NHIS In Ghana - 2

It was very interesting to read that the Minister of Health has admitted that the onetime premium policy for the NHIS is not viable. In fact the report claimed that the NHIS scheme will go bankrupt by 2013 if some additional funds are not found to keep it alive.http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=198000 I feel vindicated all over again. I have been talking about the impossibility of the onetime premium payment since it was announced and I have written about it on this blog. I applaud the Health Minister for having the courage to admit the obvious. It may cost him his position eventually, but at least he would have satisfied his conscience that he did the right thing by speaking the truth and defending the constitution instead of toeing the party line.  It is important that we stand by the Minister instead of vilifying him to embolden others like him to speak up. There are many people in places of power who know very well that they are on the wrong side of the issues they so doggedly defend every day. Yet they continue to do so just for their personal convenience.

As our elders say, “he who makes the path does not know that it is crooked”. Sometimes it takes others to point out your mistakes and advice on what path leads to the ‘light’. That is what all the men who surround the president and his top policy guys are supposed to do. Unfortunately these men turn out to be the worst enemies of the president.  Their preoccupation is their stomach. The many silly policies which have littered Africa since the dawn of independence are testimonies to the irrelevance of these men who surround African leaders. They nod ‘yes sir’ even when they know very well that what they are supporting is very wrong.

One of my favorite authors Kenneth Ashworth pointed out that, “Sycophancy is like elephantiasis. The longer it goes untreated the more stolid and immobile it makes you”. The NHIS scheme is too important to play politics with it. The men who surround the president should please speak up if they want the good of the president and the party, for the party that preside over the death of the NHIS will pay dearly in many elections to come. History will also judge harshly the president under whose watch the beginning of the end of the NHIS started. For proponent of the onetime payment policy, it is alright to admit for once that they were wrong. I don’t even know why African Politicians find it so difficult to admit when they are wrong. Yes, the opposition may capitalize on such admission and maybe eventually win power. But what most politicians fail to realize is that truth is the most mind altering drug, not some cocaine or weed. Once people know the truth, it changes their minds and their thinking forever.

Please, let us boldly go out there and with solid reasons explain to the people that the onetime payment plan is not going to work. Once the people understand the stakes, they will have the clarity of thought to make the tough decisions.  

The Tragedy of Small Decisions – NHIS in Ghana

I believe one of the good things to have happened to Ghana was the introduction of the National Health Insurance Schemes (NHIS). The evidence is clear; no nation has ever lifted itself out of abject poverty without a strong health care system. In fact this is intuitive – you need a healthy work force as well as a healthy citizenry to pursue a sustained development program. The NHIS is therefore a welcome policy in that it has the potential to offer much needed health services to the people of Ghana as well as raise the much needed funds to sustain the health sector. In fact if managed well, this policy has the potential to reverse the brain drain in the health sector. As the evidence points out, Ghana has been losing a lot of health professional to the western countries. Most of these health professionals are leaving Ghana because they are tired of the system. Salaries are low and equipments are outdated and inadequate. An insurance scheme has the potential to provide the necessary resources needed to pay realistic salaries to medical professionals as well as provide some of the cross cutting equipment and technology needed in the medical field.

However the proposal for only a one time premium payment for the NHIS is a sure way to bankrupt the scheme and make it irrelevant within a very short period. It seems the politicians are playing politics with this one too to secure votes. But this is one area that we just have to tell the people the truth. For once let us think about mother Ghana and do the right thing. It is obvious that no government no matter how rich will be able to provide FREE health care service. The Scandinavian and the British systems are the closest to a free health care service and in spite of all their riches, the scheme is fast threatening to bankrupt their economies. This is a matter of basic human behavior – any valuable thing that is free is over subscribed. That is why almost all insurance policies have a co pay – some negative incentive to prevent over use and abuse of medical insurance policies.

