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Statement: Eradicating Preventable Diseases   
 
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05-Sep-2014  
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“When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.” (1)

Health is wealth, and a healthy nation is a productive nation. These underscore the importance of good health. Ghanaians cannot boast of this complimentary wealth, which comes with good health because of the appalling state of our environment.

Filth robs our nation of significant resources as we spend millions of Ghana cedis each year to treat preventable diseases such as malaria, cholera, guinea worm etc. at the expense of executing major developmental projects. Preventable diseases rob our nation of essential manpower and productivity. It takes an aggressive and uncompromising attitude, a strong will and a decisive character to eradicate such preventable diseases as malaria and cholera from our country. These are the positive attributes the PPP will bring when offered an opportunity to serve this country.

CHOLERA

Cholera continues to be one of the fastest killer diseases which are highly preventable. It is not only a killer, it is also a drain on public purse and disgraceful to a country's image. Today, the president of the republic has to virtually go on begging errands pleading with people to keep their environments clean and helping them do same giving the overwhelming cholera toll. It is not a bad attempt, however, it is not a solution, we cannot champion adhoc measures in solving deep rooted problems.

This year, the cholera pandemic hit the nation in June and barely 3 months of the outbreak some 9000 cases have been reported with over 85 deaths in some 46 districts already. The story has not been different over the years. In the first quarter of 2012 alone, Accra has recorded 826 cases of cholera with 17 confirmed deaths. Even though, this is an improvement over 2011's figures of 3,000 cases and 24 deaths within the same period, the situation still leaves much to be desired. Our worry is this: if the capital city with all its glitz and glamour records these many cases, what then happens to other less modern towns and villages?

Cholera remains a global threat and is one of the key indicators of social development. While the disease no longer poses a threat to countries with minimum standards of hygiene, it remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed. In a suburb of Accra called “Lavender Hill” for instance, liquid waste and raw human faeces are poured into the sea and this find its way into our water bodies for drinking and pose a huge cholera threat.

In our cities, towns and villages, the biggest challenge facing us is the seeming insurmountable problem of garbage disposal, filth, and standing pools of water.

Successive governments have attempted to deal with this serious problem. In the Rawlings-led NDC administration, the privatization of garbage collection started on a large scale. In the case of the Capital City Accra and others, a private company with garbage collection equipment imported to be used by this private sector-led initiative to rid the City of garbage ran into operational, legal and financial challenges.

In the Kufuor-led administration, the privatization of garbage collection and the beautification of the environment paved the way for a private company, Zoomlion to collaborate with the National Youth Employment Program. Private sector companies today dominate the garbage collection activity across the country. The results prove that privatization is not the answer. Arming state institutions to work effectively and providing better leadership at the top is the answer. Sanitation departments in our metropolitan, municipal and district assemblies should not be the least regarded areas in local government. They must be well-equipped and supported so that the people in their areas will know that they bite and can take on anyone who breaks the regulations concerning sanitation and a clean environment.

The inability of past well-meaning efforts to deal with the problem of sanitation and to bring about a clean and healthy environment means we need to find a different solution from what we have tried already in recent times.

MALARIA

Malaria is largely a disease of poverty. It has been a major cause of poverty and low productivity accounting for about 32.5 percent of all Out Patient Department (OPD) attendances and 48.8 percent of fewer than five years admissions in the country. (2)
The attempt to control malaria in Ghana began in the 1950s. It was aimed at reducing the malaria disease burden till it’s no longer of public health significance. In view of this, interventions were put in place to help in the control of the deadly disease. (3)

Ghana committed itself to the Roll Back Malaria (RBM) initiative in 1999 and developed a strategic framework to guide its implementation. The goal was to reduce malaria specific illness and mortality by 50% by the year 2010.

To achieve the goal, four main strategies were pursued. These were to:
• Promote multiple prevention which includes promotion of treated bed nets usage; chemoprophylaxis in pregnancy and environmental management.
• Improve malaria case management at all levels(from household to health facility);
• Encourage evidence-based research to come up with effective interventions and
• Improve partnership with all partners at all levels.
In 2005, President Bush launched a five-year, President Malaria Initiative (PMI) estimated at $1.2 billion to reduce the intolerable burden of malaria and help relieve poverty on the African continent.

