Verbs are louder than nouns

Is The Akufo-Addo Government in Support of Galamsey?

galamsey

The President’s initial response to the public’s vehement objections against the destructive ramifications of galamsey is passive and convenient. Available records show that NPP MPs have been loudest on the ills of galamsey and yet seem disempowered in the fight against the menace. It is unclear and worrying whether the Executive and Legislative arms will act decisively on galamsey and halt the devastating and near catastrophic environmental consequences.

In his party’s (NPP) 192-paged manifesto for the 2016 General elections, is a thin 3-paragraph statement of intent on small-scale mining (page 96). It reads:

It is NPP’s view that the artisanal, small-scale mining sub-sector needs restructuring so that its activities can take place within guidelines set up under the appropriate regulations.

This will enable small scale miners to work and earn their livelihoods in a regulated, secure, and lawful environment.

By this process, the environment, especially our water bodies, can be protected and degraded land can be reclaimed through tree-planting and reforestation.”

Underlying the manifesto promise is a sequential thesis that the economic gains of galamsey is far more important than environmental destruction and under a friendlier regulatory environment, those involved in illicit mining will turn a new leaf and act responsibly. The paragraphs fail to admit that there are individuals like Bronzy One in galamsey who are determined and unashamed to operate in defiance of existing regulations. So the issue is not all about ignorance of regulations or high requirements for the licensing and operating of small-scale mining.

Also, the President is reported to have said that in order to solve the galamsey menace, “we need a comprehensive policy which may even involve legislation…” At best, the party and the President’s position on Galamsey appears ambiguously evasive.

A Comprehensive Policy?

What the President is calling a comprehensive policy is not clear. The Minerals and Mining Act 703 (2006), the Artisanal Mining Framework and other related blueprints are existing regulations which make clear provisions for small-scale mining. The situation at hand is one whereby a growing number of individuals have put their economic interests above environmental concerns under the pretext of employment generation and have shown demonstrable effrontery to disregard the rules. This doesn’t require an extra layer of policy. This is a matter of political will and law enforcement.

“It is not multiplication of laws which would bring sanity in any nation; it is rather the serious application of the law to go for those who matter. This is because we are enjoying some impunity in this country in which we arrest small boys, give them bail while the one who is investing in this monumental project is relaxing somewhere…we are encouraging plain illegality in this country…”

Mr. Samuel Atta Akyea, NPP-Abuakwa South, March 20 2015

 

Forces and Interests Involved

Galamsey may be a “complex” issue for the NPP government but not Ghana. Most galamsey operating centres are in NPP strongholds. Even the President’s own beloved Kyebi, his maternal home in the Eastern Region, is a hot spot for galamsey. Galamsey activities in Kyebi and its environs have put the Birim river at the highest risk of complete destruction. If the President cracks the whip on illegal mining, that in deed is going to be politically risky for his party. But just as the President will not sit with armed robbers and drug dealers to arrive at a comprehensive plan on acceptable conduct, in the same vein, he should not invite lawbreakers to the table for a discussion on a comprehensive plan for galamsey. We have reached a stage where the common and national interest of the sovereign state of Ghana supersedes individual interests in and gains from galamsey.

 

Does Parliament See Galamsey as a Problem?

“Their activities have reached epic proportions in the country due to many factors, including the influx of foreigners (Chinese) into the sector and the impunity of persons engaged in illegal small scale mining activities. These activities have had a devastating effect on the environment by destroying farmlands and polluting a large number of water bodies and thereby adversely affecting the livelihoods of the persons living in the communities where these activities take place”

Mr. Kyei-Mensah-Bonsu, MP-Suame, July 9 2015

“…Galamsey is an illegal act and we cannot make a law and prescribe measurement in banning galamsey inside the law…I even think the three years minimum is too low if you consider the havoc illegal mining is doing in our countryside; polluting our water bodies, degrading our forest reserves and the countryside”

– Dr Matthew Opoku Prempeh, MP-Manhyia South, July 9 2015

 

“…the Birim River is heavily polluted as a result of galamsey activities in the area. Due to this, GWCL produces only an average of 60m3/d (0.01MGD) of water at Osino, which is woefully inadequate to serve a demand of 407m3/d (0.09MGD) for the entire coverage area. As a result, potable water supply is currently limited to Osino. Supply to Nsutam from the Bunso Water Supply System is intermittent as a result of the raw water problems. Mr. Speaker, there is the need to actively fight the menace of illegal mining.”

