90% OF HIV PATIENTS IN GHANA TO BE ON TREATMENT BY 2020

Ghana 2018 | HEALTH & EDUCATION | VIP INTERVIEW

TBY talks to Dr. Owen Kaluwa, Country Head of the World Health Organisation (WHO), on Ghana's progress in combating communicable diseases, mental disorders, and malnutrition.

How has your effort to reduce communicable diseases progressed in the past two years?

When I took office in 2015, the country had already made considerable progress in dealing with communicable diseases, especially Neglected Tropical Diseases (NTDs), HIV, tuberculosis, and malaria. The progress has been continuous and considerable, though there is still a great deal to do. For example, there had been a gradual increase in the number of people with HIV put on treatment. Malaria cases have gone down considerably across all age groups. Progress continues against TB as well. We have to continue making progress in responding to these diseases if we are to attain the associated Sustainable Development Goal (SDG) targets. If we take HIV, for example, we hope by 2020 to have put 90% of HIV patients in the country on treatment to ensure we remain on course for ending the HIV epidemic by 2030. As of 2016, we were at 34%. This means we still have a long way to go and thus we must intensify our efforts to address communicable diseases. WHO is working with countries to develop and implement sustainable action plans for combating these diseases. These goals can only be achieved with the collaboration of all stakeholders including governments, the private sector, NGOs, the civil society, and development partners.

Can you guide us through the WHO's guidelines on improving healthcare for mental disorders in Ghana?

First let me start by saying that over the years, the global focus on health in low to medium-income countries has been on communicable diseases, and in many instances rightly so. However, our estimates indicate that by 2030 non-communicable diseases including mental health disorders will exceed communicable diseases in terms of burden of disease i.e. illnesses and death. WHO has developed guidelines on improving mental health, including the Global Mental Health Action Plan for 2013-2020. This has clear objectives and actions for member states to implement. In addition to that, the WHO has developed a mental health gap action program to address the gap between the magnitude of mental health disorders and the capacities of health systems for dealing with them. One of the major issues is the lack of specialized psychiatric care at district and community levels where most people live. Most of the mental health problems occur in areas with inadequate health system capacity. The program focuses on the critical interventions that can be implemented to alleviate the burden and improve care at lower levels of the health system. We want to improve training for mental health workers in the mid-lower health categories. We have various manuals and guidelines that underpin this approach. A number of countries are working to adapt these guidelines for use in their respective settings.

What is the strategy to tackle other non-communicable diseases?

The burden of non-communicable diseases continues to increase and yet resources available to healthcare providers from national and international partners are not expanding. Most of the international development partners are doing a great job supporting communicable diseases, but there is still a significant gap when it comes to non-communicable diseases. For cardiovascular diseases, cancers, chronic respiratory disease, and diabetes, WHO has developed a package of essential services which includes promotion, prevention, care, and rehabilitation. The aim is to scale-up the response to non-communicable diseases at the lower levels. This requires increased financial resources. We must focus on how we can increase domestic resource allocation to health, prioritizing health spending in budgets and forming national partnerships to leverage the capacities of the resources available beyond the health sector. The government and its partners should indeed act, but individuals must also play their part by adopting healthy lifestyles. Tobacco use, alcohol abuse, unhealthy diets, and lack of exercise are major risk factors to non-communicable diseases. Adopting healthy lifestyles helps reduce and prevent these diseases, thereby minimizing the cost of response.

What is your assessment of malnutrition among Ghana's youth?

The rates of stunting have improved in Ghana, though the problem of anemia continues to be a key challenge. We need to address this. The government has launched a folic acid supplementation program for adolescent girls and pregnant women, which we believe will contribute significantly to addressing the problem. Addressing malnutrition requires a combined effort from many different sectors, and there is a clear role for health, agriculture, and education sectors. It is no longer adequate for a single sector to address health or developmental issues alone. We need everyone to come together to make a difference.

What is the best strategy to ensure health insurance gains?

One of the major priorities of the WHO is Universal Health Coverage, i.e ensuring that all people have access to high-quality health services they need without facing financial hardship. Defining the services and health needs of people should be done, but this should come with financing mechanisms that ensure people receive the care they need. Health should be available to all as a human right. Proper strategies for financing health would allow us to do this, and national health insurance schemes like the one that has been designed for Ghana is one of the best mechanisms for ensuring that this happens. I have visited a number of districts and regions and learned that the national health insurance scheme is critical to health service delivery in Ghana. Improving the efficiency of the NHIS will result in great benefits to health service delivery. The government's current efforts to improve the scheme are extremely valuable and totally necessary in order to maximize the benefits. If we improve health service delivery, then we can improve health outcomes all across the country. Digital technology in health or ehealth will also be extremely critical in the attainment of universal health coverage, because if we are to have service available to everybody then we must reach everyone. Telemedicine, for example, would allow highly qualified specialists to provide advice and guidance for the care of patients across the country. Digital technology in health is something that we must pursue if countries are to attain Universal Health coverage.

What are your expectations for 2018?

The government is finalizing the national medium-term development plan for health, the UN is finalizing its Sustainable Development Program for Ghana, and WHO, we are developing our country cooperation strategy for health that defines our priorities moving forward. 2018 will be a critical year to implement these in a coordinated and harmonious way in order to firmly position ourselves on the road toward achieving our health goals in relation to SDGs. Additionally, 2018 will be critical for strengthening our capacity to prevent, detect and respond in a timely manner to public health emergencies. In February 2017, we conducted a joint external evaluation of Ghana's core capacities in relation to International Health Regulations. We found a number of areas that need to be strengthened and we will be working with the government to develop a National Action Pl