Ghana was a beneficiary of this initiative. The goal of PMI was to reduce malaria-related deaths by 50 percent in 19 countries in Africa [Ghana inclusive] that have a high burden of malaria by expanding coverage of four highly effective malaria prevention and treatment measures to the most vulnerable populations: pregnant women and children under five years of age. Malaria remains a killer with continued worrying incidences. The prevalence of malaria in Ghana over the past 5 years remains with an average growth of 14.22% a year.
What then is the problem we must solve?

• The problem we face in Ghana as far as preventable diseases are concerned is the lack of proper sanitation. At the helm of this is the hurdle most government’s face i.e effective leadership.
• Lack of -sense of urgency in addressing issues that directly impact on human survival.
• Inadequate education on preventable diseases and how they can be prevented through simpler means.
• Lack of aggressive approaches in handling the menace – the last country wide spraying exercise was in 1960.
• Over reliance on one-method at a time to combat malaria especially.
• Lack of law enforcement to empower relevant bodies to execute their mandate.

It is possible to eradicate malaria if only we can get rid of our filth and slums. It should not be an adhoc measure, it must not be an appeal by the president to do a weekly clean up. it must be a lifestyle, It is achievable. Countries that walked that path were successful. What is required is a militant approach, strengthening of institutions and a sense of urgency to combat these diseases. The PPP will provide the leadership to make this happen.

How did other countries chase-out malaria?

Efforts to control malaria in the United States were heightened at the turn of the 20th century during the U.S. military occupation of Cuba and the construction of the Panama Canal. At the time, malaria and yellow fever were a major cause of death and the disease among the workers constructing the canal. Of the more than 26,000 people working on the Canal in 1906, more than 21,000 were hospitalized for malaria. Recognizing the devastating toll that these diseases were having, an aggressive integrated program of insect and malaria control was put into effect. The program had dramatic results – by 1912, of the more than 50,000 workers, only 5,600 were hospitalized.

It takes a leadership that is concerned about the welfare of its people to decisively deal with this menace. In building the Panama Canal for instance, it took an effective leadership to identify the need to eradicate the malaria disease in order to have a healthy workforce for the project. For two years, attention was diverted from building the canal to eradicating malaria. This is what Ghana needs.

In 1914, the US Public Health Service (USPHS) went to Congress to secure funds to control malaria in the United States. These efforts were heightened in 1933 with the creation of the U.S. Tennessee Valley Authority (TVA) where an organized malaria control program was established. At the time, malaria affected 30 percent of the population in the region where the TVA was incorporated. After implementing aggressive research and control operations, the disease was essentially eliminated in the TVA region by 1947. A key part of this effort centered on attacking mosquito breeding sites. These sites were reduced by controlling water levels and insecticide applications.

In 1942, Malaria Control in War Areas (MCWA) was established to control malaria around military training bases in the southern United States and its territories, where malaria was still problematic. MCWA worked to prevent reintroduction of malaria into the civilian population by mosquitoes that would have fed on malaria-infected soldiers, in training or returning from endemic areas. MCWA also trained state and local health department officials in malaria control techniques and strategies.

When the Center for Disease Control (CDC) was formed in the USA in 1946, its mission was to fight malaria. Its work centered on the control and eradication of malaria in the U.S. It helped launch the National Malaria Eradication Program. According to the CDC, the program primarily featured applying DDT to the interior surfaces of rural homes or entire premises in counties where malaria was reported to have been prevalent in recent years. By the end of 1949, over 4,650,000 house spray applications had been made. In 1947, 15,000 malaria cases were reported. By 1950, only 2,000 cases were reported.

By 1951, malaria was considered eradicated from the United States. By the turn of the 20th century, malaria had begun to disappear from many parts of the United States as America became more industrialized, and living conditions improved.