– Mr Sampson Ahi, MP-Bodi, November 26, 2014

 

“Mr Speaker, in my constituency and my neighbouring constituency—Adotobiri, Amansie West, Fomena and those areas, all water bodies are not endangered species. If you travel round, you cannot see one stream of water where, in your worst thirst, you can pick and drink. Every water running around, whether it is a stream or a big river, is muddy and it is because on both sides of the river bodies, are huge excavators, excavating the earth and prospecting for gold”

– Mr. Joseph Osei-Owusu, NPP – Bekwai, June 5 2013

 

The fourth parliament (2005-January 2009) passed the Minerals and Mining Act in 2005 to regulate the activities of small-scale and large-scale mining. Section 83 of the Act states “a license for small-scale mining operation shall not be granted to a person unless that person

 

  1.    Is a citizen of Ghana,
  2.    Has attained the age of 18 years and
  3.    Is registered by the office of the Commission in an area designated under section 90(1)”

 

The Minerals Commission is mandated with the responsibility to regulate and implement policies related to mining, among others. But the Commission has not lived up to expectations. The Parliamentary Hansard of 12 December 2013 captures the MP for Pru East, Dr Kwabena Donkor as saying,

 

The current practice where the mining sector has rightly drawn public criticism for (illegal mining) practices arises largely as (a) result of regulatory failure. And since the Minerals Commission has the statutory responsibility to regulate the sector…we should make demands for a more robust regulatory regime to protect our environment and natural resource wealth.”

 

We have a situation whereby the existing regulations on mining are not complied with, and the political and regulatory institutions entrusted with the power to ensure compliance have joined us in lamenting about the devastation caused by galamsey. What we have seen from Presidency and Parliament for more than 10 years is an endless conveyer belt of commentary on Galamsey with occasional “piecemeal measures” to stem the phenomenon.

 

This is a response to the President’s invitation to citizenship.

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What is Charles getting from this Bogus Democracy?

I’ve been feeling terrible this morning. Pondering how harder it has been to climb the socio-economic ladder through legitimate means. And nothing brings me much heartache than seeing how some of my friends have to endure and overcome structural impediments and corruption on the road to economic prosperity. The situation of my friend, Charles needs telling. Charles isn’t just a man from an extremely poor family; in his early 30s he acts as a father, brother and breadwinner for a rather big family. Not a family of his own. I’m referring to the one his father left behind. He had to relocate from Hohoe in the Volta region to Accra to make a decent living to support his family. He spent several years under apprenticeship before eventually moving on to establish his own tailoring business. Charles is working extremely hard to get out of poverty. But then he has competitors working equally hard to keep him out of business and keep him in poverty. These competitors aren’t other tailoring businesses. They are his Assembly Man, MP and the Leviathan called government.

The little he gets, the government collect levies, taxes (direct and indirect), electricity bills, etc from. Whilst this parasitic transaction persists, whilst Charles honors his part of the social contract, his Assembly Man, MP and the overall government architecture hardly do their part. For instance, Charles had to cough up thousands of Cedis to make a 2-year rent advance payment for his shop and house. A 2-year rent advance is illegal but Charles was compelled to pay because there are no alternatives and effective mechanisms to seek redress. His representative in the district Assembly prioritizes events management over balanced development; his MP prioritizes salary increment, appropriation bills and party politics over the lapses in the administration and management of the rent act; and the government is all over the place pursuing an affordable housing programme he cannot afford.