At present, Mr. Eric Ametor-Quarmyne, a Deputy Director at the NHIS says government currently finances 97% of the funds for the scheme while individual premiums make up only 3%. Now, that is really messed up. I don’t know why anybody should be happy about this. I get it, nobody likes to pay money, especially to the government. However, Government of Ghana cannot continue to be responsible for 93% or even 70% of the funds needed to run the NHIS scheme. Government of Ghana cannot sustainable finance the NHIS scheme at this level and at the same time deal with all the other critical issues of national importance. We have to know that the cost of medical care is not going to be static and as cost goes up so will the amount of money the government needs to pay to keep the scheme viable. Maybe the NHIS will only be providing funds for only malaria and diarrhea treatment. I don’t know why we think we have to depend on the government for everything. How can we enter the 21^st century medical treatment and technology era if we are to depend on unreliable government contribution to our health care?  We don’t want a scheme that will only treat small medical problems, but a program that will come through when we need it most to treat our life threatening conditions. Today, an average organ transplant cost $59,000 (GHC 82,000) per patient. Do we think the government will have the funds to be paying for these treatments on a regular basis? Nobody should tell me that organ transplant and other such medical treatments will be only isolated cases in Ghana. Gone were the days when we referred to chronic illnesses like diabetes, hypertension, renal failure, cancer and heart failure as the WHITEMAN’S diseases. Today, these diseases are very prevalent or fast becoming prevalent in Ghana. These diseases are usually associated with affluent countries. Although we are not that affluent, globalization has made a lot of the western lifestyles that make people prone to these diseases available in Ghana. It is now very common to find people in Ghana moving from their air conditioned homes to their air conditioned cars to their air conditioned offices. They are no longer walking in the sun and sweating, no exercise and yet they still eat all the fattened chicken, beef, unhealthy canned food and drink all the finest alcohol money can buy. Like the proverbial Fanti man, we are all now digging our graves with our mouths. If we want to live long and healthy lives, not only must we change our lifestyles we must also be ready to pay our share into the NHIS to make it more viable.

My brothers and sisters, I was amazed when I read about current technology on tissue allograft. I am sure a lot of you will be wondering what tissue allograft is. I am no medical doctor, but tissue allograft make it possible to transplant bones, heart valves, blood vessels, skin and tendons from the body of one person to another. Usually a person may donate his body after death or his next of kin may donate his body after death to harvest these body parts to benefit living persons who for medical reasons may need these parts. Can the government alone pay for all this? Of course not. But is it politically expedient to promise the people that all they need is a onetime payment to the NHIS system and the government will take care of the rest. The average person is instantly happy with such a proposal not knowing that his potential health care will be limited by what money the government can ‘afford’ to pay into the scheme. Yet when government officials are sick they are taken abroad to enjoy all the wonderful medical technologies at the expense of the tax payer. As if the life of a politician is worth more than that of an ordinary citizen. This is what I refer to as the Tragedy of Small Decisions. When people pandering to the politics of the four year cycle fail to make decisions that will benefit society in the long run.

The people of Ghana deserve to have access to the best medical technologies available in the world and it is obvious that a government financed NHIS system will not provide this. Let us therefore reject the onetime payment nonsense and embrace a fair recurrent payment system that will not be too burdensome on the people. This is my contribution.

