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July 16, 2004

Singular Determination

The Director General of the Ghana Health Service Reflects on How to Produce Health

No one had ever asked him the question before. Who produces health?

For Agyeman Badu Akosa, director general of the Ghana Health Service, it is a key question. The answer both challenged him and encouraged him.

Agyeman Badu Akosa, director general of Ghana Health Service

Agyeman Badu Akosa, director general of Ghana Health Service

It’s not hospitals or doctors, though both play important roles. “You realize it is the mother who produces health, who makes sure the children eat well, drink [safe] water, get vaccinated,” says Akosa. “If that is an accepted premise, then in order to prevent risk, you’ve got to provide mother with the best knowledge.”

The concept assured Akosa that his agency is on the right track. The Ghana Health Service has set a goal of placing a trained community health nurse in 5,280 communities throughout the country. The nurse would not only tend to minor injuries and ailments, but would also share health knowledge and encourage households to supplement a pregnant woman’s diet with extra protein and water, prevent diarrhea by boiling or filtering water, consider family planning, and practice disease prevention.

“I feel that we have chosen right path and as much as possible we need to redesign our resources to achieve the objective of having all 5,280 communities served,” says Akosa, whose agency oversees the public health efforts and health care delivery for the country’s 20 million people. Currently, nurses are in just one-tenth of the communities, though there are plans to increase the country’s eight community nurse training schools to 14.

Akosa gained this insight during discussions at the annual seminar for Strategic Leadership in Population and Reproductive Health, which is sponsored by the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Akosa was one of 20 high-level health officials from 18 countries who came to Baltimore on July 5, 2004, for the two-week long course.

The seminar did more for Akosa than confirm the importance of Ghana’s community health service plan. “The beauty of coming to this program is you begin to challenge your thinking pattern, the way you do things,” he says. “As a leader, I will make sure I create opportunities to share what I learned with my team.”

His goals include reducing his country’s maternal mortality rate of 590 deaths per 100,000 live births. “We think this [rate] is deplorable. We need to develop all necessary strategies to reduce it drastically,” Akosa says. Other key issues that need to be faced include malaria (which causes one-fifth of the deaths of young children) and malnutrition (which is the underlying reason for more than half of all child mortality).

“I’m not a public health physician. I’m a pathologist, but I’ve taken on challenge of directing health care delivery in Ghana,” says Akosa, who became director general in 2002. “[The seminar] opened my mind. There are lots of things to be learned and a lot of challenges that need to be faced, but I have a singular determination.” —Brian W. Simpson