*Written by new G&RI team member Mina Shahid
October 17, 2010
So I wasn’t planning on writing a part 2 on this topic but I can’t resist due to some recent experiences with medical care in Ghana. Imagine a hospital that has no running water or sanitation facilities. I know… it’s hard to believe. It almost seems like a ridiculous thing to even consider – how can a hospital not have running water?
Well my friends, unfortunately that is the case in many of Ghana’s rural health centers and even metropolitan hospitals. This past Friday, I woke up in the morning not feeling too great. I figured that I had malaria because I missed a few days of my anti-malarials but after 3 days of taking the treatment medication my condition didn’t really change, just got worse. So yesterday afternoon I went over to the Saboba Medical Center and got tested for Typhoid and Malaria. The results – no malaria, but I definitely had typhoid! It seems that everybody is getting typhoid in Saboba these days including a colleage of mine. I asked the nurses at the clinic what the deal was, and they mentioned that they’ve seen an increase in typhoid cases in the past month probably due to the heavy rains.
But only if we had some data to verify this, then we could make some decisions at Ghana Health Service on how to deal with the issue. One approach may be to use the Ghana Information Service truck which has speakers attached to it to broadcast messages in the community about how it’s typhoid season and the steps you can take to prevent getting it. Once again, the data is missing, so decisions can’t be made effectively.
On to the issue of hospital infrastructure. Typhoid is a water-borne disease often caused by poor sanitation infrastructure. Hmm, so you must be wondering - isn’t it counter-productive to have a hospital that has no sanitation infrastructure, treating typhoid patients. I’d say, it’s probably not the best case scenario.
And this is why a fellow EWBer has been ill for the past week and in and out of hospital in Tamale. She probably got even more ill while she was in the hospital due to a lack of sanitary conditions. Once again… how can a hospital not have running water?
The answer is not lack of money. It’s not lack of technology. But in fact, as Patrick Awuah mentions in his Ted Talk, it is lack of leadership. You see these hospitals were built with running water and sanitation facilities but they’ve never been maintained and subsequently they no longer function. Maintenance is a thing of leadership, of being capable to plan ahead, to look at data and finances and allocate appropriate measures to keeps things working.
So this is where G&RI comes in. The G&RI strategy is not only based on creating district data systems and ensuring evidence-based decision making but it is also heavily founded on improving district leadership as a whole. We’re working with district officers to improve their ability to manage their work, while making better decisions for the people of their communities. We’ve seen District Coordinating Directors (DCDs), the administrative heads in the districts as key leaders, and have been running a DCD Fellowship exploring various leadership skills that they think would help them do their job better. I’m beginning to believe that lack of strong leadership in district governments is a major issue affecting Ghana’s decentralization processes and rural development and I’m happy that the G&RI team is addressing it.
I know it sounds a little cliché, this idea that what Africa needs is “good leadership.” But spend a week on the ground in a district, and you’ll begin to believe it. If the respective health offices in Saboba and Tamale had leaders who had the skills to plan effectively for maintenance of their facilities, than perhaps there would be running water and sanitary conditions. What is both frustrating and exciting about working in the government system in Ghana is that there is so much potential for positive change if some of the barriers can be overcome.
So in concluding, it’s important to keep in mind that systems only work for change if the people running those systems want change. The G&RI program will go nowhere unless district officers desire to create informed decisions, and provide better public services to constituents and often this is a result of good leadership.