Singapore
With its equatorial climate, heavy rainfall, dense living conditions and economic dependence on trade and tourism - its port is the world's busiest while its international airport handled over 32 million passengers in 2005 - Singapore should serve as the perfect petri-dish for breeding diseases. Yet the island state has managed to keep most of them at bay with stringent regulations and tough enforcement - and its experience could offer lessons for other countries. Its weapons against malaria consisted of legislation, an emphasis on public housing and urbanisation, education, and the destruction of mosquito breeding sites. During the 1960s, the government embarked on a programme to move people out of Chinatown's slums and rural communities, into new, high-rise public housing with better sanitation and health care.

Today, the vast majority of Singaporeans live in high quality public housing. Life expectancy, at 79-80 years, is higher than in the United States while per capita gross domestic product has soared from $512 in 1965 to $26 836 in 2005, on a par with Spain. But modernisation was not enough to keep some diseases under control so the authorities stepped in. Under the Infectious Diseases Act of 1976, cases of dengue, malaria, tuberculosis, venereal diseases and others must be reported to the authorities, who can quarantine individuals, as happened during the outbreak of Sars in 2003.

Another piece of legislation, the Control of Vectors & Pesticides Act, which dates from 1968, gives inspectors the right to enter homes or other places in search of mosquito breeding sites - like flower pots and containers that collect water - and to fine offenders.

In tropical Singapore, you could be fined 100 Singaporean dollars if environmental inspectors find mosquito larvae in your home because of such carelessness. For building sites, they can run to 20, 000 Singaporean dollars and can include a jail term. Tough measures, such as giving inspectors the right to enter people's homes to check on the status of their flower pots, have helped Singapore eradicate malaria. "Development has helped to eliminate indigenous cases of malaria’’ says a Singapore reporter. Research shows that such policies proved successful because of the government's zero tolerance for corruption and the emphasis on law enforcement. Again, this is a case of effective leadership. This is the incorruptible leadership the PPP is offering Ghana.

Singapore is also keen to encourage research into vaccines and treatment for some of the more common tropical diseases that still affect its people and others worldwide. Currently, Swiss drugmaker Novartis AG has started a research and development programme in Singapore, working on areas such as dengue and tuberculosis. Still in Singapore, in a tropical military training island [Tekong Island], malaria was eliminated by the Singapore armed forces through integrated combination strategies The program was based on:

1) Preventing importation of malaria through screening of visitors,
2) Preventing human-to-mosquito transmission through early case detection and mosquito control,
3) Preventing mosquito-to-human transmission through personal protection, and
4) Contingency plans.

A response plan involving multiple agencies was developed in the event of an outbreak of malaria (defined as a single case of malaria on the island) despite the previous measures. In addition to routine clinical management, this plan comprised active surveillance for malaria cases and intensified vector surveillance. This was done in conjunction with the DSO National Laboratories, tertiary hospitals in Singapore, the Ministry of Health (MOH), and the National Environment Agency (NEA).

Systematic environmental works were performed to reduce breeding sites, and insecticide use targeted both adult mosquitoes and larvae. Surveillance programs were simultaneously set up to determine the effectiveness of the interventions. At the end of the exercise, Mosquito populations declined from 103 mosquitoes per sampling site in January 2007 to 6 per site by March 2007

In Ethiopia, the Ethiopia government has been working with The Carter Center to improve and sustain the targeting of control efforts. One key example is the establishment of the specialized "MALTRA" weeks, which intensify health education, trachoma control, and malaria testing and treatment activities into one-week periods twice a year, freeing time to be devoted to other disease prevention work. In addition, the Center has assisted with new guidelines for malaria surveillance and epidemic detection to ensure that outbreaks are dealt with quickly and the impact on public health minimized.

OUR POLICY
PROVIDE BETTER HEALTH CARE AND CLEANER ENVIRONMENT:

Our focus is on the area of prevention where education is paramount.
Ensure a cleaner environment free from preventable diseases like malaria, cholera and guinea worm.
Provide affordable and accessible health care for all in every region
Ensure emergency care throughout the country to save lives.

