Ladies and gentlemen, distinguished guests, and fellow citizens, good evening

As we gather here today, under the theme "Down Memory Lane: From 1993 to the Present," we embark on a journey of reflection and analysis that resonates deeply with the heart of our nation. Our focus is none other than Ghana's democracy and its consequential impact on one of the most fundamental aspects of our society: public health.

In 1993, Ghana made a significant transition towards democracy, marking a pivotal moment in our history. As we stand here in the present day, it's only fitting that we delve into an inquiry of great importance: Has Ghana's democracy delivered a health dividend for its people? It is with a sense of duty and an inquisitive spirit that we address this question, delving into the intricacies of life expectancy, maternal mortality, infant mortality, under-five mortality, and the crucial measure of survival to the age of 65 years.

Life expectancy, a barometer of a nation's overall health and well-being, serves as an essential yardstick in our analysis. Over the past three decades, have Ghanaians experienced an increase in their life expectancy? What tale does this statistic tell about the quality of healthcare, education, and social welfare in our democratic journey? And how does this trajectory compare to nations with similar Gross Domestic Product (GDP) levels?

Maternal mortality, a sobering indicator of the health system's capacity to protect and preserve the lives of mothers during childbirth, demands our attention. Has Ghana's democracy translated into a reduction in maternal mortality rates, ensuring that women can bring life into this world without facing unnecessary risk? And once again, how do our experiences align with those of our economic counterparts?

Infant mortality and under-five mortality rates stand as stark reminders of the fragility of life in its earliest stages. These measures encapsulate the effectiveness of healthcare interventions, nutrition, and the social support system in securing a thriving start for our youngest citizens. Have the democratic changes ushered in during the past three decades translated into tangible improvements in these critical aspects? And how do our figures stack up against countries with similar economic profiles?

Lastly, survival to the age of 65 years, a milestone that signifies the attainment of seniority, carries deep implications for the overall vitality of a nation's populace. Does Ghana's democratic era ensure that our citizens are living longer, healthier lives, thereby contributing to a robust, productive society? Can we, as a nation, proudly state that we are safeguarding the well-being of our elders?

To answer these questions, we must embark on a journey of data, analysis, and comparison. We must engage with the nuances of policy decisions, resource allocation, and the intricate tapestry of socio- economic dynamics. In our pursuit of understanding, we will find ourselves exploring the landscapes of public health and governance, seeking the nexus where the two intersect for the betterment of our society.

As we unfold the pages of Ghana's democratic history, we do so not only as observers but as participants in a collective endeavour. Our examination of health indicators is an acknowledgement of our duty to ensure that democracy's dividends reach every Ghanaian, from the youngest to the oldest, from the most vulnerable to the most prosperous. It is a commitment to fostering a nation where the well-being of our people is the cornerstone of our progress.

Ladies and gentlemen, the road ahead is illuminated by the lessons of our past. It is through these lessons that we can shape a future where our democracy not only endures but thrives in its mission to bring prosperity, dignity, and good health to all Ghanaians. As we delve into the journey "From 1993 to the Present," let us embark with open minds, willing hearts, and an unyielding dedication to the betterment of our great nation.

OPENING CREDITS

We cannot go through this exercise without looking back at what our founding fathers thought of healthcare and what their expectations were for Ghanaians. Kwame Nkrumah, the first President of Ghana, possessed a profound and holistic perspective on the healthcare system he envisioned for his nation and the broader African continent. His views, expressed during his tenure from 1957 to 1966, continue to reverberate as a testament to his commitment to the well-being of his people. The framework for health delivery set up post-independence has by and large not changed much to this day. For example, the chaos of outpatient departments remains even in an era where computing allows for better organisation of human traffic.

Nkrumah's philosophy was rooted in the belief that access to quality healthcare was not merely a privilege but a fundamental human right. He declared in a speech to Parliament in 1961 that, "It is not enough to have a healthy population; we must also have a population with the right mentality." With this in mind, he embarked on an ambitious mission to build a comprehensive health infrastructure, investing in medical facilities, training programs, and disease prevention.

