We want to focus on some diseases which are peculiar to rural communities in Ghana.
Through this lecture we aim to appreciate some of the socio-cultural and politico-economic factors that nurture these diseases.
Some of the health problems of rural communities are those generally described as NEGLECTED TROPICAL DISEASES (NTDs). They are so called because governments and NGOs have neglected them focusing instead on malaria, HIV/AIDS, TB, cholera and the five vaccine-preventable childhood killer diseases.
Neglected tropical diseases (NTDs) affect all 10 regions of Ghana. Eleven(11) million Ghanaians are estimated to be at risk of contracting one or more NTDs. NTDs are debilitating and disproportionately affect the poor and vulnerable.
ENDEMICITY OF NTDs
With regard to the north, the area was designated by the colonial administration as a ‘labour reserve’ for the supply of cheap labour to the mines, cocoa farms, the army and the police.
In that regard, the north was vital for the development of the more favourably endowed south.
SOME PROFILE OF RURAL COMMUNITIES
According to GSS (2007) more than 70% of rural residents have no access to proper toilet facilities; the majority defecate in the wild.
The situation is more critical in the northern regions where close to 80% of the people have no access to decent toilet facilities.
It is no surprise, therefore that in Ghana, the ff scenes are common:
According to GSS, less than 30% of rural dwellers have access to safe water
Consequently, rural people carry greater disease burden than the urban areas.
Some common sources of water supply for rural dwellers are shown in the ff slides:
As to be predicted, therefore, in the rural areas, diseases that affect children and adults include: malaria, diarrhoea, cholera, kwashiorkor, typhoid, leprosy, guinea worm, onchocerciasis, trachoma, schistosomiasis, hernia, buruli ulcer and helmintic diseases.
These are essentially parasitic and preventable conditions. Some of them are due to water-poverty.
OTHER DISEASES IN THE RURAL POPULATION
Micronutrient disorders (goitre; vitamin A deficiency; bitot spot)
Skin diseases (yaws, measles, craw-craw, etc)
The mosquito breeds in stagnant shallow waters, pools and puddles. It can also breed in empty cans, and containers that can hold some amount of water.
In the villages, uncovered water containers also provide good breeding ground for the mosquito.
To address some of these problems, various gvts have instituted all manner of policies and programmes.
Some of these include:
Capitation grant and School Feeding programmes
Free delivery services
POVERTY MITIGATION PROGRAMMES
Micro credit schemes
Free distribution of insecticide-treated nets,
Health officials have argued that however hard they have tried, rural people cannot change their ways.
How valid is this view?
CRITIQUE: MALARIA ERADICATION PROGRAMMES
In spite of the huge resources spent on malaria eradication, malaria remains the number one killer of Ghanaians.
Evidently, in the rural areas most cannot afford the cost involved in dealing with mosquitoes; [ e.g. sleeping in mosquito nets (GHc 15.00)]; providing window mosquito net; buying mosquito repellents; using recommended anti-malaria medications.
Indeed, there are instances where boreholes contain salty and hard water which is not good for human consumption or can be used only after additional cost.
There are community boreholes fitted with hand pumps too expensive for the villagers to maintain
There are instances where villagers cannot pay water bills.
NATIONAL HEALTH INSURANCE SCHEME
Although gvts have tried to make health care available to the people, most policies have failed because the rural poor have no resources to address their health problems.
In situations where health care services must be paid for, 3 groups of people suffer: (1) the poor; (2) those who describe their health problems as not serious; and (3) those who need frequent visit to the hospital. Most rural dwellers are in these groups.
Consequently, the NHIS does not cover the rural poor who are most in need of health care.
THE RURAL AGED
Another vulnerable group are the rural aged. At 65 a person is by law entitled to free health care in Ghana.
However, rural health facilities do not provide the geriatric services needed by the aged (chronic arthritis, vision/hearing impairment, dental problems, etc.).
Consequently, the aged do not enjoy any (free) health care.
HOW FREE IS ‘FREE’ MATERNAL HEALTH?
Where health care facilities are inadequate and poorly resourced, free health care amounts to no health care.
What free services will a pregnant woman enjoy from a health facility that does not have the personnel to manage obstructed labour, for instance?
What services do NHIS policy holders enjoy when there are no medicines for their health problems?
‘DEVELOPMENT’ HEALTH PROBLEMS
What concrete and sustainable measures has government taken to deal with health problems arising from development projects such the Tono, Vea, Akosombo and Kpong dams?
In the case of the latter (Akosombo and Kpong dams) the most significant effort was the creation of 52 dam-affected communities most of which have become ghost towns.
‘ONIPA NUA’ is the boat clinic that used to offer medical services along the banks of the Volta River. Over the years, however, this boat has ceased plying the route because of mechanical and financial problems. The very fact that to date nobody has demanded to know its whereabouts is an indication of the lack of seriousness with which we deal with rural problems in Ghana.
RURAL COMMUNITIES’ BEHAVIOUR (MICRO-LEVEL)
While blaming the macrostructure for some rural health problems the rural dwellers cannot escape blame in some instances. There have been instances when rural people have abandoned boreholes made for them because the water is not ‘sweet’
There are instances where rural people have refused to use health facilities built for them (eg Kandiga East, etc).
But how widespread are these instances?
These days, rural people, through their chiefs, are clamouring for development. The difficulties encountered in endorsing many DCEs is an indication of the new development orientation of rural dwellers.
Most rural health centres lack adequate health personnel and functional health centres
VILLAGE HEALTH CENTRES
A functional health centre must have all the facilities and services to make it functional- electricity, water, lab, doctors, beds, autoclaves, theatres and equipment, etc.
Most village health centres have no doctors and they cannot handle serious complications
They also work according to official working period (8 am-5pm).
Consequently, villagers continue to deal with their own health problems in their own ways
THE CHPS COMPOUND
In order to bring health care closer to the doorstep of rural people, the Community-based Health Planning and Services (CHPS) compound initiative was born in 1998.
In this initiative, a nurse lives within the community and in a compound built for her. She is supposed to visit homes under her care everyday but she is constrained in several respects.
PROBLEMS OF PERSONNEL
Health personnel are reluctant to work in rural areas because of the relative deprivation of rural communities.
That is why the 3 northern regions are deprived of health personnel; even indigenes refuse posting to these regions.
Consequently, the nation has to rely on Cuban doctors to offer health services in these regions.
VICIOUS CIRCLE OF RURAL HEALTH
“People are sick because they are poor; become poorer because they are sick; and sicker because they are poor” (C. E. A. Winslow).
The indication here is that we cannot address health problems of people if we fail to address their economic and environmental conditions as well.
ECONOMIC AND POLITICAL MARGINALIZATION
The poor health of rural people is both the cause and effect of their marginalization.
Economic marginalization often leads to political powerlessness
The urban areas are more sensitive politically
Thus, aided by better infrastructure, town and cities have benefited more from health provisioning (eg Gt Accra has 15.8% of the population but 70% of doctors!)
The poor state of rural health cannot be divorced from the poor state of rural development. A person who is not healthy cannot achieve maximum productivity. Similarly, no amount of medicine can save a malnourished child. The first task is to assist him/her to regain his/her health through the provision of the necessary wherewithal for achieving adequate health.
Addressing rural poverty requires:
Holistic approach -economic, political, educational, social and cultural.
Strong national political leadership committed to practical rural development.
Persistent advocacy from civil society
Local ownership of development programmes.
Short of this, the health of rural dwellers will remain poor and their productivity levels will remain low.
As a net result, they will continue to vote with their feet.