Tuesday, June 6, 2023

Ghana: Public Health Emergency Fund Needed to Achieve ‘One Health’

At least, 1,469 individuals have died in multiple disease outbreaks that have plagued Ghana in the last two years. The diseases; COVID-19, Marburg virus disease (MVD), Monkeypox (Mpox) a nd Lassa fever (LF) have something in common. They are all zoonotic.

While scientists trace the sources of transmission of MVD and the SARS-COV-2 viruses responsible for the COVID-19 pandemic to species of bats, Mpox and Lassa fever viruses are said to be linked to rodents.

The World Health Organisation (WHO) defines zoonotic diseases as infectious diseases shared between animals and humans and that the most common infectious diseases across the globe are traced to the zoonotic origin.

It is estimated that 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic and about 2.5 billion cases of illness and 2.7 million deaths recorded annually attributed to zoonoses.

While COVID-19 had claimed 1,462 lives in the country as of March 10, 2023, four persons had died from Mpox out of the total 116 cases recorded in the last year, and two people lost their lives to MVD.

This year, Ghana has already recorded one casualty from Lassa fever, a 40-year-old trader who plied her trade at the Agbogbloshie market in the Greater Accra Region.

At least 13 others are said to be under monitoring and treatment at various health facilities and a total of 59 contacts so far traced to the confirmed cases.

According to health experts, fatality rate of these highly-infectious diseases could be as high as 90 per cent depending on early detection, diagnosis, and treatment mechanisms available.

Prior to COVID-19, about 100 billion dollars had been lost to zoonotic diseases globally with ‘poorer’ countries being worst affected, according to a 2020 United Nations Environmental Programme (UNEP) report.

Emerging zoonotic diseases, according to the WHO, have potentially more serious health and economic impacts than ‘conventional’ ones and this is evident in outbreaks like Ebola in 2014 and the COVID-19 pandemic, which has had ravaging effects on world economies.

Although no nation anywhere in the world is ever fully prepared to handle such health emergencies, commitment to actions that address or mitigate health security risks determine the extent of impact of outbreaks on a population.

According to the 2019 Global Health Security (GHS) Index, which assesses a country’s ability to prevent, detect and respond to health emergencies, the US is the “most prepared” nation (scoring 83.5 out of a 100 percent score) to respond to health emergencies.

It is followed by the UK (77.9), the Netherlands (75.6), Australia (75.5) and Canada (75.3). Much of Europe, Russia, the Middle East, Asia, Central and South America are described as “more prepared” scoring between 66 and 34.3, while majority of countries ranked “least prepared” to deal with pandemics are in Africa.

Of the 195 member countries of the WHO which were assessed, Ghana placed 105th, scoring 35.5 points, way below the average global score of 40.2 points, an indication that the country’s health system is functioning well below standards and that gaps exist in guaranteeing health security.

Ghana is vulnerable to the effect of zoonotic diseases as approximately 46% of the population is engaged in agriculture.

This means that there is a high interconnection between the human, animal, and environmental ecosystem which increases the risk of zoonotic disease transmission.

It is for this reason that the country, in 2016, adopted the “One Health” concept to promote a holistic approach to responding to possible public health threats such as high-impact infectious diseases emerging at the interface between humans, animals and the environment.

“One Health” embraces a collaborative, multi-sectoral, and trans-disciplinary approach (working at the local, regional, national, and global level) to achieving optimal health outcomes, recognising the interconnection between people, animals, plants and their shared environment.

However, seven years down the line, little has been done to fully operationalise the concept as the country continues to grapple with emerging zoonotic infectious diseases.

A study on the state of Ghana’s public health emergency preparedness and response capacity by Franklin Asiedu-Berkoe et al (November, 2022), identified inadequate funding as a major gap in institutionalising the model.

“There is an over-dependence by Ghana on external donor funding for running the public health system. The Central Government provides funding during outbreaks but donor partners are the main sources of financial support before, during and after public health emergencies.

They have been unfailing in their support so far, but there are concerns of sustainability should these donor partners reduce or withdraw their support in the future,” the research established.

Ghana’s Medium Term Development Framework

(2022-2025) makes provision for the establishment of a Public Health Emergency Fund (PHEF) in readiness for health emergencies and increase the country’s preparedness ratings regarding emerging threats but with barely two years to the elapse of the document, that promise is yet to see light of day.

To address the funding gap, the government now has the option of expanding the existing COVID-19 Health Recovery Levy, 2021 (Act 1068), which imposes a one-percent levy on the supply of goods, services and imports, to a dedicated fund for emergency preparedness and response.

In an interview, the Risk Communication Officer of the Veterinary Services Directorate, Dr Benjamin Sasu, said the absence of a dedicated fund for public health was a major impediment to building a resilient healthcare system for the country.

He said active surveillance, monitoring and availability of resources and logistics were central to detecting early signals of viruses migrating from animals to humans for early control interventions but as things stand now, financial constraints highly militate against that.

“The animal ecosystem plays an integral role in public health and cannot be