His profound understanding of the interplay between health and development led to the establishment of institutions like the University of Ghana Medical School and the Ghana Medical and Dental Council. Nkrumah's vision extended beyond Ghana's borders as he recognized the importance of collaborative efforts in addressing health challenges across Africa. He stated, in an address to the Organisation of African Unity in May 1963 that "Ghana’s well-being and health cannot be separated from the well- being and health of the African continent as a whole."

Nkrumah's legacy as a pioneer of public health remains an inspiration, reminding us that a healthy society is the cornerstone of progress and prosperity. His vision continues to guide us as we strive for comprehensive healthcare, not only within Ghana but across the African continent. Sixty-six years after independence and three decades into the Fourth Republic, are we reaping the dividends of the vision of our first President? Should Osagyefo reincarnate today, will he be proud of the quality of healthcare Ghanaians receive?

When I was asked to deliver this lecture, I reflected on the timing and the fact that my father, a man whose achievements I can hardly light a candle to was yet to be laid to rest. I would have wished that the circumstances were different so I set off to ask myself, “What would Daddy have advised?” It immediately dawned on me that the academic known for his lack of political correctness would have said “Son, go and speak out, be candid and factual but hold no punches.” I will bear this in mind as we go along so forgive me if I touch a few nerves and step on a few toes. I mean no harm; we are at a point where we either taste not or drink deep.

In August 2015, my mother passed away. The previous year, she had been diagnosed with endometrial cancer. Initially, the plan was to fly her abroad to seek care. But as fate would have it, other complications made long-distance flying impossible. We, therefore, had to deal with Ghana’s health system first-hand in a quest to keep her alive. In that period, we became aware of the good, the bad and the ugly aspects of healthcare provision. It dawned on us all that even having the option to fly abroad for care wasn’t foolproof under certain medical circumstances. I told myself I had to be an advocate. Today, following the passing of our Father this quest is even stronger.

I would also like to acknowledge the presence of my brothers Kwabena and Kofi. I pay special tribute to them as we are all in mourning, but they have deemed it necessary to sit and listen to me. To Kofi, a man I have debated and sparred with from my infancy I say sorry if some of what I say rub you up the wrong side.

DEMOCRATIC RELEVANCE OF HEALTH

In a democracy, a robust health system holds immense relevance as it serves as a tangible manifestation of a government's commitment to the well-being of its citizens. A functional health system provides equitable access to healthcare services, irrespective of socio-economic background, ensuring that the principles of democracy, including equality and social justice, are upheld. Moreover, a healthy populace is more likely to be active participants in the democratic process, making informed choices and engaging in civic activities.

Health dividends are acknowledged globally with the push to attain Universal Health Coverage (UHC) by 2030. Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. This is in line with the United Nations Sustainable Development Goal 3 i.e. “ensure healthy lives and promote well-being for all at all ages.”

The determination of whether a health system is yielding a democratic dividend for the electorate can be assessed through several key indicators. One such indicator is the accessibility of healthcare services. If citizens, regardless of their economic status, can easily access essential healthcare, it signifies that the democratic principles of inclusivity and equal representation are being translated into action.

Another crucial indicator is health outcomes, such as reductions in infant mortality, maternal mortality, and life expectancy improvements. When a health system is effectively addressing these indicators, it signals that the government is genuinely prioritizing the well-being of its citizens and creating an environment conducive to democratic participation.

I must state here that my emphasis will be on our population’s health outcomes. According to the World Health Organization (WHO), Health outcomes measure a change in the health status of an individual or a group which can be attributed to interventions. This suggests that to obtain significant health outcomes, a country must be purposeful and intentional.

In the African context, the relevance of a functioning health system is particularly pronounced due to persistent challenges like communicable diseases, inadequate healthcare infrastructure, and unequal access to medical services. For instance, countries such as Rwanda have made remarkable strides in improving healthcare access and quality, resulting in positive health outcomes. The implementation of community health worker programs, which provide health services even in remote areas, has contributed to increased democratic dividends by ensuring that citizens' health needs are met.

