CONSULTANCY EXECUTIVE SUMMARIES

 WELL INTRANET

Executive summary of WELL Task No 15

Public Health Projects in Accra, Ghana

Carolyn Stephens - September 1997

This executive summary is an amended version of an Aide Memoire on Departure, left with the British High Commission and Department for International Development (DFID) Ghana Field Office on 1 August 1997. It summarises the results of a design mission undertaken in July 1997.

The main aim of the mission was to assist the Accra Metro Public Health Department (AMPHD) of the Accra Metropolitan Assembly (AMA) to develop a public health project in support of other environmental health initiatives in the city of Accra, Ghana.

Background

Accra is the capital of Ghana, with a population estimated as 1.5 million (probably a low estimate - based on the last census of 1984). Accra faces many problems with the protection of health of the population, mainly due to the difficulties faced by the authorities in the provision and maintenance of the basic conditions for healthy life.

Despite numerous initiatives over the last decades to improve environmental conditions, preventable infectious and parasitic diseases remain the leading cause of morbidity and mortality among people living in the Accra Metropolitan area. Some of the underlying reasons for this are (derived from discussions with the AMA working group on environmental health):

• the inability of the authorities to keep pace with the rapid development of the city population and its demands for basic services

• the lack of an integrated approach to management of Accra, notably seen in poor intersectoral collaboration to prevent environmental health hazards and promote health

• poor or inadequate provision of basic infrastructure, including land and housing; amenities such as water, sanitation, and electricity; and neighbourhood facilities such as roads, drainage, and schools and health clinics

• poor or inadequate management of environmental hazards, particularly both solid and liquid waste in the metropolis

• an overemphasis on "crisis management" by the authorities, including a focus by service providers on delivery to and maintenance of basic services for the most vocal/powerful communities at the expense of the overall population and, as a consequence of the former, a cycle of emphasis by health professionals on treatment and cure of basic preventable diseases

The difficulties above are compounded by:

• the lack of accurate and clearly presented health information to guide priority-setting processes towards prevention of environmental hazards and promotion of health

• the lack of comprehensive public understanding of public health issues

• the lack of effective citizen participation in prevention of public health hazards

• weak institutional policy, particularly a lack of mechanisms and staff ability to facilitate intersectoral collaboration; and a lack of co-ordination of complementary donor initiatives by the authorities

The Accra Metro Public Health Project is in its final preparatory stage and, subject to final approval, will be supported by the UK Department for International Development.

The core preparation team in this stage comprised 2 staff of the Accra Metropolitan Assembly, (Dr Dela Attipoe, Director of the Accra Metro Public Health Department, AMA, and Mr Nii-Akwei.Allotey, (Development Planning Unit, AMA), with the assistance of a UK Public Health Specialist (Dr Carolyn Stephens of the London School of Hygiene & Tropical Medicine).

This project complements the UK- supported Accra Waste Project, as well as other donor initiatives aimed at environmental health improvements in Accra, such as the World Bank-supported Urban Environmental Sanitation Project, the UNCHS Accra Sustainable Project, and the Korle Lagoon Restoration Project.

The project will contribute to DFID Aims 2 and 3 and is included in the DFID country strategy for Ghana.

The Design Mission

Meetings and consultations were held with DFID Advisers prior to and during the mission. In Accra meetings were held primarily with local secondary stakeholders (defined as Min and AMA staff, members of the academic staff, local NGOs, and representatives of donor agencies involved in providing, maintaining and monitoring basic environmental services impinging on health).

Field visits were undertaken throughout Accra, with a focus on deprived areas including Sukura, Jamestown, La, Usshertown, Agblogblorshie Market; Sodom & Gomorra; Mamobi.

Potential technical support groups in Accra were identified, including the Department of Geography and the School of Public Health in the University of Legon; the Department of Community Medicine, in Korlebu; local consultancy groups; and key technical experts in environmental health-related local projects.

Key conclusions

During the design mission, key refinements of the Project Concept Note were made, reflecting:

• the need to recognise the recommendations of the AMA Public Health Working Group in refining the Project Concept Note (particularly institutional development; information system development and co-ordination of complementary projects across sectors).

• the need to develop the project proposal with a strong emphasis on capacity-building and sustainability (noted by the AMA working group in their review of the Kumasi Health Education Project)

• the need to strengthen the focus of the project on complementing other major donor initiatives aimed at environmental health improvement in Accra (UESP; ASP, Accra Waste)

• the need to broaden the range of target communities in which to pilot health promotion and health information activities (reflecting a shift to complementing other donor initiatives, rather than providing a small input in one or two settlements)

In addition, a major conclusion was the need to address a major risk of the project in its design stage: to develop strong project ownership by AMA (as the key secondary stakeholder) early in the project cycle. This will serve a dual purpose:

• AMA staff motivation is enhanced for the management and implementation of the project;

• AMA staff capacity in the long term to design, manage, implement and co-ordinate donor projects is improved from the design stage of the project cycle.

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