European Soccer in Ghana

For purposes of full disclosure – I am not a sports fanatic, but I think I watch and follow my fair share of sports. At least I try my best to watch and follow most of the international tournament involving the Ghana national team.
Ghana generally has always been a soccer nation and most people will do the unthinkable during football matches. I can recall many cases where people have carried their television sets in their cars looking for where to plug it to watch an ‘important’ match because of power outages in their house. But I am still astounded about the craze for European soccer in Ghana lately. That is all people talk about, drink and eat. To me, as a policy junky, everything comes down to how my country can benefit from a phenomenon.
The way I see it, our appetite for foreign goods has been so insatiable that it has extended to foreign sports. As with demand for foreign products, the foreign entities make all the money and we make nothing (except of course whatever value we derive from the consumption of those goods as individuals). Local TV stations are buying the right to show European matches in Ghana. European teams’ paraphernalia and memorabilia are being sold and worn all over Ghana. I get it, with globalization you cannot help with the demand and consumption of foreign products. Those who provide quality goods anywhere in the world are rewarded. But there is a serious economic consequence that befalls ones economy as demand for foreign products far outstrip exports. Just look around the world and you see the negative consequences of trade imbalance everywhere – from the western world all the way to the doorstep of the poorest developing country. For goodness sake let us also be patriotic; let us be proud of what we produce at home. If you don’t like what we have, try to contribute for change. Let us also promote our own sports – go to stadium and patronize the souvenirs of your local team. The churches should also stop preaching that going to the stadium is a sin because it amount to fraternizing with the ungodly – what happens when we go to work). Let pay our local stars well and give them incentives to invest their money in our economy instead of taking it abroad.
Assuming we are so addicted to European soccer that we can’t stop consumption without some serious withdrawal symptoms. Then at least let us think about ways our country can also benefit from European soccer instead of sending all our money to them. I love the Dubai guys (UAE) – I don’t think any country in the Middle East has bought into globalization the way Dubai has. Unlike other countries who are always complaining about the negatives of globalization, Dubai has strategized and thought about how to profit from globalization instead of blindly sitting down for others to dictate what they should do. In the sports arena, these guys are not only consuming the very fine and well organized sports around the world, they have actually strategized to benefit from the most exotic sports you can think about. Can you imagine that they have created an indoor skiing area comparable to the slopes of the world famous ski resorts in Colorado? I hope u get the enormity of this project. They have created snow in the middle of the desert – literally. Now their people can spend money in Dubai and enjoy Colorado without actually going to Colorado to spend money. You will be surprised the number of people who travel from all around the world to Dubai to enjoy Colorado (skiing) including even Coloradoans. That is what I call proactively embracing globalization. They have some of the best golf courses in the world and they have invested in breeding million dollar horses for racing. Everyone knows America is, among other things, famous for its amusement parks and roller coaster rides. They are famously found in Florida, Georgia, California and Nevada. This week, Dubai unveiled the world’s biggest indoor amusement park and the world’s fastest roller coaster ride. The message – don’t go to America; come to Dubai for the best amusement parks and the best roller coaster rides. You should have seen the queues when it was opened – hundreds and hundreds of people. The interesting part was that most of the people in the queue were foreigners.
It is not only Dubai that is trying to make money off of the traditionally western dominated world of competitive sports. Cricket historically has been the first love of the English people. They have dominated the organizing and the economics side of the game for a long time. Then enters the Indians and now everything is fast changing. Cricket was introduced to India during the colonial era, but most importantly the Indians have strategically placed themselves to receive some of the billions of dollars in the cricket industry. Like the Dubai people, they also realized that they don’t have to just love cricket and watch as other people made all the money. They can also fight for a piece of the pie and today the cricket industry in India is a billion dollar industry with countries such as Pakistan, Bangladesh, South Africa, England all paying for the rights of Indian cricket matches.
Instead of just patronizing European soccer and helping those guys make money, maybe we can think about negotiating to get some of our beloved European teams to play at least one match in Ghana. Can you imagine the money we will make by having thousands of fans in Ghana for an European match? All the hotels in Accra will be full, local restaurants will probably have to buy all the tomatoes in Makola to be able to cook for all the fans that will be coming in to eat. Alcohol will be flying off the shelf. Christmas will come early for taxi and trotro drivers, the guys at the art center will be tired of counting their money from the sale of artifacts. The increase in economic activities will mean more tax money for the government. The value of the international media spotlight on Ghana will be priceless.
How about building a world class golf course in the North, preferably near the Mole Game Park for sports globalization. Nobody should tell me it won’t work. If creating snow in the desert can work then anything is possible. As the Dubai people have shown, if you build it they will come. Master, how exotic can it get, playing golf while seeing all these elephants and lions watching you from afar. We can arrange with the PGA or some other golf body to just play one or two tournament a year at our Exotic Ghana Golf course. You have no idea the transformation this will have for the Northern region. The business people will be racing like crazy to build hotels, restaurants and other such facilities. The airport will of course be expanded to accommodate all the big planes coming in as well as house all the numerous private jets. The people in the north will get the much needed jobs they desperately need. Seriously, this is my future business plan – to build a golf course in the North near the game reserve- hope nobody copies my idea before I am able to raise the funds for it. Ok I have patented the idea – wink!