Therefore, it is not surprising that most governments tout investments they make in health. Often, they see the health sector as a vote generator. The question then becomes do all the inputs they make in health yield the needed outputs that must be leveraged to achieve significant health outcomes?

Our journey to answer this question starts now.

The key input of any health system after a democratic mandate has been handed to a President is money. The easiest way to compare the funds allocated to health is to determine how much money is invested per person per year (health expenditure per capita). Ghana’s health expenditure per capita in 2022 was US$84.98. This was an increase of approximately 454% of the figure in the year 2000. In comparison, Rwanda increased its figure by 422% over the same period to the current figure of US$57.50. Over that same period, Liberia and Sudan increased their figures by 306% and 53.6% to US$52.09 and US$23.39

respectively. How do the health outcomes of these countries compare? The following selected health outcomes will perhaps give us insight.

LIFE EXPECTANCY

According to the World Bank document World Population Prospects: 2022, “Life expectancy at birth indicates the number of years a newborn infant would live if prevailing patterns of mortality at the time of its birth were to stay the same throughout its life.” As said earlier, it is a barometer of a nation's overall health and well-being.

In 1993, life expectancy in both Rwanda and Liberia was 42.17 years whilst Sudan was 46.58 years. At that time life expectancy in Ghana was 56.42 years well ahead of all three countries. By the year 2000, a child born in Rwanda was expected to live to 47.13 years, Liberia 51.36 years, and Sudan and Ghana

58.20 years. Therefore 7 years after the commencement of the Fourth Republic Sudan had increased the life expectancy of its citizens by 11.62 years whilst Ghana had increased ours by 1.78 years. All three countries had shown better improvements in their citizens' health and well-being compared to Ghana.

This moved Ghana from 155^th on the global ranking of 193 countries and states to 154^th and Sudan from 170^th to 153^rd. How did Sudan and for that matter Liberia and Rwanda achieve this with a lower health financial investment compared to Ghana?

A look at the life expectancy data for 2022 and comparing it to the figures in 2000 is even more intriguing. Rwanda surged ahead and improved the health and well-being of its citizens by 40.18% moving life expectancy from 47.13 years to the current 66.07 years. Liberia had an improvement of 18.28%, Sudan 12.14% and Ghana 9.60%. Looking at investments each country made in health per capita over the same period, how is it possible that Ghana had the highest improvement (454%) but attained the lowest improvement in the health and well-being of its citizens? Is this the democratic dividend in health the framers of the Fourth Republican Constitution envisaged?

MATERNAL MORTALITY RATIO

Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. It is an indicator of the health system's capacity to protect and preserve the lives of mothers during childbirth. For a democracy to be delivering a health dividend this right of women should be a priority. Again, let’s see how Ghana has performed. Between the years 2000 and 2020, maternal mortality rates dropped by 47.3%. In comparison over the same period Rwanda saw a fall of 72.12%, Sudan 57.94% and Liberia 16.07%.

Hence apart from Liberia, the comparator countries saw a higher decrease in the risk women faced during childbirth compared to Ghana with less investments in health. Did our democracy promise a lower value for money to our wives at the outset? If not can it be said to be yielding the right dividends for the Ghanaian?

INFANT AND UNDER-FIVE MORTALITY

Infant mortality rate is the number of infants dying before reaching one year of age, per 1,000 live births in a given year. We can all accept that a democracy cannot be said to be yielding dividends if health outcomes are such that the most vulnerable are not protected. Is our democracy protecting the lives of our vulnerable toddlers? What do the numbers say?

Between 2000 and 2020, the percentage decrease in infant mortality for the comparator countries was as follows, Ghana at 48.09%, Sudan at 40.60%, Liberia at 58.20% and Rwanda at 72.27%. Yet again how is Rwanda achieving these significant health outcomes with less monetary input?

