Ghanaian Chronicle

The Case For Free SHS

Date published: November 28, 2012

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University of Cape Coast—Cape Coast.

 

Saturday, 24th November, 2012

 

Over the last year, I, and indeed all Ghanaians have watched as Nana Akufo-Addo, the NPP Presidential candidate has taken his free SHS proposal across the length and breadth of this country.

 

Some have questioned his rationale for it and accused him of political opportunism. Some have questioned his ability to pay for it and the fuzziness of his math in calculating the cost.

 

Some have questioned his timelines even while conceding grudgingly that there is merit in the proposal. Indeed, the NDC have suggested that free SHS is an idea whose time will come after twenty years. Indeed, the NDC’s position has evolved from outright opposition to the scheme to raising questions about its soundness.

 

Some have equated “free” with “mediocre” despite the knowledge that even the best educational institutions in the world grant “free” acess to the deserving poor. Perhaps those equating “free” with mediocrity are missing the fact that they are questionning the quality of the education received by many prominent Ghanaians, including President Mahama.

 

The debate on free SHS shows that politics does indeed breed strange alliances and associations.

 

Think about it. Here is the son of privilege, Nana Akufo-Addo, who never worried a day in his life about school fees, making the case that the poor deserve free education. And there, on the other side are many beneficiaries of free education, making the case that free SHS is at worse a dangerous idea or at best a good idea whose time has not come. I am still trying to explain to myself why the NDC, the party that purports to care for and about the poor, has problems with a policy designed to lift many of the poor out of poverty. Might the politcal opportunism be on their part instead of on the part of the NPP?

 

As for the supposed argument between “quality” and “free”, it matters only to the elite. To the child who is given a chance for free education against no education, the choice is rather easy. Any education is better than no education.

 

To be candid, Nana Addo and the NPP have not been perfect messengers for this issue. First, there was the “costed”, “costing” and “not-costed” debacle on the BBC. Then there were the contorted explanations about the costs that showed some confusion with the soundness of the numbers. Then there was the linkage of the payment with “judgement debts”.

 

 Despite all these shortcomings, the free SHS proposal deserve the commendation and support of all Ghanaians—for a number of reasons.

 

First, it shows all Ghanaians that depite the big words, the apparent distance and the perceived arrogance, Nana Akufo-Addo does care about the poor. We should see his commitment to this issue as a window into his soul and embrace him and his cause.

 

Second, we should ponder how many things we would achieve if we subject everything to cost analysis before embarking on it.

 

If Nkrumah had costed the struggle for independence, he would never have demanded “Freedom now!”

 

If he had costed free education for the north, he would never have implemented it and many of those opposing free education in big english would be illiterates today.

 

If Rawlings had costed the extension of power to the North, most of that place would still be in darkness and if Kufuor had costed the search for oil, we still would be without oil.

 

Third, while the students and their families will benefit from free SHS, the biggest beneficiary will be Ghana. The educated will help us transform Ghana by helping provide the skilled manpower that we need.

 

Finally, the introduction of free SHS will require the building of new classrooms, new schools and related infrastructure, in addition to requiring the training of thousands of new teachers. This will require thousands of masons, plumbers, electricians and brick-layers. In short, it will be one of the biggest jobs-initiatives in our nation’s history.

 

As for whether we can pay for it, the answer is “Yes, we can!” It is a question of priorities. The nation that can pay MP’s 80 thousand Ghana cedis after each term, in addition to loans for cars, build Presidential palaces and buy luxury planes for Presidents while paying questionable gargantuan sums to private individuals can indeed pay for free SHS. That is, if it has the will. This is not a financial issue. It is a moral issue.

 

Despite the forgoing, the best argument for free SHS, to me, is my life story.

 

I had passed the common entrance examination but was in danger of staying at home because my single illiterate mother could not afford the school fees. Out of desperation, I walked into the office of the headmaster of Osei Kyeretwie Secondary school, Mr. G.R. Bray, to ask for a scholarship. After listening to me for a while, he asked me to come back with a parent. My poor mother was so scared of the financial commitment that she initally refused to go with me to the headmaster. She relented after I cried all night.

 

 The next morning, in the headmaster’s office, after I had repeated my story, the Headmaster uttered the words that would change my life.

