I got to spend two days in Ghana this week. It was my first visit there, and the time was really productive and inspiring. I got to watch an effective health system in action – from the decision makers at the national level to nurses who live and work in the villages.
I had heard that Ghana’s health system thrived on tracking information but I didn’t realize until I got there that it has an entire culture of data. Every immunization is carefully documented in the mother’s green booklet that tracks the health care of each child, as well as recorded in large registry books. That data moves up the chain to the sub-district and district levels. This kind of rigor may sound obvious, but in many places I’ve traveled, recordkeeping is so erratic that health workers don’t know how many babies live in their area of service, much less whether they’ve had all of their shots.
I met Patricia Antwi, district director of health services in Awutu Senya, about an hour’s drive north of Accra. Every month she gathers all of the sub-district heads to validate and pressure test their data with each other. Then every quarter all of the district leaders in her region meet and do the same. They track their work and adjust their planning and decision making based on such data as patient visits, products delivered and used, and immunization coverage rates. They openly debate what they have measured to help each other improve. They admit when it doesn’t go as well as it should.
Many of us are looking at potential digital strategies for record-keeping, but paper is pretty good.
The energy and commitment of the well-trained nurses was obvious. Alice Grant Yamoah runs the community health compound in the village of Ahentia. She lives in the heart of the community with three colleagues. A couple of days a week they go out in to the villages to treat or immunize children when their mothers don’t bring them in. Alice showed me how to give six-week-old Fredrick his rotavirus vaccine. Luckily for Fredrick these are drops that are fairly easy to administer. Still, both Fredrick and his mother were patient with someone doing it who clearly was less experienced than Alice and her colleagues.
There is a lot to learn from Ghana’s successes – but the most important in my mind is that countries need to have a really strong primary health care system that includes immunization as well as maternal and child health, malaria treatment and prevention, and other things that protect children and their families. It was a strong reminder to me that health is the magic lever. If you make progress there, it will help with all other things.
I’m a huge believer in the Millennium Development Goals, and I was also struck in Ghana over how important they are in helping drive focus and progress in the right places and in the right ways.
After visiting the clinics, I had the opportunity to meet with President John Dramani Mahama, who came into office in January. I was impressed by his strong focus on the MDGs. President Mahama and his ministers have a clear sense for where there has been great progress and where they still need to drive improvement.
The MDGs have really helped Ghana’s leaders focus their efforts, develop effective plans and measure their progress. Mahama was very clear about the good strides they have made in hunger and poverty as well as child mortality and education. He was equally candid about where they must redouble efforts to hit their targets in the areas of maternal health and sanitation. They still have a ways to go, but what’s exciting is that they have a strong direction and a solid plan to accelerate progress.