That Fateful Saturday

This was first written in 2005 after General Gnassingbé Eyadéma, Togo’s leader for 38 years suddenly died in office. In a surprising move, the head of Togo’s army announced Faure Gnassingbé, Eyadéma’s son as the newly appointed president.


Alas Saturday was that fateful day
The old man lies bleak alone at bay

Death wraps it hands tight around
Never again to allow tyranny to abound

Mother Africa leaped for joy
Togo felt lose and gay

Only to watch freedom slip away
No longer free to soar the skies of May

In his shoes was put his son to rule
O treason, the military display their fool

Courageous leader went to town aloud
Bush, France and Blair condemned aloud
Obasanjo joined the men and shout aloud

In silence timorous souls rest and gird their guard
Early crawls Gentle Giant to bed

Leaders and men are separated from boys and nerds

Zimbabwe cries aloud to God for a stopover
Mugabe grip tight on power and shows no shiver

Mugabe’s Dilemma

As a compromise for independence in 1980, Robert Mugabe signed the Lancaster Agreement which among other things said the pre-independence arrangements in Zimbabwe must not be disturbed. And so it was that Mugabe led his country into independence presiding over a country in which resources especially land, where disproportionately owned by the white minority in the country. The minority white people therefore controlled the commanding heights of the Zimbabwean economy and by the 1990s had succeeded in using their vast agricultural lands into turning Zimbabwe into the bread basket of Eastern and Southern Africa. However, in spite of the successes of the white farmers in Zimbabwe, the majority blacks had never forgiven the white farmers and their ancestors for forcefully and ‘illegally’ taking their most prized possession, their land from them. Mugabe faced two very important issues. First, should he allow the white farmers to keep the land and continue to provide food and much needed foreign exchange for the Zimbabwe economy? or second, should he take the land from the white farmers and give it to the majority black people and risk disruption in agricultural production? As you may rightly know, Mugabe chose the latter and with it brought serious consequences to his country. Both of the choices Mugabe faced can be defended depending on one’s moral decision making compass.
Faced with this dilemma, the Kantian will ask, do I wish to make it a universal rule that when a group of people have systematically disenfranchised another group of their priced possession is it right to let them keep the property even when the original owners want it back? Expressed in another way, is it right and just to keep another person’s dispossessed heritage and blame it on your ancestors. If you do not want to make this a universal law, then the Kantian will say that in spite of the consequences to the Zimbabwean economy Mugabe should choose to return the land to the rightful owners.
The utilitarian on the other hand will have a different set of reasoning. To the utilitarian, when faced with alternatives, one must choose the choice which gives the greatest good to the greatest number of people. Thus, the question is, will giving the land back to the original owners ensure the greatest good to the greatest number of people. What do the people of Zimbabwe need the most? Is it land they have to expertise to till or is it food, jobs and foreign exchange to modernize their economy. Taking the land from the whites will disrupt agricultural production, decrease investor confidence and eventually put the economy in trouble. However, the majority black people will continue to agitate for fairness for as long as the minority whites control the land.
As events in Zimbabwe have shown, Mugabe took the Kantian approach and is in the process of correcting all the wrongs that his people have faced over the years. However, in the process the economy collapsed and it is only now beginning to pick up. Nevertheless, it is not likely that the Zimbabwean economy will get to the 1980s and 1990s level anytime soon. Perhaps it is only the demise of Mugabe and the weakening of his ZANU PF party that will increase the pace of economic development.
There may have been a third choice that Mugabe could have taken: a pragmatist approach to resolve his dilemma. There is no doubt that the white colonialist had a bigger foot print in Zimbabwe and Southern Africa than the rest of Africa. The white minority stayed and continues to hold vast resources to the detriments of the natives. It is also obvious that white owned businesses make up a significant size of the economy of Zimbabwe. In addition, the white minority, although claim Zimbabwean citizenship continues to hold ties with their western ancestors. Thus any attempt at targeting their businesses which has the impression of a witch hunt will incur the wrath of their western allies. Furthermore once the western countries who control most of the world’s resources declare your country unfriendly to business you might as well close shop and go home. This is because nobody will be coming to do business with you. This is a scenario that confronts most of the countries in Southern Africa. However, instead of being ideological, countries like South Africa and Namibia decided to take a middle of the road approach – a pragmatic approach that has restored land to the blacks without dispossessing and disrupting the white businesses in the country. With this policy, South Africa set up a plan that will gradually transfer land and other resources to black families and tribes. Although both sides did not get all they wanted, at least there is some order in the process of land redistribution as oppose to the gangster-style redistribution policy being pursued in Zimbabwe. It is therefore refreshing to see success stories in South Africa and Namibia where families and tribes have negotiated with the white ‘land owners’ to keep the land and work on it while paying the black families and tribes a percentage of the profits from the land.

