Lessons from the past: Safeguarding Ghana's public health against the unpredictability of epidemics

Throughout history, human populations have been relentlessly threatened by diseases, with epidemics and pandemics causing the loss of countless lives globally. These threats have become even more virulent in modern times, as incurable and life-threatening diseases continue to grow in strength despite advancements in human knowledge and technology.

Africa, particularly sub-Saharan Africa, including Ghana, has not been spared. The region has experienced and continues to experience a series of emerging and reemerging diseases, many of which qualify as epidemics.

While we have made significant progress in overcoming some common diseases that once claimed numerous lives, the threat of epidemics such as cerebrospinal meningitis (CSM), Yellow Fever, Cholera, Ebola, Dengue Fever, and Lassa Fever remains a constant concern. These diseases often strike unexpectedly, heightening their threat.

Currently, Lassa fever poses a significant threat to Ghana’s public health, especially given that several neighbouring countries have reported substantial fatalities from the disease. Lassa fever is considered endemic in Benin, Guinea, Togo, Nigeria, Liberia, Mali, and Sierra Leone, underscoring the need for vigilance and preparedness in Ghana.

On March 28, 2023, the Ghana Health Service (GHS) confirmed the presence of Lassa fever in the country. This confirmation came after samples from two suspected cases identified on February 26, 2023, tested positive at the Noguchi Memorial Institute for Medical Research.

Following the confirmation, the GHS traced 56 contacts of the initial two cases, leading to a total of 14 confirmed cases of the disease in Ghana. Unfortunately, one person succumbed to the illness.

The Director-General of the Ghana Health Service, Dr. Patrick Kuma-Aboagye, confirmed the death in a statement on March 28, 2023.

He noted that the remaining 13 cases were being managed in designated health facilities, and "a total of 97 contacts have been identified, with efforts underway to identify more."

Ghana also reports significant morbidity and mortality from meningitis, particularly in the northern parts of the country, every year. The impact of these diseases on families, health facilities, and the national economy is substantial. Therefore, it is crucial to implement measures that enable us to respond to these threats early and effectively.

Why epidemic preparedness fund? 

Historical experience has demonstrated the critical importance of contingency planning in managing disasters. While no abstract plan can precisely match the specific circumstances of an unexpected public health crisis, such plans provide a vital foundation. Without them, fear and panic can quickly take hold during major public health emergencies.

Health experts and advocates have long urged the government to establish a public health emergency fund to ensure an effective response to public health crises. Epidemic-prone diseases pose a significant threat to public health security. However, with epidemic preparedness plans in place, timely detection of outbreaks can be followed by prompt and appropriate responses.

The frequency of epidemics involving emerging and re-emerging infectious diseases is increasing, bringing devastating health, social, and economic consequences, especially in developing countries like Ghana. Given that Ghana is not immune to such diseases, it is crucial for the country to take proactive measures, such as establishing an epidemic fund, to respond effectively to public health threats. This fund would provide clear guidance on necessary actions for preparing for and containing disease outbreaks.

An epidemic preparedness fund would significantly enhance our epidemic management efforts. Epidemic management involves anticipating, preventing, preparing for, detecting, responding to, and controlling epidemics to minimise their health and economic impacts. By setting up such a fund, Ghana can better safeguard its public health and economic stability against the threat of epidemics.

Ghana’s funding history   

Setting aside funds to address critical national concerns is a well-established practice in Ghana. The country has a notable history of creating specific funds to support key sectors of its economy, such as the National Health Insurance Scheme Levy, the Road Fund, and the Ghana Education Trust Fund (GETFund). These funds are backed by legislation due to their significance.

For example, the GETFund was established by an act of Parliament in 2000 to provide funding to supplement the government’s efforts in providing educational infrastructure and facilities in the public sector. A percentage of the Value Added Tax (2.5%) goes into this fund.

Similarly, the Road Fund was created by an act of Parliament in 1997 to finance the routine and periodic maintenance and rehabilitation of public roads. This fund sources its revenue from vehicle license fees, international transit fees, fuel levies, bridge and ferry tolls, and weighbridge fees.

The National Health Insurance Scheme (NHIS) is funded through the National Health Insurance Levy, which is a 2.5% levy on goods and services collected under VAT, 2.5% of Social Security and National Insurance Trust contributions per month, and returns on National Health Insurance Fund investments. The NHIS aims to provide access to quality healthcare for all residents of Ghana.