Let's take a look at the probability per 1,000 that a newborn baby will die before reaching age five, if subject to current age-specific mortality rates, termed Under-Five Mortality. Between 2000 and 2020 the risk of children dying by their fifth birthday was decreased by the following percentages, Rwanda at 78.73%, Liberia at 59.80%, Ghana at 56.08% and Sudan at 54.90%. Yet again with the highest percentage change in health input, Ghana is not achieving the best outcome.

PERCENTAGE OF THE POPULATION ABOVE 65 YEARS

A high percentage of any population reaching age 65 or above indicates improvement in health delivery systems and an indication of better health outcomes. Moreover, a higher proportion of elderly citizens also suggests lower mortality rates among younger age groups. From a governance standpoint, this metric showcases the efficacy of policies related to healthcare, social support, and economic stability. Countries that experience an increase in the percentage of their elderly population often demonstrate proactive governance, investment in healthcare infrastructure, and policies that promote healthy ageing.

Based on available data between 2000 and 2020, Ghana increased the percentage of its population above 65 years by 6.89% (from 3.19% of the total population to 3.41%). Comparatively, Sudan saw an increase of 33.07%, Rwanda 29.17% and Liberia 5.96%.

It is clear from the selected health outcome indicators that under the Fourth Republic, our health system has not delivered as much as it could based on the inputs successive governments have made. Under this democracy, our health system comparatively seems not to improve the longevity of the population as a whole, can't protect our women adequately during childbirth, and is failing the most vulnerable (the very young.

DEMOCRATIC HEALTH OUTRAGE

Then there is the forgotten populace who rely on traditional medicine, priests, fetishes, juju men and outright quacks. Their percentage is not clearly defined but is known to be significant. They are forgotten because though there are merits in herbal medicines, we see many of these products being touted as cures for all sorts of ailments some of which can only be managed and not cured. How in a democracy, we allow such reckless commentary about healthcare in clear violation of our laws whilst these concoctions damage the liver, kidneys and other organs is just disgraceful. Unfortunately, when these organs are damaged, many who fall into this cohort lack the financial clout to access services such as kidney dialysis. Can this be said to be a positive health dividend emanating from our democracy?

As a pharmacist, I am the first to acknowledge that the origins of many orthodox medicines are from plants. I am also aware of research done by leading light such as Professors Kwame Sarpong, Ansa-Asamoah, Dwuma-Badu and Ayim into the efficacy of many plant extracts in Ghana. My call therefore is not a frown on herbal medicine but a charge for further research and stricter regulation of the sector based on existing laws. After all, I am inclined to believe we live in a democracy and not a banana republic.

If you factor in that under this democracy the country’s Central Medical Stores were destroyed by arsonists who to date have not been traced and prosecuted, the picture is opaque. Should we be happy with this performance? I doubt.

HEALTH AS A VOTE DRIVER

Why then have politicians over the last three decades managed to use slogans in health as a vote driver? Before I try to answer this question, let's look at our mortality rate as a population compared to the comparator countries. Between the years 2000 and 2020, Ghana decreased its crude death rate (the number of deaths occurring during the year, per 1,000 population) by 23.72%, Sudan by 30.93%,

Liberia by 43.60% and Rwanda by 63.24%. This indicates that even though Ghana has had the highest increase in financial investment in health we have shown the least improvement in the ability of our health system to keep the population alive. Is it any wonder that we have the slowest improvement in our life expectancy at birth?

The truth is our politicians are very good storytellers and sloganeers. They are well aware that investments in health take a while to trickle down as health outcomes. For example, achieving significant improvements in infant mortality rates may take between 5 to 10 years, for life expectancy, it can take around 10 to 20 years and for maternal mortality rates, it may take around 10 to 15 years. Therefore, they are clear that they can not claim credit for most of these outcomes over a four or even eight-year term. However, if they build a hospital, CHIPS compound or paid trainee nursing allowances they could point at these at the next election whether or not they are value-for-money investments or misplaced priorities. Being the storytellers they are they opt for the tangibles and carve their stories around them. Hence slogans like “Agenda 111” have become catchphrases on which votes are procured.

