Desmond Yaani, an Ophthalmic Nurse at the Builsa South District Hospital, says the Ghana Health Service (GHS) can emulate the Ghana Education Service’s (GES) initiative for broader consultation on policy implementation.

He said education reforms in recent years had shifted towards broader consultation with teachers, head teachers, and unions within the educational sector, and that, “By listening to those in the classroom, policies have gained greater relevance and local buy-in.

“Healthcare, a sector arguably more complex and intensely people-centered, deserves a similar evolution. Stakeholder engagement cannot remain a symbolic gesture or a meeting restricted to Regional Directors. It must be decentralized,” he added.

Yaani, who is also the Upper East Regional Public Relations Officer (PRO) of the Ghana Registered Nurses and Midwives Association (GRNMA), said this in an interview with the Ghana News Agency at Bolgatanga.

He said the hierarchy of the GHS was a clear pyramid explaining that, “At the narrow apex sit the policymakers and senior executives; at the sprawling base are the thousands of nurses, midwives, physician assistants, laboratory staff, and community health workers who form the backbone of national care.

“While leadership is concentrated at the top, the true stress test of any policy occurs at the bottom. Yet, a persistent gap remains: health policies are frequently designed in high-level boardrooms and handed down to the frontline with minimal consultation.

“This top-down approach risks creating paper reform policies that look flawless in a report but crumble under the weight of clinical reality,” Yaani said.

The Ophthalmic Nurse noted that a frontline worker understood the pulse of the system in a way data could not fully capture.

“They are the ones who navigate the bottlenecks, improvise during resource shortages, and witness exactly how a patient experiences the system,” he said.

He insisted that if management of the GHS listened to only managers at the top, a dangerous distance would grow between policy and practice, and that directives were issued with fragmented implementation.

He said such situations led to mounting frustration among staff, dropped compliance, coupled with withered accountability.

“When health workers are engaged as partners rather than just implementers, they become co-owners of the reform,” he said.

Mr Yaani said to bridge the gap between policymakers and the implementers for improved service delivery in the GHS, managers of the Service at the top could consider a structured bottom-up feedback loop by creating safe spaces for frontline staff to propose practical solutions to local workflow issues.

He further advocated the use of District platforms to synthesise grassroots input, and ensure national policies were grounded at the local level, and acknowledged that while senior leaders had the technical expertise, frontline workers' “lived experiences " were necessary to make that expertise functional.”

“The strength of a pyramid is not found in how much weight the apex can hold, but in the stability of its base.

“True leadership is not diminished by listening downward; it is fortified by it. As Ghana faces evolving health challenges and a growing population, the solutions often already exist within the wards and clinics,” he added.

Yaani stated that if the health reforms were to be truly transformative, the voices from the ground must move from the margins to the centre.

Listening to the base of the pyramid was no longer optional; it was a necessity for survival, Yaani stated.

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