At best what the tripartite union (the assembly, legislature and government leadership) has given him is corruption and mismanagement.

Corruption and mismanagement of public funds were the principal reasons adduced by the Military led by Colonel E.K. Kotoka for the overthrow of Dr. Kwame Nkrumah on 24th February, 1966. A few years after this significant event, most of our legislators (MPs) were born (about 70% of our MPs are between 40-59 years). Those who were witnesses to the tenure and eventual toppling of Nkrumah’s regime are divided on the transformational impact of his leadership. One of such is the Speaker of Ghana’s Parliament, Professor Mike Oquaye who recognizes the visionary qualities of Nkrumah on different sectors but describes as “palpably false” the assertion that Nkrumah is the founding father of Ghana. Well the debate on whether Nkrumah is the founding father of Ghana or not becomes insignificant, irrelevant and trivial when placed within the context of the present circumstance of Charles.

After all, after showing socialism, dictatorship, the perceived misery, suffering, tyranny and all thinkable ills of Nkrumah’s government the exit door, what liberation, political and economic, has subsequent leaders and public servants brought to Ghanaians like Charles who break their backs on a daily basis? Have they ever learned from the omissions and commissions of Dr. Nkrumah?

To whom much is given much is expected, the saying goes. Yet what prevails here is the opposite. Public servants take more from us. We pay them more. And in exchange, we get less. Permit me to walk you into Ghana’s Parliament. Of the 79 bills passed in the Sixth Parliament of Ghana, 31 bills (39.2%) were “Tax Bills” introduced to increase taxes, customs duties and levies. Of the seven appropriation bills introduced to approve the budget, revenue mobilization comprised 50.7% of the Sixth Parliament’s legislative agenda. MPs take home around GHS 270,992 (US$63,021) in ex-gratia every four-years alone (altogether GHS 74,522,800 (US$ 17,330,883) for 275 MPs and that amount can pay about 17,000 of the highest paid public sector workers (in government ministries and agencies); and about 34,000 Psychiatric Nurses). Yet, the Right to Information Bill, with which we can accurately measure the level of self-enrichment, remains unpassed 20 years and counting. Yet less than 60 MPs of the 275 are active in Parliament.

These facts does not only provide a glimpse into what goes on in Parliament. They also tell us how MPs fight for good conditions of service for themselves without commensurate improvement in the performance of their oversight, legislative and representative functions. When those at the intersection of power and our collective interest serve at best with “yeah…yeah” and “nooo…nooo”; when our collective interest is lost in the noise of partisanship and high-flying ideologies, then we have a debate significant, relevant and critical in our present circumstance.

What is Charles getting from this bogus democracy?

Building Ghana From the Bottom Up: Can Nana Addo’s Government Walk the Talk?

Poverty reduction through job creation is among the list of priorities for President-Elect Nana Akufo-Addo. Whether he will be relying on the grace of trickle-down economics to execute this priority can best be answered by time. He will be presiding over a country with significant within-region inequality in the North and a local government structure rife with data management systems too inadequate to facilitate accurate tracking of pro-poor initiatives. In the execution of items on his agenda for job creation to ensure prosperity and equal opportunity for all, he will also have to be mindful of the segments of the population which are most vulnerable to the consequences of fiscal interventions, and will need some support before being transitioned into productive employment.

Nana Addo’s government intends to allocate US$1.6 billion to alleviate poverty. Throughout his campaign, he did not clarify whether this fund will be independent of or mainstreamed into LEAP (Livelihood Empowerment Against Poverty). What was clarified, however, is that this pro-poor intervention will be implemented in a decentralized manner. Therefore, this implies district ownership, participation, and management of the intervention. This leads to a situation where the inability to meet the targeted US$1m for each constituency will be the misery of the District Chief Executive (DCE). However, since DCEs are appointed by the President, Nana Addo will not be able to refute his fair share of the misery if the intervention does not pan out as designed.