But then again we are partly to blame. Is it not strange that in a country whose constitution speaks of the directive principles of state policy, we find a government commencing the building of new health facilities when previous facilities started by the previous government remain uncompleted? How have we as citizens become so divided and supine that we fail to stand up when things like this happen knowing very well that the main driver of such schemes is procurement and sometimes sleaze? This is a major contributor to the waste we see in our health infrastructural projects and perhaps a major contributor to why our health inputs yield marginal outcomes.

When they try to compare their performance in health, our politicians elect to compare with the performance of their opponents and not with the performance of countries with similar GDP or health expenditure per capita. So whilst they keep themselves busy shouting themselves hoarse as we look on, we slide down the global rankings of most health indicators whilst countries like Rwanda rise rapidly. They behave as though we are in a race to the bottom.

Yes, I would be the first to acknowledge that there have been improvements overall in most of our health outcomes in the last three decades. I also acknowledge that activities such as Ghana’s extended program on immunisation, the eradication of guinea worm in the country and the gains made under the Sasakawa Global 2000 initiative.

To illustrate, the introduction of the National Health Insurance Scheme (NHIS) under the Kuffuor administration was an excellent health opportunity. It was supposed to improve access to affordable healthcare through the minimisation of out-of-pocket payments by ensuring that access to healthcare is not constrained by a lack of funds at the point of use a requirement for a country to attain Universal Health Coverage (UHC).

This, if achieved should have led to significant improvement in the outpatient per capita of the country. A look at data published by the Ministry of Health suggests that since the introduction of the scheme, there has been only a marginal increase from 0.98 visits per citizen per year in 2002 to 1.13 in 2021. To put things in perspective on average this should be around 4 in a proactive health system. What it means is on average each citizen should be visiting a primary care clinician every three months.

This should have led to early diagnosis of especially noncommunicable diseases, improved prognosis through enhanced patient concordance and ultimately a better quality of life and life expectancy. Unfortunately, the data presented suggests that though coverage has improved, the health outcomes expected have not occurred.

Also, there is no evidence to suggest that all stakeholders know exactly what the NHIS is offering. A quick example is, do patients and carers know exactly what drugs are covered by the NHIS? Anecdotal evidence suggests that information is not clear to septuagenarian and octogenarian patients. If we are fortunate enough to achieve that length of life against the odds of the current life expectancy figures, would we know exactly how to access any dividend in monetary terms? Pause and think about this and ask, What went wrong?

It is disingenuous therefore for politicians to speak to absolute numbers and not the comparative trends. The former approach which is their preference is the hallmark of mediocrity.

Unfortunately, our gullibility as citizens prevents us from reading between the lines and challenging this approach. Sometimes we even take sides as gladiators in the theatre defending the very things that affect our quality of life negatively. Who did this to us? I remember that a former President told us that Ghanaians have short memories. Then the one who criticised him for making that statement took over under the slogan, “We have the men.” Seriously? Does the data as presented tell us that the supposed men have behaved like knights in shining armour?

I do not believe that if the framers of our Constitution were asked today, they would be proud of the circus our health system has become on the altar of political expediency. I reject any assertion that they would accept that these are the best dividends are health system can provide in a democracy.

LESSONS

I have tried to limit the choice of comparator countries to Africa. I have done so because I am not oblivious to the fact that often those who want us to continue down the trend of mediocrity frown on any comparison of our situation with more developed countries. I cannot help but ask are these naysayers correct? As the title suggests, “Let's go down memory lane.” In 1960, Singapore had 1.6% of its population above the age of 65 years. At that time the percentage of Ghana’s population above that age was 2.96%. This meant Ghana’s health system ensured more longevity for our population compared with Singapore. By 1970, Singapore had increased this percentage to 3.28% and was at par with Ghana. Today, the percentage of Singapore’s population above 65 years is 15.12% whilst Ghana's is 3.55%. How did Singapore succeed where Ghana had failed so badly?

