Ghana may be positioning itself as a health and medical tourism destination if the planned construction of one hundred and eleven health and medical infrastructure facilities across the country is delivered. Tagged as ‘Agenda 111’, the ultra-modern health and medical infrastructure proposition is potentially the largest healthcare project in West Africa.
Last week, President Nana Addo Dankwa Akufo-Addo cut the sod symbolically at Trebe – a town in Ashanti Region – to signal commencement of the Agenda 111 hospital projects across the country. The Agenda 111 project includes 101 district hospitals, six regional hospitals in the newly created regions, two specialised hospitals in the middle and northern belts, as well as a regional hospital in the Western Region and renovation of the Effia-Nkwanta Regional Hospital.
According to President Akufo-Addo, the coronavirus pandemic exposed the deficiencies and structural gaps in the healthcare system due to years of under investment and neglect of the health sector. Therefore, the current investment is an attempt to address the uneven distribution of healthcare infrastructure and also to make Ghana the centre of excellence for healthcare delivery in the sub-region.
Contrary to the notion that Agenda 111 was an afterthought, President Akufo-Addo said the investment was an original plan to inspire growth in the economy’s various sectors and also to help create jobs for the youth, adding: “It is a Ghana first agenda. It’s the largest healthcare infrastructure project ever undertaken in the history of Ghana since independence”, he said.
The project is to ensure that all Ghanaians have access to quality healthcare services; and with the National Health Insurance Scheme boost the provision of healthcare infrastructure and financial accessibility to healthcare. The facilities to be accessed by Ghanaians include four state-of-the-art surgical theatres for maternity, obstetrics and gynecology; a full complement of male, female, paediatric and isolation wards, among others.
Attaining SDG Three
Health is one of the three essential social services designated by the United Nations as universal rights. The others are education, water and sanitation. Therefore, the investment’s objectives are two-fold. First, it is to improve quality healthcare delivery at the district level; and second, to boost access to healthcare services for all citizens in tandem with United Nations’ Sustainable Development Goal Three.
SDG Three enjoins member-states to provide health and well-being for all – including a bold commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. It also aims to achieve universal health coverage and provide access to safe and effective medicines and vaccines for all citizens, irrespective of social and economic status.
Health tourism
Touted as the largest health infrastructure ever undertaken in our country’s history, “Agenda 111 casts a vision for Ghana’s health care sector to become a centre of medical excellence and a destination for medical tourism”, says the president. During the Commonwealth Speaker Series on African Healthcare in 2019, speakers were unanimous in their views that Ghana can become a medical tourist destination for the entire West Africa region.
Dr. Rodney Armstead, President of LuccaHealth Medical Centre, was optimistic that Ghana offers better opportunities to foreign investors such as LuccaHealth – a United States (US) medical facility – to improve healthcare and work with Ghanaian institutions and doctors to provide excellent health services for health tourists.
The top-ten medical tourism destinations are Japan, Korea, the US, Taiwan, Germany, Singapore, Malaysia, Sweden, Thailand and India. These countries are earning billions of dollars in health revenue – with much of it coming from Africa.
In Africa, only South Africa is a top destination for medical tourism; with many Africans, including Ghanaians, increasingly going to that country for medical attention. This is the vision Ghana hopes to replicate in order to diversify its revenue.
President Akufo-Addo disclosed that Africans spend about US$6billion annually to seek medical care abroad, and was hopeful that when completed the sector can generate about US$2million for the country’s GDP annually. The population of West Africa is expected to reach 1.5 billion people by 2030, which explains Ghana is positioning itself to serve this population.
Together with a strong and emerging pharmaceutical sector, health tourism might just be the strategy Ghana needs to diversify revenue in an era of dwindling revenue from the real sector due to the impact of COVID 19. My only worry is the ease with which other West African nationals acquire Ghana ID cards and access health and other services without any form of taxation or payment for the service.