It is important for Nana Addo to complement the LEAP program; not only because of its evident promise to mitigate short-term poverty per se but because research has shown the potential of the program to improve civic participation, a sense of citizenship and community relations. Before the LEAP program, from 2,400 LEAP prospective beneficiaries sampled across the country, the State was perceived as uncaring (36%), neglectful (32%) and insensitive (14%). After the LEAP program, 72% of respondents were of the view that the program has restored their trust in the State to meet their needs.

Since the promises (one district, one factory; one constituency, US$1m) which highlighted his campaign where localized, a functional local government machinery will be critical for the Nana Addo government. In fact, it was at the Kunbungu district of the Northern region that he assured voters that his government will “build Ghana from the bottom up”. He now has the opportunity to walk the talk.

The Laws Must Be Crazy: Evaluating the Mental Health Act

Introduction

The passage of the Mental Health Act in 2012 was an important milestone for Ghana’s mental health system, considering the system’s “lunatic” history. In the ensuing paragraphs, this article offers a brief narrative about the history of mental health in Ghana, highlights certain important legislative issues which needs to be addressed and discusses why the implementation of the Mental Health Act will be an additional burden to an overwhelmed mental health system.

History of Mental Health in Ghana

Attempts to regulate mental health in Ghana date back to the latter part of the 19th Century. In 1888, the Lunatic Asylum Ordinance (LAO) was enacted under the governorship of Sir Griffith Edwards. This ordinance was rather draconian, as it labelled the mentally ill “insane” and ensured their arrest and imprisonment. Such was the zeal and fervour to carry out the provisions of the Ordinance that by the close of the century, the special prison in which the mentally ill were reposed, had become congested. This called for the construction of a “lunatic asylum” in 1906. This asylum is the present Accra Psychiatric Hospital.

In 1951, the Accra Psychiatric Hospital had its first Psychiatrist in the person of Dr. E.F.B Foster, a native of Gambia. He continued reforms undertaken by his predecessors Dr Maclagan (1929-1946) and Dr. Wozniak (1947-1950) and furthered steps to eradicate the prevailing injustice and make the facility more humane. He transformed the “lunatic asylum” into a hospital. Indeed, this semantic transformation was an imperative response to the equity and justice question: if mental illness is just like any other illness, then why should the mentally ill be treated differently from the others? Under the leadership of Dr. Foster, more Doctors and Nurses were trained in addition to other initiatives to improve the hospital. The Accra Psychiatric Hospital was the only established Psychiatric facility in West Africa in the early 50s. Two additional psychiatric hospitals were built in 1950 and 1970 respectively.

After Ghana’s independence in 1957, part of a comprehensive plan for the health sector was the construction of five new mental health hospitals supported by Psychiatric units to accommodate about 1,000 people. At the time, Ghana’s population was below eight million.

The ordinance still remained enforceable until the enactment of the Mental Health Act 1972 (NRCD 30), which focused on institutional care taking into account the patient, the property of the patient and voluntary treatment.In 1983, under the Provisional National Defense Council’s (PNDC) regime, improvement of psychiatric services especially at the Accra Psychiatric Hospital became a concern. A committee which was formed in this regard, saw the need to integrate mental health within the larger health sector. Their recommendation led to the creation of a Mental Health Unit within the Ministry of Health.

Currently, there are only three Public Psychiatric Hospitals (Accra, Pantang and Ankaful) in the country, all located in the Southern part of the country with 1200 beds altogether. There are about six privately operated ones. From 1957 to date, 59 years and counting, the strategic vision for five new mental health hospitals is yet to be realised.