Public Disgrace and Private Apologies

There are some people who have a penchant for spewing hate and inciting passions. The least provocation set them off on the road of insults and insinuations. On that road, they shout on top of their lungs to whoever will hear them. They care not who listens or not. They will insult, speak half truths, cast insinuations, exaggerate and flat out lie to damage others hard earned reputation. Yet, they come back with their tails in between their legs to apologize privately. Such people are a menace to our society and one must be very wary when dealing with them. Once you identify such people, you have to do all you can to stay as far away from them as you possibly can. And if yoked with them such that they cannot be avoided, then keep matters as private as you can. When you find them on the road of insults and insinuations don’t try to engage them. How can you tell the wise from the fool when both are on the same road. In time people will come to realize the fool they are and pay them no attention.And when they apologize in private, treat it with all the contempt it deserves.

Reaching Middle Income Status With Investment in Teachers

Truth, I am not that old. In fact I am still in my 30s, but as far back as I can remember teachers’ strike has been an annual affair in Ghana. And in some instances, teachers’ strike has culminated in a disruption of the academic calendar. When I finished secondary school, I had to wait one year before going to college because a strike by university teachers had created a one year lag in the education system. Yes, there are some selfish teachers unions with lazy members in Ghana who will lay down their tools at the slightest provocation. However, on the whole we are just not taking good care of our teachers. We have been paying lip service to improving the lot of teachers for decades and decades. And yet we still talk about accelerating economic development and reaching middle income status. History teaches us that countries like the Malaysias, the South Koreas, the Singapores and the Indias that we love to compare ourselves to have all seen tremendous economic development through continuous investment in teachers and education. Teaching is the profession that makes all professions possible and yet we treat teaching like a hobby and therefore ‘undertrain’ and underpay teachers.
The Unites States is now no longer first in many of the things they use to produce almost exclusively. They are no longer the global leaders in innovation, technology and math and science education. Every expert argue that the US has fallen behind these critical areas because investments in teachers and education have stagnated while other countries like China, Singapore, India and co have doubled and in some cases quadrupled funding for education and teachers.
Our whole policy and attitude towards teacher education shows that in spite of the fact that we talk about reaching middle income status we are just not making the necessary investment to get us there. Controversial as it may sound, the truth is our current teacher training colleges are filled with second class students. Anybody who graduated from secondary school in the 1980s and 90s is a witness to this phenomenon. Majority of those who did not make it to our universities chose to go to the teachers training colleges. We therefore end up with student teachers who are either not our best candidates or candidates who see teaching as a stepping stone to their dream career. In any case, with the limited number of places at our universities it is not surprising that many secondary school graduates end up in teacher training colleges. In fact life is filled with many twists and turns that we may find ourselves in many places that we never intended. However opportunities in such places may line up with our goals and interests so much so that we may even wonder why we did not think about our current position in the first place. Unfortunately however this is not the case in the teaching field in Ghana. In fact even people who have had a lifelong dream of pursuing the call of teaching are easily discouraged right from the training school because of inadequate resources and by the time they get their first posting, they are already looking for the next profession. My brothers and sisters, it the teacher who produces the engineer, the doctor, the carpenter, the teacher, the nurse and all the professions we need to propel our economy into the middle income status we so desperately desire. Common sense therefore tells us that if we need quality professionals to help propel our economy into middle income status then we have to begin by investing seriously in our teachers. Our oil reserves can double or even quadruple but if we do not invest in teachers and education our middle income status will forever be a mirage. We have been selling gold for a long time and gold prices have been on the increase for some time now and yet we have not seen any significant increase in incomes in our country. It is time to put our treasure where are mouths are.