Five Questions With…Jemima Araba Dennis-Antwi 

1. Covid-19 has had a major impact on the capacity of health systems to continue the delivery of essential health services. What impact will this have on the Leave No One Behind agenda?

Global health is critical to all aspects of human development. HEALTH IS WEALTH; without good health for its people, a country’s economy will grind to a halt. The coronavirus pandemic has been, and continues to be, an unprecedented scourge of modern times. Its ravages have left many countries devastated, though the magnitude of its impact has varied from country to country. Families and communities bear the brunt of the heavy burden of sudden loss. The global community has counted over one million losses with a second wave occurring in the latter part of 2020. Some countries are already locking down to limit the spread and effects of this second wave. Every day, people are losing their jobs and their income with no insights into when normal times can be expected. The heavy loss of individual income, with its attendant loss of well-being, have implications for health and well-being in general.

Health care systems in many countries have had to bend over backwards to make the 16 basic essential services available to clients during the time of COVID-19. These services range from the variety of reproductive, maternal, newborn and child health services, care of infectious diseases and managing non-communicable diseases to ensuring service capacity and access is maintained and sustained. In the first wave of the pandemic, delivery of many of these services was disrupted as affected patients were limited in mobility and could only seek services in times of emergency. There was no ‘normal’ anymore, no routine services.  In some countries, most of these services were given little attention or shut down entirely as health professionals were re-assigned to COVID-19 related jobs or services. In other circumstances, though the services were available, patients made personal decisions not to access health facilities for fear of being infected.

Health professionals were constrained in terms of numbers of staff to care for affected patients because of death and incapacity due to ill-health. Logistics, equipment and consumables especially Personal Protective Equipment (PPE) and bed capacity were inadequate, and burnout among staff was common in the face of dedication to duty and service. Emotionally, health workers feared for their lives.

The Leave-No-One-Behind agenda of the SDGs 2030 seeks to ensure that in all nations, all people in all segments of society are reached, with the furthest behind accessed first. Vulnerable groups including children, youth, people with disabilities, women facing gender abuse, people living with HIV, older people, indigenous peoples, refugees, internally displaced persons, and migrants are key to the achievement of this agenda.

The COVID-19 pandemic with its associated lockdowns has already led to documented evidence of an alarming rise in Gender-Based Violence as families face psychological and social stress due to economic and health insecurities. The impact of the pandemic on the Leave-No-One-Behind agenda is obviously grim. National attention in terms of both policy and resources has been diverted to addressing the pandemic. Resources that would otherwise be invested in improving the lives of the vulnerable groups have the potential for being reduced or not released at all especially in lower-middle income (LMIC) economies. The decisions of affected families with vulnerable family members not to seek care have implications for disease prevention, management, and debilitation. The cost of health care has increased. In countries where patients have no form of insurance and are expected to pay for services out-of-pocket, access for all is a challenge.

There is a need for an urgent global drive to motivate all countries of the UN to re-strategise: to revise policies and sustain interventions that not only address COVID-19, but also reduce its negative impact and enable vulnerable groups to access care supported by insurance and well-resourced services. Partnership is key to optimal access.

2. The pandemic has revealed the fragility of our world, however countries across sub-Saharan Africa are doing much better than had initially been anticipated. Will COVID-19 shift where knowledge and power sit within global health?

Admittedly, the novel coronavirus has resulted in great devastation across the globe with national governments introducing measures for combat and the maintenance of national security. Africa’s first case was recorded in Egypt in February 2020 and by mid-August, Africa’s COVID-19 numbers had spiked to 1,084,904 confirmed cases, 24,683 deaths, and 780,046 recoveries (BBC Coronavirus in Africa). It is documented that contrary to global expectations of worse infection in Africa, the evidence shows a relatively low infectivity.

Many African countries such as Ghana instituted diverse strategies and interventions aimed at reducing the socio-economic and health impacts on the populace. Some of the interventions have included mandatory quarantines on economic and religious activities, social distancing, mandatory infection prevention practices, screening, contact tracing and testing and covering the cost of admission for diagnosed patients. In addition, we’ve seen the introduction of social interventions to mitigate the cost of the socio-economic impact on families such as tax exemptions and allowances for frontline health workers, free electrical power and water for the populace over a period of time.

I believe that some of the 52 Sub-Saharan African countries have gained varied, notable, and successful experiences around the management of COVID-19 which are worthy of recognition by the global health community. The competencies built by the best performing African countries are best practices and form a body of knowledge that stakeholders of global health should utilize to inform progress in other countries.