Mental Health Legislation: Inconsistencies and Illogicalities

In 2004, the mental health bill (now an Act) was introduced in Parliament. The bill took into account modern trends, standards and best practices and also made provisions for the regulation of public and private mental health facilities in the country. The bill spent eight (8) years on the shelves of Parliament before being passed into law. Below are some legislative issues before and after the passage of the bill into law:

1. Though the 1992 Constitution of Ghana, article 15, paragraph 2 states that “no person shall…be subjected to (a) torture or other cruel, inhuman or degrading treatment or punishment, (b) any other condition that detracts or is likely to detract from his dignity and worth as a human being,” we have not yet included the offense of torture, as defined in article 1 of the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, in our Criminal Code, 1960 (Act 29). Denial of adequate food, shackling to trees or metal objects and arbitrary flogging are some of the cruel, daily experiences of some mentally ill persons. These practices are tantamount to torture.

Human Rights Watch, in its 2012 report, “Like a Death: Abuses against Persons with Mental Disabilities in Ghana” found that persons with mental disabilities in Ghana often experience a range of human rights abuses in some prayer camps and hospitals. These patients are ostensibly sent to these institutions by their family members, police, or their communities for help. Abuse takes place despite the fact that Ghana has ratified a number of international human rights treaties, including the Convention on the Rights of Persons with Disabilities (CRPD), which was ratified in July 2012. The abuse includes denial of food and medicine, inadequate shelter, involuntary medical treatment, and physical abuse amounting to cruel, inhuman and degrading treatment.

The findings by Human Rights Watch were similar to an earlier graphic narration of human rights abuse at the Accra Psychiatric hospital by Anas Aremeyaw Anas.

The Mental Health Act provides for the establishment of a Mental Health Tribunal to oversee, among others, human rights violations. However, implementation of this Tribunal is still in the pipeline. For this Tribunal to function effectively we must train Health Lawyers to help interpret, advocate and enforce the Mental Health Act, and to protect patients’ rights. But according to Doku, Wusu-Takyi and Awakame (2012), “the law faculties of the University of Ghana and Kwame Nkrumah University of Science and Technology, do not offer elective courses of study in Health law hence lawyers trained in Ghana qualify without exposure to health law training, let alone mental health law”. So the threat of non-fulfilment of the mandate of the Tribunal or breach of patients’ rights is real.

2. Our Criminal Code, 1960 (Act 29) criminalises suicide. Section 57 of Ghana’s Criminal Codes states that, “whoever attempts to commit suicide shall be guilty of misdemeanour”, making suicide and corruption “criminal mates”. Meanwhile, a content analysis of media reports on adolescent suicide in Ghana showed that from January 2001 through September 2014, a total of 44 adolescent suicides were reported; 40 cases were completed suicide and four were attempted suicides. Barely three months ago, a Police Officer in uniform, who is supposed to know the laws of the land better, committed suicide after killing his mother-in-law and two children. If the criminalisation of suicide serves to deter people from attempting the act, then it needs a second look; because suicide is the product of clinical depression and destructive thinking.

In other jurisdictions, the illogicality inherent in the criminalisation of suicide has been recognised and appropriate steps have been taken. For example, The Indian Government was moved to take steps to reform its national health policy when the country’s suicide rate hit 258,000; the highest number of deaths by suicide globally according to the World Health Organisation (2014). The Indian Government decriminalise the act of suicide, ‘with the aim of improving possibilities for discussion and intervention around suicidality’.

Another Burden?

There are fears that the aforementioned legislative issues will add to the catalogue of existing burdens our mental health system is carrying. Already, 3.2 million Ghanaians are estimated to have mental disabilities (disorders); 650,000 are reckoned to have severe mental disabilities. For the treatment of both mild and severe mental disabilities, the country has 600 (demoralised and poorly paid) severe mental disabilities. For the treatment of both mild and severe mental disabilities, the country has 600 (demoralised and poorly paid) Psychiatric Nurses and 12 practicing Psychiatrists; all contained in three under-funded Public Psychiatric Hospitals (all located in the Southern part of the country).

Though the Mental Health Act seeks an orderly resolution of these heavy burdens, it is unlikely that it will achieve this in the foreseeable future. Unless there is flexibility and innovation in our approach toward mental health issues . A notable example is the Public-Private Partnership (PPP) between the Ghana Health Service and BasicNeeds Ghana. Using the mental health and development model, this partnership has made mental health care accessible; providing medicines and counselling in primary care settings (homes) to 43,312 people with mental disorders and epilepsy in the Northern parts of the country and, delivering economic opportunities to families affected by mental illness through 253 self-help groups.