Source of funding
According to the president, government has already devoted US$100million from the Eurobond as initial funding for the Agenda 111 project, but the long-term investment could hit US$1.5billion. “So far, sites have been identified for 88 of the 111 hospitals; and after cutting the sod, work on the other 87 sites will also commence,” says the president. He announced that acquisition of the remaining 13 sites will be completed shortly for work to begin.
All things being equal, the hospitals are to be completed in 18-months, and work will begin on the regional and other hospitals in the latter part of the year. “Each of the hospitals will be built at a cost of US$12.8million and another US$4.8million will be spent equipping them – bringing the total cost of each the hospital to US$17.60million, and they are expected to be completed within 18 months.”
However, there are growing concerns over where government will raise the rest of the money from to pay for completing the 111 hospitals. The concerns come at a time the economy’s debt level is rising and not correlating with the ongoing infrastructure development.
However, Vice President Dr. Mahamudu Bawumia has fought back, explaining that although the country’s total public debt has increased from GH¢122billion in 2016 to GH¢214billion (62.2% of GDP) for 2019, a strong fiscal position and better debt management has slowed the rate of debt accumulation and reduced it to the lowest in the last decade.
On how the project will be financed, Deputy Minister of Finance and Member of Parliament Mr. John Kumah has also explained on radio that government will use budgetary and financial arrangements to provide the financing.
He said government will also empower the Ghana Infrastructure Fund to raise part of the funding from the private sector. Mr. Kumah further explained that government does not expect that all contractors will raise certificates for payment at the same time. Since all contractors are not likely raise the certificates at the same time, payment will be guaranteed.
Job creation
Construction of the 88 district hospitals will also require about 250 domestic contractors to supervise the work. It is estimated that 25,000 people will be employed during the design and construction phase of the 111 hospitals – thus providing direct jobs to architects, masons, carpenters and other construction workers in the country. On completion about 20,000 health professionals, including doctors, specialists, nurses and other allied health workers will be employed.
Further, domestic facility management professionals will be utilised as part of government’s policy for developing domestic capability in the building and construction sector of the economy. “This will undoubtedly help retain most of the money in the country so as to engender further investment,” says the president. The use of local capacity will reduce the unemployment rate among the youth. Unemployment reduction is one of the demands of protagonists from ‘Fix the economy’. In a way, Agenda 111 is a clear response to fix the health sector in the country.
Local participation
A consortium of 20 firms comprising architects, civil, structural and mechanical engineers, quantity surveyors, biomedical engineers designed the hospitals to reflect “our unique domestic requirements – including impact of climate, social cultural conditions, and traditional practices”. In fact, the use local consultants and constructors is an indication that government has confidence in our local content – in as much as the project will improve local participation in the manufacturing and construction sector; empower the local economies; and incentivise the private sector to become the engine of growth.
In fact, it is refreshing to note that all the district hospitals will be designed and built by Ghanaian companies. This will undoubtedly lay the foundation for launching a nation-wide housing programme for a construction revolution. Certainly, the development of local capacity will ensure that the bulk of money expended remains in Ghana for further development.
Diabolic agenda
Agenda 111 has clearly overshadowed the diabolic agenda of some individuals and groups to oust the indefatigable Minister of Health, Mr. Kwaku Agyeman Manu. An assessment of plans to procure the Sputnik COVID-19 vaccine indicates he did not do anything wrong to the point of causing financial loss to the state – though there was some indiscretion in the process. In his untiring efforts to help Ghana overcome the devastating impact of COVID-19, the minister got the virus and survived by the grace of God.
The manner in which the opposition sought to give him a bad name and hang him appears to revive the notion that Ghana is not worth dying for. Vilifying him for working in the public interest is unpatriotic. In fact, Agyeman Manu is one of the star performers of the Akufo-Addo Administration. It is to be hoped government will keep its word/commitment and find the money to complete Agenda 111 as planned.