 

 He told my mother in Fante, “Ka woakoma to woyam. Aban befa woba no ho ka nyinaa. Oboko school FREE!”

 

 From there, by the grace of God and my country, I went on to Presby boys— Free; then to the University of Ghana Medical School— Free before going on to University of Toronto and the Medical College of Wisconsin. The last two were also free. And by the way, the education that I got was top quality all the way. That made me qualified to practice as a Doctor in the United States and to train future Doctors here. Without that offer of free education from my headmaster, Mr. G.R. Bray on behalf of a generous and visionary Ghana, today, I would not be who I am. That is why I am irrevocably for free education. Opposing free SHS would be the equivalent to turning round and removing the ladder that I climbed to success so that others would be denied the chance to climb up. I would be ungrateful and ungenerous if I did that. That is why I support free SHS without equivication and indeed, with passion.

 

My fellow Ghanaians, I know there are thousands and maybe even millions of you out there with stories like my own. In the next two weeks, let us thank Ghana—by supporting free SHS.

 

While my account is historical, today, there are many boys and girls whose future are at stake. Last night, I learnt from Hon. Kennedy Agyapong that in the last two weeks, he has paid the fees of 46 students who had qualified for SHS but could not afford to take up the places offered to them. I have heard similar stories from many others and I have paid a few of such fees myself.

 

Let us hear the cry of poor parents and desperate boys and girls and give them and education a chance.

 

Let us move forward—together.

 

Arthur Kobina Kennedy

 

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Sylvester Mensah & Frimpong-Boateng

Politics of Health Insurance

By Sodzi Sodzi-Tettey

([email protected])

Between the New Patriotic Party’s (NPP) ‘collapsing’ (black) and the National Democratic Congress’s (NDC) strengthened (white) National Health Insurance Scheme (NHIS), there appears to be no grey areas. And nowhere was this better portrayed than at last week’s political parties health platform organized by the Ghana Medical Association (GMA) at its 54th Annual General Conference held in Cape Coast in the Central Region.

The closer the election gets, the better crystallized the issues get. As it turns out, NHIS appears to be to health what free Senior High School (SHS) is to education. In the latter, it is without doubt a contest between the NPP’s promise of free SHS and the NDC’s quality/access platform. In health, the battle appears to belong to the party that does the better job convincing us that the scheme under the NDC is either collapsing or not. This depressing focus itself might not have been so unwelcome had the argument been better informed by and been fair to the current facts and had contending parties crying loudest about the collapsing scheme, done a better job outlining their own specific interventions to resuscitate same.

Indicative of the impending fire, both debaters, the NPP’s Professor Frimpong-Boateng and the NDC’s Sylvester Mensah started off exchanging light verbal jabs. While Frimpong-Boateng questioned the propriety of a head of a public institution – Chief Executive of the NHIA – speaking on behalf of the ruling party, Sylvester Mensah countered by querying when the former had seen the anomaly in this, given his own contest in the presidential primaries of the NPP in 2008, at a time when he was CEO of the Korle Bu Teaching Hospital.  Further, while Frimpong-Boateng showed two pictures depicting the worsening sanitation on the Korle Gonno beach from 1924 to 2009, Mensah countered that given the NDC’s assumption of power in 2009, worsening sanitation at the time reflected more poorly on the preceding NPP government than the NDC.

Rather than recount their presentations, I would rather reflect on some of the contentious issues that came up for discussion starting with one doctor’s passionate appeal for the NHIS not to be politicized.

As good a sound bite as this phrase “non politicization” is, to all practical intents and purposes, what does it really mean? Some social mobilisation experts have argued that any social protection programme that affects more than 20% of the population immediately assumes a political dimension. Given the over 60% of the NHIS coverage, should anyone be surprised that the matter of the NHIS is front and center of the health debate and is a call for its non-politicization realistic or even necessary? Perhaps, the best one could ask for is for the NHIS debate to be critically factual and not overcome by jaundiced analysis delivered on the altar of political expediency.

