The Alliance for Reproductive Health Rights (ARHR) and its Partners are working on an initiative to promote gender-equitable and intersectional approaches to policy implementation, programming, review, and accountability in Ghana.
This is to promote a better understanding of the situation of women and girls within the Public Health Care (PHC) system, beyond the data and assumption that there would be equitable access to institutional provisions and essential services for all sections of the population, including vulnerable group.
Ms Vicky T. Okine, the Executive Director for ARHR, said the initiative, supported by an entity called Co-Impact, had prioritised the areas for further action at the community, local and national levels, as part of the Alliance’s two-year agenda on putting women and girls at the centre of the country’s PHC system.
Its focus included policy implementation, building the capacities of frontline health care workers, ensuring that feedback mechanisms and accountability were accessible to women and girls; empowering them to feel able to increase their participation in decision making around PHC, since the system offered them several opportunities to do so.
In view of this, the ARHR has recently undertaken two studies related to gender and intersectionality, as well as power and political economy issues.
At a stakeholder validation workshop on “Exploring Gender, Intersectionality, and Power in PHC in Ghana,” Ms Okine said the emerging research findings and proposals would offer participants from academia, civil society, health professionals among other parties in the health sector, an opportunity to review the key issues related to gender, intersectionality, inclusion and responsiveness of heath care and essential services to persons with multiple vulnerabilities.
The study among others, explored what implications power, its location and exercise had on PHC delivery including women’s and girls’ access to these services and the knowledge shared would provide key information for in-depth discussions by the participants for onward application within their varied contexts.
Dr Esther Ofei-Aboagye, the ARHR Advisory Board Chair, who moderated the session said Ghana’s choice of PHC as a strategy for prosecuting the Universal Health Coverage (UHC) agenda, required greater attention to ensure that people realised their health rights to access available services for improved health outcomes.
The Ministry of Health (MOH) and Ghana Health Service (GHS) had initiated several important interventions including the 2030 UHC agenda and embarked on the Network of Practice Framework, to ensure that various parties worked together at the sub-national and national levels for people to receive the health services they needed.
“We appreciate what is in there for women by way of their Maternal and Reproductive Health (M&RH) services and the fact that the Ministry has just reviewed its Gender Policy and brought it up with current development in the country,” she said.
However, the ARHR perceived PHC beyond M&RH service, with dimensions that were promotive, preventive, and rehabilitative; involved several players and institutions aside those within the health sector due to government’s collaboration with Civil Society Organisations (CSOs) and other players working within the system.
“So, if we want to put women and girls at the centre, we must know where they are, their concerns and what is required,” Dr Ofei-Aboagye said.
She explained that the women and girls in this context were not a homogeneous group, but varied in terms of age, economic activity, status, education and geographical locations among others, raising the notion of intersectionality and the differences in vulnerabilities, all of which come into play to impact on the ability of women and girls to access their health care needs.
“Maybe the needs of an older woman living in a remote village who has suffered from various health challenges including fistula, will definitely not be the same as her younger counterpart in an urban area who is highly educated,” she said.
She said the Alliance sought to unpack all these things, to make Ghana’s health systems and policies more sensitive.
Dr Patrick Kuma-Aboagye, the Director General, GHS, said the concerns raised by the ARHR and its partners were of critical interest to the Service and health sector, particularly, the issue of power, where it was located, who was exercising it, and its effect on the service delivery, were key for better health outcomes.
He said, “We can put in the services and have the policies, but what happens in practice must be known.”
He said Ghana’s health sector compared to others in Africa, may seem to be doing relatively well with its 49 per cent coverage of UHC as of 2022, it was dangerous for any attempt to fall asleep with barely six years to reach the 2030 target, because the country had 51 per cent more to achieve.
He urged the participants to effectively engage on the study findings to fine-tune their proposals to inform health sector policy decisions.
There were three study presentations by researchers from the University of Ghana (UG), Legon and ARHR involving topics on the: “Context of Institutional Arrangements and Relationships for PHC Delivery in Ghana,” “Power and Political Economy analyses of PHC-related services and supply-side barriers to accessing these facilities,” and “Gender sensitivity and intersectionality in PHC and related services in Ghana”.
Mr Benjamin Oppong-Twumasi, ARHR, considered what pertained on the ground in terms of the institutions, players, as well as issues of financing and the constraints.
The key findings and recommendations included improving financing for PHC, ensuring fair distribution of healthcare professionals, and empowering women and girls to participate in practices such as Community Health Management Committees.
Professor Gordon Abekah-Nkrumah, UG, also looked at the power and political economy of PHC-related services, drawing attention to the diverse sources of power flow, from national and sub-national levels, and considered how this influenced policy making or issues getting onto the agenda of policy makers.
He cited countries like Rwanda which had succeeded in having a coincidence of views and interests, enabling it to push through some of the reforms they wanted and drew some lessons for Ghana.
Prof. John K. Ganle, leading another research team from the UG, said Gender and Intersectionality were factors that impacted on both women and girls as well as men and boys differently, rather than an individualistic thing, but it must be looked at in terms of relationships, being relational at the family level, service delivery, institutional levels, and in the wider context.
Prof. Gale said both studies therefore indicated that at the household and community levels there were gender and power issues, and with these learnings the Alliance was going to apply them further to the Ghanaian context, unpack the issues and see how best to intervene.
GNA
CAA/GRB
12 July 2024
