The role of academia in establishing a national public health fund - Report

Recognizing the critical importance of national planning for preparedness in public health emergencies, there was an in-person gathering of over 120 delegates and 200 online participants in a hybrid symposium on the theme “Establishing a public health emergency fund (PHEF): the role of academia” on Wednesday 7th June, 2023 hosted by the University of Health and Allied Sciences at the Professor Anyidoho Auditorium on the Trafalgar Campus, Ho.

The goal of the symposium was to 1) explore the need and to advocate for the
establishment of a national fund; 2) examine the role of academia as advocates in partnership with Civil Society; and 3) identify potential sources and strategies for establishing the PHEF.

We, the participants, from Civil Society, major Ghanaian Universities, Ministry of Health, the Ghana Health Service and Bilateral Organizations wish to communicate the following outcome of the symposium:

The COVID-19 pandemic had an immense impact on the population’s health, our national
economy and society as a whole, some of which effects still persist. Similarly, the recent Ebola epidemic in neighbouring West African countries with weak health systems and lacking in emergency preparedness cost precious lives and livelihoods and serve as a warning to us.

In Ghana, certain levels of preparedness already exist, such as the health sector infrastructure, training institutions and some skilled personnel including public health experts. The country boasts a cadre of over 160 field epidemiologists trained from basic frontline to advanced levels through the Ghana Field Epidemiology and Laboratory Training Program (GFELTP), skilled scientists, academics and researchers whose expertise were demonstrated during the COVID19 pandemic from identification, tracking, clinical management and control of the spread of diseases during outbreaks.

Ghana is signatory to international agreements (e.g. the International Health Regulations, 2005), Article 21(a) and 22 of which are designed “to prevent the international spread of disease” and whose main focus is on countries’ investment in: Emergency preparedness, Early Detection and appropriate Response; and post-event Rehabilitation; Our government, having committed to establishing a national health emergency fund (HEF) in the Medium-Term Development Policy Framework (MTNDPF 2017 – 2021), developed a costed National Action Plan for Health Security (NAPHS, 2019 – 2023) predating the onset of the COVID-19 pandemic.

Having failed to meet its original target, Government has reaffirmed its commitment to establishing the HEF in the new MTNDPF (2022 – 2025). Despite the laudable steps, we have identified gaps and opportunities for meeting our national ambitions for health security and our international commitments as follows:

I. Gaps and Opportunities to Address Them

Lack of the necessary investments in public health emergencies, as evidenced by insufficient budgetary allocations dedicated to future emergencies.

We recognize Government’s commitment to retaining the 1% COVID-19 levy instituted to
mitigate the impact of the pandemic. This levy is expected to generate close to 2.3 billion Cedis in 2023 alone. This significant amount provides an opportunity to serve as seed funding for the establishment of the Public Health Emergency Fund (PHEF) without the need for new legislation. We at this symposium call for the renaming of the COVID-19 levy as “Emergency Levy” retained at 1% to support public health emergencies including disasters.

Furthermore, we call for clear Government budget lines to serve as matched funding to help grow the PHEF and enable bilateral support and additional funding support from philanthropic individuals and other benevolent organizations.

Preparedness is an active process requiring dedicated funding for trained personnel,
infrastructure, equipment and resources for surveillance and readiness to respond at all levels of the health system during major epidemics or disasters. The PHEF can be utilized for preparedness activities, including capacity building and training of frontline workers, laboratory detection and diagnostics, drug discovery, vaccine production, research and development (including clinical trials). The fund will also support monitoring and surveillance efforts to enhance early detection and response to public health emergencies.

II. Proposals for the Governance of the PHEF

We recognize the centrality of the Ministry of Finance and the Ghana Revenue Authority in the collection of the Levy and other sources of funding and investments relating to the fund. To ensure the effectiveness and integrity of the PHEF, we propose the following for governance:

a). Independence and Freedom from Government Interference: The PHEF should be
established as an independent entity, free from government interference, to ensure unbiased decision-making and effective utilization of funds. Leadership appointments to serve on the Board of PHEF should be based on merit and evidence of integrity, selflessness and community service.

b). Transparency and Accountability: The governance structure of the PHEF should prioritize transparency and accountability at all levels. Clear mechanisms for financial reporting, audit, and evaluation should be established to maintain public trust and ensure effective utilization of resources.

c). Multi-level Coordination: Recognizing that epidemics and emergencies often start within communities, the PHEF should have well-defined structures and pathways that seamlessly extend with linkages from the national level to the regional, district, and sub-district levels. This will enable efficient coordination and response across all levels of the healthcare system.

d) Attracting Multilateral and Bilateral Partners: Government investment in, and good governance of the PHEF are necessary to attract multilateral, bilateral and benevolent partners to contribute to its growth. A transparent and effective governance framework must be stablished to instill confidence in, and encourage potential donor support.

III. Post-Epidemic Activities

We further advocate that post-epidemic activities should focus on continuous monitoring and surveillance to assess the impact of public health emergencies, identify areas for improvement, and maintain a state of readiness for future outbreaks or emergencies. This should include ongoing research, data collection, analysis, and evaluation to inform evidence-based decision making.

IV. Advocacy

To ensure the realization of the PHEF, we recognize the need for Civil Society Organizations (CSOs) and Academia to collaborate, create a community of practice and maintain a common purpose for continuous advocacy for our national health security and to gather annually to review the progress made in realizing our common goal. Therefore we are joining forces as CSOs and academia to advocate for the establishment and sustenance of the PHEF, on this 7TH Day of June, 2023.

We conclude by reiterating our key message, that: establishing a dedicated Public Health Emergency Fund (PHEF) is crucial for addressing gaps in preparedness and response to public health emergencies. The proposed PHEF, initially supported by the 1% COVID-19 levy, (renamed as Emergency Levy) offers opportunities for capacity building, research, vaccine production, and surveillance. To ensure success, an independent and transparent governance structure is essential, fostering accountability and attracting multilateral partners. Continuous monitoring and collaboration between civil society organizations and academia will enhance
post-epidemic activities and advocacy efforts. Let us work together to strengthen our nation's preparedness for future emergencies and ensure our national health security.

Signed, 10th June, 2023

Prof. Paul Amuna (Symposium Chair)
Fred N. Binka School of Public Health, UHAS

Mr. Stephen Atasige (Symposium Co-Chair)
Ghana In-country Coordinator.
Global Health Advocacy Incubator

Dr. Emmanuel Ayifah (Symposium Co-Chair)
Deputy Director
SEND GHANA

CONTACT PERSONS:

1. Prof. Paul Amuna [Acting Dean, Fred N. Binka School of Public Health (UHAS)] –
0203685877
2. Prof. Evelyn Ansah [Professor of Epidemiology, Institute of Health Research (UHAS)] –
0244869700
3. Mr. Stephen Atasige [In-country Coordinator, Global Health Advocacy Incubator
(GHAI)] – 0594107008
4. Ms. Harriet Nuamah Agyemang [SEND GHANA] - 0244982439