A PPP led government will solve the problems we have by restoring the state’s responsibility for a clean and healthy environment throughout Ghana. The state has the mandate for garbage collection, enforcement of sanitation laws and the beautification of common areas in our local environments. Even when the state awards a contract to a private company for garbage collection, it still retains the responsibility to manage the work to determine the quality and timeliness of work performed. This requires capability, commitment and willingness on the part of the state to deal with the problem. The state needs to enact appropriate laws, monitor performance and enforce the laws where problems are experienced. The PPP has the desire to reform the state’s bureaucracy to make it deliver on this responsibility.

PPP’S APPROACH – UNDERSTANDING PAST SOLUTIONS

Malaria and cholera cases have gone out of hand in Ghana.
These diseases as the PPP understands are diseases of poverty and a cause of poverty. Not only are poor people at increased risk of malaria infection and death, but also they are less likely to be able to pay either for effective treatment or for transportation to a health facility capable of treating the disease. Both direct and indirect costs associated with these diseases episode represent a substantial burden on the poorer households. One district in a study showed that while the cost of malaria care was just 1% of the income of the rich, it was 34% of the income of poor households. (6)

Given fixed household incomes, high fees imply that consumption of other goods or services, possibly food and education, could be reduced. This is an example of the so-called "inverse care law", in which those persons with the greatest overall need for healthcare (i.e., socially and economically deprived persons) are the least able to obtain it.

A study conducted by the Ministry of Health in 2008, estimated that annual economic cost of reported malaria cases alone in Ghana was US$772.4 million where the figure is hovering around GH˘42.88 or US$32.30 per person. Considering the budget for Ministry of Health in 2008 of about GH˘20million a year, it meant that the total economic cost of malaria, embracing the cost of treatment and the productive time lost under the spell of the disease is several times greater than the ministry’s annual budget. It is clear that the solution is prevention NOT just treatment as some are advocating. Prevention requires leadership that can act with urgency, the type the PPP is offering.

We in the PPP recognize that the country sits on a time bomb till unwavering commitments are garnered by all stakeholders to convincingly alleviate the disease from the economy.

The Malaria journey started by the W.H.O supported indoor residual spraying exercises with DDT during 1950 and 1960. During the period many households in Volta and Northern regions benefitted with the techniques of aerial spraying in Accra and surrounding areas. It also involved the use of Chloroquine added to salt and sold at Post Offices. We recall that during that time school children will form long queues for their chloroquine tablets before they go to school.

In the 1970 to 1980s the use of Chloroquine was intensified at all health facilities in Ghana. This period was then followed by the United Nations’ Roll Back Malaria Partnership that began in 1999. In 2000, Ghana joined in a youth-led initiative geared towards supporting 44 African Nations that signed the historic declaration in Abuja in 2000 to scale Malaria down to 50 percent by the year 2010 and near zero deaths by 2015.

It is quite worrying to note that despite these interventions, the country has not been able to achieve the set target of 50 percent reduction in malaria infections as stipulated in the 2000 Declaration in Abuja.

Such preventable diseases have been known to slow economic growth by reducing the capacity and efficiency of potential labour force.
We must not forget that maternal and child mortality which is one of the millennium development we are yet to achieve is partly caused by preventable diseases especially malaria.

It is an undisputed fact that the growth of every economy depends heavily on the health conditions of its labour force. A weak labour force renders work unproductive limiting the marketing potentials of business enterprises and projects. The capacity of the economy is challenged with abundant frail workers.

In addition, these diseases have severe socio-economic impact through increased poverty, impaired learning and decreasing attendance to school and work, as well as direct costs that include a combination of personal and public expenditures on both prevention and treatment of the disease. There is no gainsaying that these preventable diseases are leading the majority people into the trap of chronic poverty where poor households are compelled to expend large amount of money on treatments of the disease.

No wonder the capability of malaria has wrecked efforts in the pioneering and engineering of innovative development paths in other sectors of the economy. If efforts by earlier governments were followed through we could have achieved some level of eradication in the economy.
Unless the trend of impacts of malaria is reversed, there is ostensibly no bright future to dream of a better Ghana. The citizens of this country are held captive by these preventable diseases; we are at risk of losing our pride as Ghanaians.
The Progressive People’s Party efforts are to apply a sense of urgency in devising lasting solutions to make Ghana a malaria and Cholera free economy. There is hope for a Cholera and malaria-free Ghana.