This is an opportunity for continual power engagements that recognize the ability of all stakeholders as equal players in the promotion and achievement of global health.

3. You studied healthcare provision for SCD in Ghana in depth and recommended that SCD requires a holistic approach involving a multiplicity of healthcare professionals. Is a template for other areas?

Sickle cell disease (SCD) is a serious hereditary and chronic blood disease that affects millions of people globally, especially among people living in malarial endemic areas. Due to the commonality of mixed race in many individuals, SCD can now be found in any part of the world. However, sub-Saharan Africa has the highest numbers of affected persons living with the disease and outcomes are often poor due to lack of resources for quality care. Where there is limited or no care, most children die before they reach adulthood. SCD is a major public health challenge which has now risen to the fore-front of the global health agenda. By the nature of the disease, affected persons are prone to anaemias, common infections and vaso-occlusive episodes with an ultimate potential to affect many organs of the body. Affected persons also tend to have social-psychological challenges as they learn to live with the disease. It is the multiplicity of complications of the disease, coupled with the social-psychological effects that call for a holistic approach to health care.

Therefore, any health condition of a chronic nature that tends to have similar effects on those affected and their families calls for a multi-professional approach to care. Systems of health insurance to support the cost of care – which is often expensive – and strong social support are vital to improve the quality of life among patients.

4. Do you feel that the current pandemic has changed how you will carry out your work in the future?

Yes, the current pandemic has brought into its wake the discovery of potentials which hitherto many health professionals working in policy, programs, research, and practice had not considered. For me, one of the most powerful discoveries has been the internet and social media. The lockdown re-engineered a global desire among health professionals to keep connected, update knowledge and skills and to share best practices for global health promotion. E-media has become very vital for health systems development and I believe post-COVID-19, we should be able to continue to explore the benefits for increasing global health development.

I would like to continue to use online educational and other social media platforms for the capacity building of health professionals through online interactions and knowledge sharing. Recently, many organisations have held conferences online and online education has become popular, convenient, and cost-effective. Through the work of the Centre for Health Development and Research (CEHDAR), I am currently applying this concept to work with health professional colleagues and regulatory bodies to establish accredited online courses for continual competency building for renewal of licenses to practice.

5. Which aspect of your work have you found most rewarding?

Over the last thirty-one years, I have had the humbling opportunity to work in both the public and development sector in the varied areas of health systems strengthening through the establishment of projects/programs, academic and professional  institutions, public health promotion/education, research and strengthening midwifery systems in over 10 African countries and beyond as part of the Ghana Ministry of Heath, the Ghana Newborn Screening for SCD Program, the Ghana College of Nurses and Midwives, the International Confederation of Midwives etc. and more recently through my work with the UN as a Maternal Health/Midwifery Consultant with UNFPA Sierra Leone. All of these have been doors to serving my professions of midwifery and nursing as well as humanity. Through the assigned responsibilities, I have had professional interactions with Government Ministries of Health and worked with policy-makers in Directorates, development partners, local and international NGOs in health and others to develop and implement policies and programs for health and systems improvement.

Though I have found all the opportunities rewarding in terms of giving to humanity and contributing to building my professions of midwifery and nursing, my best experiences have been working with families affected with SCD and establishing the Ghana College of Nurses and Midwives as its first President and Acting Rector.

Briefly, my work with SCD humbled me a lot as I became acquainted with the many difficult challenges of patients and their families. This drove me to engage in many activities with them and the health system towards health promotion for patients. Many families found solace in the Sickle Cell Association meetings and programs we run routinely. Working collaboratively with other colleagues and international partners, the global SCD community learned about the work in Ghana.

My work with the Ghana College of Nurses and Midwives as its first President and first Acting Rector gave me the opportunity to bring the compendium of learning experiences over the years to work with my colleague nurses and midwives and the health sector in Ghana to establish the specialist college with perpetual succession. Though I have completed my terms of office since 2018, seeing graduates of the College and their continual contributions to the quality of care as Nurse and Midwives Specialists in the clinical sector today makes me appreciate the power of the mustard seed.

Today, nurses and midwives in Ghana have the opportunity for higher and diversified careers in specialist care as there are over 14 specialist programs running. Other countries in Africa, such as Sierra Leone, are tapping into this resource to build the capacity of their nurses and midwives.  I believe this is just the beginning!