Conclusion

In principle, the Mental Health Act is an essential document which keeps pace with modern developments in the delivery of mental health services, protects the human rights of mentally ill persons and ensures orderly conduct of public and private mental health facilities. But the reality is that, to date, we have ‘mad persons’, male and female, roaming the streets of Ghana naked. Instead of the proper treatment and rehabilitation of these persons, we have a Criminal Code which fails to overtly prohibit all manner of torture against the mentally ill but puts them among tycoons of corruption; and an educational system which cannot nurture Specialised Lawyers to serve as advocates for their human rights.

***This article was originally published on odekro’s blog on October 14, 2016***

How Ghana Can Avoid a False Start in the Race to Excellence in Public Education

road to excellence-2

We should spend less time ranking children and more time helping them to identify their natural competencies and gifts and cultivate these. There are hundreds and hundreds of ways to succeed and many, many different abilities that will help you get there
– Howard Gardner, Psychologist

The road to better quality and transformative public education is paved with lots of contradictory prose and as a result, weak convergence on the way forward. Often those at the decision making table are quick to count the cost when it comes to taking real action (mostly because they were appointed to manage a system they don’t use); a posture which gives our Academicians an opportunity to delight themselves in flowery, technical vocabularies in their ivory towers of abstraction (pun intended). We had a reenactment of this annual ‘concert’ when news of the 2016 West Africa Senior School Certificate Examination (WASSCE) results broke.

As usual, our students passed with colors that did not fly. Out of the 274,262 students who took part in the exams, 45% did not do well in English, 50% did not do well in Science and 66% did not do well in Mathematics. This blew the whistle for Morning Show Hosts of media houses, Public Relation Officers of Education agencies, cynical politicians and Academicians to assemble and have their annual loquacious feast, which marks the unpacking of cliché remarks, accusations and defensiveness.

Using the WASSCE results as rudimentary basis by contrasting failure rates to pass rates, they repeated ‘the biggest mistake of past centuries’, which is, ‘to treat all students as if they were variants of the same individual’. It became farfetched to imagine, let alone understand the unique circumstances of each WASSCE candidate.

Our system is biased toward exam performance. No doubt. Instead of being one of the proxies for intelligence, academic exams has become ‘the’ proxy.

Not every student will be academically astute and the thought that failure to pass WASSCE (or any ‘paper’ exam in general) will affect the potential and future of the not-so academically brilliant student is nowhere near an intelligent guess. Our over-emphasis on ‘paper’ education is just as disturbing as the churn-out of graduates without employable skills.

What is equally disturbing is our inability to put a firm grip on the dropout rates in our public schools. The much promised free Senior High School (SHS) program, if well implemented, will be of great relief to indigents especially. It will only be ineffective if many people become disinterested and distrustful of public education.
Though the retention rate (the indication of flow through basic education) at primary school stood at 82 percent as at 2014, the figure dropped to 78 percent at Junior High School. The rate further drops at subsequent levels of education. In the absence of reliable data owing to data management and access challenges in Ghana, it is not out of place to intuit that the dropout rate could be higher than projected.

An understanding of the circumstance and psychology of drop-outs is necessary.

The parents and guardians of these dropouts do not have the financial means to further the education of their wards. They are paralyzed by poverty. Hence some of these young dropouts by virtue of economic disadvantage eventually resort to illicit means and social vices to cope and feed themselves. This improvisation eventually become costly to society and even themselves in the long run. It is instructive to note that these people have needs which require immediate satisfaction. Some are teenage parents. Some are first-borns who have to take care of younger siblings and to some extent, their families. Thus, the usual, traditional form of education, the read and write mode of instruction, which takes a while to complete will not work. These people want food on the table. They want to take care of their siblings and family. The last thing they want is an exams re-sit; another nightmare.

