Agenda 111, myth or reality?

A popular maxim "health is wealth or wealth is health" is because when the body is healthy, the mind too is healthy to focus on endeavours.

Illness in any form is a drawback, as anybody who is indisposed and bedridden cannot fend for himself or herself, let alone make any contribution to national development.

This scenario explains why our governments spend a greater portion of our national resources on healthy, because a healthy labour force promotes increased productivity.

Being abreast of the construction of the Agenda 111 hospitals across the country, the full extent was lost on me until I took a trip to two of these projects at Paga and Garu, both in the Upper East Region.

I did not know that a revolution was taking place in the health sector. Unfortunately, the dearth of government communications in various sectors has denied people information about what their heritage, the oil revenue, is being used for.

The facilities in these district hospitals would be at par with some tertiary hospitals.

Committee members of the Public Interest and Accountability Committee (PIAC) undertook a tour of the region and districts to verify work on petroleum revenue funded projects.

Although members usually have reservations about the progress and quality of work on these projects, the team that went to Paga and Garu were excited about the future direction of health delivery in the country. The spectacle is better experienced rather than received through secondary sources.

Rationale

The rationale for Agenda 111 was stated at the sod cutting at Trede in the Atwima Kwanwoma District in the Ashanti Region on August 17, 2021.

PIAC Committee inspecting projects at Paga

President Addo Dankwa Akufo-Addo described the initiative as the biggest ever investment in the nation's healthcare sector. At the time, the project was envisaged to construct 101 district hospitals, seven regional hospitals for the new regions , including a new one for the Western Region, two new psychiatric hospitals for the middle belt and the northern belt and the rehabilitation of the Effia-Nkwanta Hospital in the Western Region.

President Akufo-Addo said the COVID-19 pandemic did not only disrupt lives and livelihoods, but also exposed the deficiencies in the nation's healthcare system, because of under-investment and neglect.

The President also said 88 out of 101 sites had been identified for the commencement of work on the district hospitals, and gave an assurance that the acquisition of the remaining 13 sites would be completed in the latter part of the year.

Facilities

At the time of the sod cutting, the President said the modern, fully equipped state-of-the-art hospitals would have facilities for outpatient services, including consultation services for medical and surgical cases, ophthalmology and dental services, a physiotherapy unit, maternal and child health unit, public health unit, four state-of-the-art surgical theatres for maternity, obstetrics and gynaecology, accident and emergency, and for general surgery and imaging facilities.

In addition, each hospital will have the full complement of Male, female, paediatric and isolation wards as well as support facilities, which will include a kitchen, laundry, sterilisation department, mortuary, energy centre, maintenance department, and staff accommodation for doctors, nurses and other health workers.

Building local capacity

The government also describes Agenda 111 as a "Ghana First" agenda, which has been carefully thought through to inspire activity and growth in various sectors of the economy, and help also to bring jobs to the youth.

In line with the government's policy to boost local content, a consortium comprising about 20 Ghanaian consulting firms, made up of architects, civil, structural, electrical and mechanical engineers, quantity surveyors, bio-medical engineers, and other technical teams designed these hospitals to reflect the nation's unique domestic requirements.

These professionals are supervising the construction of the hospitals, being undertaken by 250 local contractors to be maintained by domestic facility management professionals, as part of the government's policy of building local capacity in the building and the construction sectors of the economy, which will help to retain most of the money in the country to boost further investment in the country.

 All the Agenda 111 hospitals are of a standard design of 60 and 100-bed capacity depending on the size of the population but with room for future expansion.

Jobs

When these projects are completed, it is envisaged that Agenda 111 will provide job opportunities for 20,000 health professionals, therefore, give the Ministry of Health to recruit more doctors, pharmacists, nurses and other health professionals.

There will also be indirect jobs for the residents in the hospitals' locations for persons who sell food, drinks, hospital consumables to the hospital, the staff, patients, transport business and visitors.

Genesis

During the COVID-19 pandemic addresses by the president, which has come to be known as the "Fellow Ghanaians" series, President Akufo- Addo highlighted the unequal distribution of healthcare facilities in the country, "as we have tended to focus our healthcare infrastructure in Accra, Kumasi and one or two other big cities. As we have seen, epidemics and pandemics, when they emerge, can spread to any part of the country.

The government thus identified 101 districts with no secondary health facilities otherwise known as district hospitals.

It was also realised that with the creation of six additional hospitals, there was the need for six regional hospitals and a befitting one for the Western Region, as well as the construction of three new psychiatric hospitals for the coastal, middle and northern belts. 

It was also felt that the Effia-Nkwanta Hospital in the Western Region must be facelifted. 

This need led to the formulation and declaration of Agenda 111, the biggest ever investment in the nation's healthcare sector. The Ghana Priority Health Infrastructure Project (GPHIP) is what is referred to as Agenda 111; it has now been scaled up to 104 with the addition of Karaga, Nkoranza and Manhyia.

State of work 

Work is ongoing at about 96 sites, with the projects at various stages. Work ranges from about 10 per cent and 80 per cent, including work on two psychiatric hospitals.

It is the considered position of Health-GIIF, chaired by Dr Anthony Nsiah-Asare, that about 20 of the hospitals should be inaugurated by December. He enumerated some of the challenges hampering work to include, cashflow, terminations as a result of non-performance, incomplete documentation and indeed delays in land acquisition.

The Committee charged with responsibility to oversee the Agenda 111, chaired by Chief of Staff, Mrs Akosua Frema Opare, is optimistic the President will inaugurate a number of the Agenda 111 hospitals before December this year.

According to Dr Nsiah-Asare, the Agenda 111 hospitals are generational in character, hence they qualify to be legacy projects, urging the use of a bigger portion of oil revenue to complete all of them.

"If oil revenue is used to complete the hospitals, every Ghanaian will be a beneficiary because of the spread of the project and the importance of health care," he added. 

The writer is a member, PIAC.