Edwin Yawson’s inaugural lecture, a week-long exhibition of his scholarly works was held at the Balme Library. His research has focused on health systems, health policy, planning and financing, ageing and chronic non-communicable diseases and HIV/AIDS. 

Prof. Yawson at the opening of an exhibition of his scholarly works at the Balme Library

In attendance were Prof. Clifford Nii-Boi Tagoe, Former Vice-Chancellor; Mr. Edward Omane Boamah, Former Minister for Communications; Dr. Asamoah Baah, Former Deputy Director, World Health Organization (WHO); Dr. Stephen Ayisi Addo, Programme Manager, National AIDS/STI Control Programme; Prof. Richard Adanu, Rector, Ghana College of Physicians and Surgeons and former Dean of the School of Public Health, UG; Dr. Koku Awoonor-Williams, Former Director, Policy, Planning, Monitoring & Evaluation (PPME); and Dr. Divine Banyubala, Registrar, Medical and Dental Council of Ghana.

The lecture was also attended by members of the University community, the media fraternity and the general public.

A group photo with senior officials of the University


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A cross-section of participants at the lecture