Fortunately, some have honed their entrepreneurial edges into business enterprises. They however go about their businesses just to survive and thus, their businesses miss out on opportunities to grow and expand due to deficits in soft skills and better business management strategies. A study conducted in 2014 cited inadequate managerial knowledge and skills as one of the numerous challenges confronting small and medium scale enterprises in Ghana.

At the moment, perhaps it will not be practically feasible to attempt to balance investments across the various sectors of education. What is urgent however, is the need to support ongoing government efforts and leverage impact through a capacity building programme for these entrepreneurial drop-outs. In 2012, the government of Ghana trained 5,000 Junior High School graduates in Technical and Vocational areas (garment, cosmetology, electronics and auto-mechanics). In 2013, the number of beneficiaries increased to 8,000.

The talk about technical and vocational education gains momentum only when the issue of skills deficit of University graduates comes to the fore. It is a secondary topic, which clearly tells where our priority as a country lies. This has to change.

What a 19th Century Inventor Taught Me

One day, my mother took me to this place. She told me that that place was the only place we can bring my father, who was then several miles away from us, closer. I was excited and curious at the same time. Why? Because for the first time, I was going to see this place and also going to discover what makes this place so special. So off we went. We got to the hallowed place and met a gentleman who manage the place. My mother read something from her notebook to the gentleman who kept pressing some buttons on a device as she spoke. Then she was given this C-shaped object. She placed it to her ear and said, “Hello”. This marked my first encounter with the telephone.

Somewhere in the late 90s, I had the privilege of benefiting from the imagination and steadfastness of people I have not met. Until I went to Secondary school and came by Encyclopedia Britannica, I didn’t know the face, skin color, nationality, socio-economic status and level of literacy of Alexander Bell and the other pioneers of the telephone. Even if I never got to meet these people, my material experience of their belief that people widely apart physically can be brought together, was enough. Today, we have seen and still seeing tremendous creative disruption in communication technology.

One interesting thing I observed in the historical narratives on the Reconnaissance, Enlightenment, French Revolution, and the Industrial Revolution was that the clamor for change was largely driven by grit and self-application to studies. According to John Mackey, “almost all of the extraordinary engineering that we all take for granted in the transition from rural to industrial society, was created by uneducated workmen”.

Perhaps the absence of (systemic, strait-jacket) education inured to the benefit of these workmen. I don’t think the self-educated Thomas Edison would’ve made 1,000 attempts at inventing the light bulb had he had all the facts. The bottom line was curiosity and self-interest. These workmen together with Edison were concerned about making a difference, expanding the frontiers of earthly possibilities and didn’t give a shuck about scoring 10/10.

To those of us privileged to receive higher education, what impact are we making with our knowledge? To what extent is the use of our knowledge advancing progress? Have we been educated to think problems, ink solutions and leave the work which begs our brains and hands to others to do? We don’t necessarily have to be a genius like Alexander Bell and the rest. By acting on what we know to make a positive difference on those who don’t know what we know, we engineer progress.

Mental Health in Ghana: What We Should Do With What We Know

Globally, 700 million people are estimated to have a mental disorder and over a billion are likely to experience one in their lifetime, including 80% from low and middle income countries.[1] An estimated 3.2 million Ghanaians are likely to experience mental disorder at a point in time. [2]  These are worrying statistics especially for low and middle income countries like Ghana where the health system within which mental health is situated, is reactive.

After Ghana’s independence in 1957, part of a comprehensive plan for the health sector was the construction of five new mental health hospitals supported by Psychiatric units to accommodate about 1,000 people. At the time, Ghana’s population was below eight million. [3] Currently, there are only three public psychiatric hospitals (Accra, Pantang and Ankaful), five privately operated ones and about five Psychiatrists to a population of approximately 25 million. Besides that, the Psychiatric hospitals are incapacitated to handle enormous cognitive and psycho-social disability cases across the country; significant under-investment, medication and requisite logistics are inadequate coupled with frequent strikes by Psychiatric Nurses due to unpaid salaries and other work benefits.