Perhaps the very politicized health insurance debate might be better appreciated when viewed against the historical perspective of its conceptualization and the political womb in which it was conceived and delivered. In the 2000 election, ‘Cash and Carry’ or payment at the point of service delivery by being a barrier to access had assumed a political dimension with the NPP promising to replace it with the NHIS which it did. Further, the initiation of the free maternal care programme was something that President Kufuor took political credit for and rightly so. If today, the NDC is citing improvements in indicators and other important management interventions to buttress its claims of a non-collapsing scheme, I doubt that this should overly worry anyone. Finally, given the very politicized and unpopular nature of the ‘Cash and Carry’, why should anyone be surprised when the issue of an allegedly returning ‘Cash and Carry’ becomes a battleground issue? With the NPP claiming that ‘Cash and Carry’ has returned when the facts clearly show that the fortunes of cash and carry have admittedly been dealt a deadly blow with the revenue generated from facilities from ‘cash and carry’ dwindling from over 80% to less than 19%, it is arguable that at 19%, ‘cash and carry’ cannot be said to have ever really gone away.

So rather than convince us that ‘Cash and Carry’ is returning (when it never went away), or that it is insignificant (high 19% notwithstanding), our time will be better spent if both parties focused on their strategy, if any, for achieving universal coverage.

Perhaps, the hottest issue on the day resulting in flared emotions pertained to interpretation of figures indicative of increasing utilization of outpatient (OPD) services. Utilization of OPD services has risen from 12.5 million to 25.4 million between 2008 and 2011. While the NDC maintains that this “is evidence of the growth and expansion of the NHIS”, the NPP would have us believe that this means more people are getting sick! The latter of course begs the question: can the NPP adduce data to show that more people are now getting sick? If in 2000, we were all in unison that cost was a barrier denying access to millions of Ghanaians in need of care, how is then that when more people are utilizing OPD services now, we argue not that access is increasing but that more people are falling sick?

There is no consistency, unfortunately. When utilisation improved from about 5 million to 12.5 million between 2007 and 2008, it was very much interpreted as a sign of expanding coverage and growing access. How one indicator can be subjected to different interpretations, based on political convenience, is what remains baffling to many.

Amidst the throes of passionate debate with this highly contested issue, Sylvester Mensah described Prof Frimpong-Boateng’s argument of more people getting sick as “smacking of mental imbalance.” This expression was of course unacceptable to the audience as it detracted from the pure contest of ideas that this had been billed as. Sylvester Mensah subsequently withdrew the comments and the debate proceeded.

With utilization increasing, the inevitable concern about its impact on quality of care was elevated by doctors, especially given stagnating health workforce and unexpanded infrastructure, growing workload regardless. Doctors cited basic laboratory tests that were being denied patients. With the NDC planning to expand coverage of the minimum benefit package to include Mental Health, the disabled and prostate cancer while collaborating with the Ghana Health Service to roll out nationwide cancer screening programmes, doctors expressed seriously reservations about current limitations in cervical cancer care under the scheme. Covering surgery to the neglect of radiotherapy for a patient with advanced forms of the ailment raised serious quality concerns which Sylvester Mensah promised to consult further on.

Prof Frimpong-Boateng then questioned the financial sustainability of the scheme concluding with the fact that the NDC had tactically refused to repeat the difficult “One time premium” premium promise of its 2008 manifesto in the current one. In his rebuttal, Sylvester Mensah argued that effective management practices and cost containment measures were accountable for the scheme’s current survival, the NPP’s initial projections in 2005 that at current funding levels, the scheme would not be financially sustainable by 2009 notwithstanding. Consistently, the NPP has been at great pains to convince us that the scheme is collapsing. So fixated infact that asked at the first Presidential debate of the Institute of Economic Affairs to list three key issues in health worth his policy interventions, the party’s flag bearer could only come up with ‘collapsing NHIS’. So let us assume without admitting that the NHIS is indeed collapsing. Wouldn’t the natural question then be one of what each party is proposing to do about it? Given our collective keenness to move from lamentations to solutions, it is not so obvious to me at all what the NPP specifically wants to do about this allegedly ‘collapsing’ scheme beyond noticing and naming it.

Many previous health policy conflicts have been positive, creative and affirmatively disruptive leading to significant reframing and tangible improved outputs – health insurance law, free maternal care, inclusion of children, passage of mental health law etc. This current health debate is at serious risk of becoming disappointingly flat and pointless: singing about collapsing or strengthened schemes without a clear strategy for achieving universal coverage and translating improved access to better neonatal, child health and maternal outcomes and therefore improved population health.

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