These funds have been maintained by successive governments since their inception, and their effectiveness is well-documented. However, unlike these sectors, the public health sector, which is crucial to the nation's wellbeing, lacks a dedicated fund or reliable sources of funding. This gap became evident when COVID-19 struck in March 2020, forcing the government to resort to borrowing to supplement its resources in fighting the pandemic. This approach left a lasting impact on the country's economy.

Recognising the unsustainability of borrowing, the government passed the COVID-19 Health Recovery Levy Act, 2021 (ACT 1068), to generate more funds to combat the pandemic. While this fund was beneficial during the pandemic, COVID-19 is not the only public health threat in Ghana.

During the COVID-19 pandemic, the country also faced outbreaks of cerebrospinal meningitis (CSM), polio, and yellow fever, which can spread rapidly and cause significant fatalities if not managed effectively. This highlights the urgent need for a dedicated public health fund to ensure a robust and sustainable response to future public health emergencies.

What’s next after COVID-19? 

Even though the World Health Organisation (WHO) declared an end to the COVID-19 pandemic on May 5, 2023, Ghana has maintained its COVID-19 Health Recovery Levy Act, 2021 (ACT 1068). The fund established by this act is still operational. 

Some health experts and advocates argue that considering the end of COVID-19 and the continued existence of the COVID-19 Fund, it would be prudent to amend and convert the COVID-19 Health Recovery Levy Act into a broader fund that can respond to all public health emergencies, including COVID-19.

A dedicated fund for public health emergencies would enable the country to respond promptly and effectively to any public health threat. Epidemics can spread rapidly, causing large-scale outbreaks and widespread panic, highlighting the need for preparedness. Delayed responses to epidemics can lead to undesirable outcomes, with significant public health, social, and economic consequences.

It is important to note that resources are more likely to be used judiciously when an outbreak is well-prepared for with a detailed preparedness plan. Such a plan should clearly outline what actions need to be taken before, during, and after an outbreak.

The need for an epidemic fund is long overdue

Professor Kingsley K. Asare Pereko, a public health expert and Head of the Department of Community Medicine at the University of Cape Coast’s School of Medical Sciences (UCCSMS), supports calls for the government to establish an epidemic preparedness fund. 

He believes the idea of setting up such a fund has been discussed for far too long and should be implemented without further delay.

“It is very, very important to set up the epidemic fund. When you set up the fund before emergencies strike, you have some buffer to cushion yourself before external help comes,” he noted.

According to Prof. Asare Pereko, resources play a critical role during disease outbreaks, and the failure to acquire the necessary logistics or resources on time can exacerbate the problem, exposing more people to harm. 

He explained this point with an anecdote: “Even individually when you do not have money and any of your children falls sick, it becomes dangerous because one cannot tell when external help will come. But if you have something on you, you can immediately act before you get external help.”

The establishment of an epidemic preparedness fund would provide a crucial buffer, allowing for immediate action and reducing the reliance on external aid during public health emergencies. This proactive approach would enhance the country's ability to manage and mitigate the impacts of future outbreaks.

The way forward   

There is no harm in hoping for the best as long as you are prepared for the worst. Since we cannot stop natural disasters, we need to equip ourselves with the necessary logistics for such events. Preparing to respond to epidemics and other public health emergencies like meningitis, Lassa fever, cholera, or Ebola is a crucial aspect of healthcare delivery.

To implement a coordinated, timely, and effective response that prevents unnecessary deaths and disabilities—especially in resource-limited settings—a dedicated fund is essential. Ghana cannot afford to ignore the need for such a fund amid the threat of emerging and reemerging diseases. 

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System Summary

Lessons from the past: Safeguarding Ghana's public health against the unpredictability of epidemics

The piece examines how Ghana can strengthen its public health defenses by drawing on lessons from past epidemics. It reviews historical responses to health crises, identifies current challenges, and outlines strategies for improvement, including better surveillance systems and enhanced healthcare infrastructure.

Emphasising the importance of community involvement and public education, it offers policy recommendations to improve preparedness for future epidemics and considers how adapting past lessons can help address emerging health threats effectively.