Considering what we now know, what should we do? Already there has been a remarkable impact on the ground through a public-private partnership (PPP) between the Ghana Health Service and BasicNeeds Ghana. Using the mental health and development model, this partnership has made mental health care accessible, providing medicines and counselling in primary care settings (homes) to 43,312 people with mental disorders and epilepsy in the Northern parts of the country and delivering economic opportunities to families affected by mental illness through 253 self-help groups. This is a results-based, highly effective intervention working within a curative paradigm. How about a preventive, cost-effective intervention?

Leading Mental Disorders in Accra (Jan - Dec, 2010)

 

Fig.1: Depression was the leading mental disorder in Accra in 2010. To a large extent, this disorder can be prevented through self-help groups, effective coping mechanisms and proper life adjustments

 

Somewhere in March 2015, a team of young professionals including myself in Ghana, UK and US including Psychiatric personnel from the Korle-Bu Teaching and Pantang hospitals organized a first-order, mental health intervention programme at a rural community in the Ga East district of Accra, to help people utilize their internal resources to make appropriate life adjustments in the face of stressors and also, to identify severe cases which require referral to mental health specialists. The extent to which mental health awareness and preventative mental health care have been reduced in importance in the Ghanaian setting was what moved us, in a rather significant way, to act. Not all of us are aware of our mental health needs and not all of us can afford treatment if diagnosed with a debilitating mental illness like clinical depression which often results in suicide.

 

The Government of India was moved to take steps to reform its national health policy when the country’s suicide rate hit 258,000, the highest number of deaths by suicide globally according to the World Health Organization (2014). The Indian government decriminalize the act of suicide, ‘with the aim of improving possibilities for discussion and intervention around suicidality’.[4] Suicide is criminal in Ghana. Act 29, Section 57 of Ghana’s criminal code states that “whoever attempts to commit suicide shall be guilty of misdemeanor”. Meanwhile, a content analysis of media reports on adolescent suicide in Ghana showed that from January 2001 through September 2014, a total of 44 adolescent suicides were reported; 40 cases were completed suicide and four were attempted suicides. [5] Due to prevailing stigma of mental illness, people hardly report and that partly explains the statistic. But the overriding point is that we should not wait until suicide rates go through the roof before doing what needs to be done.

 

The economic and social burden of mental illness can be lighten through among others, the scaling up of interventions driving big impact like the PPP programme between the Ministry of Health and BasicNeeds and inclusion of mental health awareness and education into other health promotional activities. At the micro level, youth groups, religious organizations and other associations can make use of available life adjustment skills and mental health tools. To get the mental health system right in Ghana, we all have to get on board.

 

References:

Victoria de Menil. (2015). Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs. CGD Policy Paper 068. Washington DC: Center for Global Development.

Human Rights Watch. (2014). NGO appeals to government to prioritize mental health service. Ghana News Agency, March 5, 2014.

Nkrumah, K. Dark Days in Ghana.

Quarshie, N., Osafo, J., Akotia, C., & Peprah, J. (2015). Adolescent suicide in Ghana: a content analysis of media reports. Accra: Department of Psychology, University of Ghana, Legon.

[1] Patel & Saxena (2014); De Silva & Roland (2014) cited in Victoria de Menil. 2015 “Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs”. CGD Policy Paper 068. Washington DC: Center for Global Development

[2] Human Rights Watch (2014); NGO appeals to government to prioritize mental health service. Ghana News Agency, March 5, 2014;

[3] Dark Days in Ghana by Dr Kwame Nkrumah

[4] ibid

[5] Nii-Boye Quarshie, Osafo J, Akotia C & Peprah J. (   ). Adolescent Suicide in Ghana: A content analysis of media reports. Accra: Department of Psychology, University of Ghana, Legon.