What world are we in now? What is our country turning into? Are endemics now opportunities for profit making or the lives of precious Ghanaians are at risk?
Malaria has become the battle of several sub – Sahara African countries. The West African sub region alone is said to have an estimate of about 300 million people at risk of malaria infection. This implies that all the about 27 million population of Ghana are at risk of malaria infection. Several factors such as lack of proper disposal system, poor drainage systems among others which serve as breeding grounds for mosquitoes, the major carriers of the malaria parasites can be held liable for the assertion. This has resulted in constant hikes in malaria cases across the continent. However, governments with support from the World Health Organisation (WHO) have put up several efforts to curb the situation but this has only resulted in a little progress. In the case off Ghana, successive governments have developed and implemented what is known as the malaria control programme with much emphasis on children under 5years of age and pregnant women. Some these efforts include the introduction of treatment drugs, the distribution of free treated mosquito nets; the National Health Insurance Scheme (NHIS), Indoor Residual Spraying (IRS); not forgetting the efforts of private individuals who took business advantage to manufacture or import insecticides and mosquito coils. This essay therefore discusses how effective the various intervention have been; what has not been done right and what can be done.
One effort made towards malaria was the introduction of drugs meant to attack and kill the parasite within the system of the affected person. These drugs includes chloroquine and other medications such as quinine which were popularly used between 1950s and 2000s, a treatment policy referred to as monotherapy. However, in 2004, there was a change in treatment policy to artemisinin combination therapies (ACTs), i.e. artesunate-amodiaquine, for treatment of uncomplicated malaria. This treatment policy has since been revised twice, in 2007 and 2009, to include other ACTs, namely artemeter-lumefantrine and dihydroartemisinin-piperaquine. However good this laudable intervention is, how has the government at the time considered the feasibility of the intervention project when majority of communities that are at higher risk of malaria infection do not have basic health facilities? How are the residents of such communities able to diagnose themselves of the disease and even get access to the medicine, and even administer it in the right proportion to get healed? It is therefore no surprise that after the introduction of this intervention, the problem still persisted. It is therefore necessary for all stakeholders to come together with a research team to locate and furnished all remote areas lacking health centres with one and a well-trained experienced health care provider.
Another is the distribution of free mosquito nets to households across the country. This was done with the purpose of preventing people from malaria infection. However, there was no proper orientation for people to understand the need to use the nets to protect themselves and their families at night against the parasite. This assertion is based on the fact that in certain communities, the nets were used for fishing purpose instead of the original intended purpose. Also, in some cases, the mosquito nets do not get to the intended consumers rather, they end up in the hands of some greedy individuals. It is therefore very sad, disappointing and disheartening how the nets which are meant to be distributed free to citizens are sold on the open market, yet authorities look on unconcerned. Along the distribution of the nets was Internal Residual Spraying, IRS. This intervention process also was faced with the same problems that the net faced. One prominent among them is the diversion of the chemicals meant for the spraying to the residence of some private individuals who in turn sold them or used them for other purposes. Finally, the introduction of insecticides, repellent coils and creams was a good effort but it has failed to arrest the situation because the base cause of the problem still remained untouched. These include: improper disposal of waste materials which most of the time provide better breeding grounds for the mosquitoes – the carriers of the parasites that cause malaria. Stakeholders must therefore invest in destroying the breeding grounds of mosquitoes which include stagnant waters, choked uncovered drainage systems and the several improperly disposed containers that harvest rainwater which also constitutes breeding ground for the mosquitoes.
Finally, the introduction of the National Health Insurance Scheme (NHIS) was met on its debut with so much goodwill for malaria control intervention on the back of the fact majority of Ghanaians are poor and therefore could not access basic health services due to lack of funds to do so. So the introduction of the national insurance cover was an initiative to encourage persons to take advantage of it and go to the health centre to access basic health care. However, this goodwill was hit with several setbacks – first, government delays in the payment of claims which has led to many health centres running at a loss, hence refusing to offer health care to persons on the service. Second, as a result of government’s failure to pay claims on time, most hospital offer only diagnostic services to patients and ask to them to purchase the drugs on their own. The only drug offered therefore is paracetamol in most cases. As a result of this, the malaria death toll has not been significantly reduced. As country, we seem to be continuously marking time, without any vision of moving forward on the radar of malaria eradication. Meanwhile, we hear the annual government budget allocating so much money to the NHIS but the system is as stagnant as the stagnant waters that provide perfect breeding grounds for the malaria vectors. I do not want to believe that we are waiting to see how far the First Lady’s Malaria Foundation will take us before we make any move. We must therefore wake up as a nation to arrest the situation now, stop the politicisation of issues and prosecute corrupt officials now before the worsening situation gets worst.
By Amos Edem Diana
The writer is a L. 200 student of Physician Assistant Studies at the University of Cape Coast