PPP’S APPROACH II – Solution

The rules, regulations, by-laws, and policies needed to address these problems are all in place but what has been lacking is lack of governmental or leadership commitment, over politicization of measures, inadequate financial resources, limited human resources, non-involvement of relevant bodies and institutions and in some cases sheer incompetence. The Progressive People’s Party (PPP) will not reinvent the wheel but rather learn from the countries that were successful in eradicating this menace of cholera and malaria and come up with achievable solutions.

The PPP strongly supports the empowerment and non-interference of agencies and institutions charged with the responsibility of maintaining for example clean and healthy environment, proper waste management system, provision of good drinking water and good planning of towns and cities. We in the PPP will provide social intervention and alternatives when it matters so that our actions do not cause distress.
The solutions
1. Using militant approach to ensure all hands on deck. Bring back sanitary inspectors populary known as ''Town Council'' and enforce citizen involvement in addressing sanitation challenges - Maintenance of clean and healthy environment
2. Provide effective Leadership through monitoring and supervision to eradicate Malaria/Cholera/ in the shortest possible time.
3. Attack Poverty – Develop infrastructure and provide capability for the people to solve the huge problem of poverty.
4. Empowering institutions to focus more attention on preventive measures supported by control/treatment.
5. Increasing government budget allocation on research on preventive strategies and methods.
6. Halt the over reliance of a single method of eradication and encourage varying researched and scientifically proven methods.
7. Improving water supply – Treatment of selected water sources.
8. Paying attention to sustaining human resource capital within the health sector and improving on health facilities.
9. Developing strategies that would enable the identification of disease-specific endemic communities while establishing community-based surveillance systems.
10. Maintaining up-to-date databases, effective and sustainable supervision and sustenance of relevant advocacy programmes.
11. Drastically improving our health facilities with relevant equipments and to deliver up to acceptable standards.
12. Recycle solid waste and channel this into energy production to meet the many energy needs of this country.

CONCLUSION

Fifty Seven years on, we still suffer severely from the grip of preventable diseases. Preventable diseases rob our nation of an energetic workforce, kills our pregnant women and our little borns.

Preventable diseases such as cholera and malaria can be dealt with successfully by managing the environment well. We in the PPP are convinced that this responsibility largely lies with effective leadership. In fighting this menace, there is need to consider some other areas pivotal to the success of our agenda; paramount among them is the need to solve the problem of water supply to ensure clean water for every household and investment into public houses in order to do away with the slums and bring back into full force sanitary inspectors to ensure clean environments .

We are aware that these will require huge investments but we must make if we want to permanently eradicate preventable diseases. As we have always said, transformation needs great minds and insightful leadership and the Progressive People’s Party is demonstrating again today that new policy ideas like this one requires dynamic leaders who are capable of managing the challenges this transformational policy change will present.

Political leadership have been unable to use aggressive approaches in handling the menace – the last country wide spraying exercise for instance was in 1960. To reverse this trend, an aggressive and uncompromising attitude, a strong will and a decisive character is required to eradicate such preventable diseases as malaria and cholera from our country. Effective leadership; a sense of urgency in addressing issues that directly impact on human survival; and adequate education on preventable diseases and how they can be prevented are essential ingredients missing so far in the Fourth Republic. These are the positive attributes the PPP will bring when elected to serve.

The Americas, Britain, Singapore and others were successful because they believed in their human resource and they were concerned about their welfare. Also, they were prepared to go for long term solutions no matter how difficult to ensure that the problem is permanently solved. They employed pragmatic, realistic and result-driven approaches to eradicate malaria and cholera from their countries. The PPP strongly identifies with the sense of commitment espoused by these countries and is equally committed to ensuring that our environment is clean, our human resource healthy and our economy buoyant as a result.

Ghana can become a strong, healthy nation under a PPP Administration.

Awake Ghana!

Thank you for your attention.
 
 
Source: Peacefmonline.com
 
 

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