The answer lies in that country aspiring for the very best among all nations. The competition in all aspects was not between the different political parties though elections mattered but with countries that they had no business competing with. To quote Lee Kuan Yew, “For a society to be successful it must maintain a balance between nurturing excellence and encouraging the average to improve.” There was no emphasis on those below average. There were no ifs or buts it was just a quest to be excellent. It is therefore unsurprising that according to Statista, the Health and health systems ranking of countries worldwide in 2023 ranked Singapore first with a health index score of 86.9%. Of the comparator countries, Rwanda had a score of 64.6%, Ghana 63.1%, Sudan 60.5% and Liberia 48.6%.

One similarity I see between the health models of both Rwanda and Singapore is strong political leadership driving the concept of taking healthcare to the community which enables those with undiagnosed chronic diseases to be identified early at the community level. This allows for early intervention and better health outcomes. Is this an approach worth exploring?

Looking at the health outcome data and the significant advances Rwanda is making, I see them making similar strides. We, therefore, owe it to ourselves to be the generation that said enough of the mediocre organic growth in health outcomes. If not, just as I stand before you today and paint a pale canvas, the generation after us could have an even worse verdict of our stewardship. To think that Ghanaians had

better longevity in 1960 compared with Singapore but today comparing the two countries is seen as outrageous brings me to this conclusion.

LEADERSHIP MODELS 'WHAT GOOD LOOKS LIKE'

Examining health systems that achieve remarkable health outcomes, such as those of Singapore and Rwanda, unveils a common thread in their approach to identifying and empowering leaders. These exemplary systems stand out for their adept methodologies in leader selection and development.

At the core of their success lies a rigorous merit-based system for leader identification and appointment. This involves transparently advertising vacant leadership roles and implementing meticulous processes to discern the most suitable candidates. These leaders operate under performance-based contracts, bound by measurable health outputs and outcomes that serve as performance benchmarks. These parameters are periodically evaluated by overseeing authorities, fostering a culture of accountability.

Central to their effectiveness is the provision of secure tenure for leaders, ensuring stability for medium to long-term planning. These plans are rooted in prevailing health outcomes and encompass ambitious targets aimed at driving substantial enhancements over time. Through their tenures, these leaders orchestrate the guidance and supervision of subordinate officials, often appointed through a decentralized merit-driven framework.

Notably, even shifts in political leadership fail to necessitate an overhaul of health leadership, promoting continuity and strategic alignment. Embracing the notion that "leadership is the cause, everything else is an effect," these health systems operate with a resolute vision that propels their endeavours forward.

THE WAY FORWARD

In conclusion, as we navigate the intricate intersection of Ghana's democracy and public health, a path forward must be charted that aligns our democratic principles with the pursuit of better health outcomes for all our citizens. Our journey "From 1993 to the Present" has illuminated the need for a more collaborative and comprehensive approach to leveraging our democratic system to yield dividends in health. A look at our Presidential election results since 1993 points to no political party ever winning over 60% of the popular vote cast. A critical analysis will show that each of the two dominant parties who have had an opportunity to govern have between 44% and 46% of voters as core following. They only win elections when a majority of the remaining 10% opt to side with them.

However, in practice post-elections, the winning candidate looks inwards selecting voices from within his circles whilst ignoring any inputs. The losing party waits its turn and jettisons most of the activities the previous government initiated. The marginal 10% who are the kingmakers go back to sit on the fence whilst observing the winning party govern. Only to become disgruntled when the health dividends do not materialise. Did the framers of our Constitution promise us improved health dividends or a comical display of musical chairs?

It is crazy that we can consistently ignore the intellectual contribution of over 50% of our population on a partisan basis and expect that our health inputs will yield transformational outcomes. How we can believe that the supposed men capable of turning our health fortunes reside in approximately 45% of our voting population defies me. Perhaps, the former President was right, we have short memories. We have become averse to obvious statistics that stare us in the face.

To think that the leadership of our health system and all teaching hospitals change in line with our electoral cycle is bonkers and often sends chills down my spine. How can we expect these leaders to plan for medium to long-term health outcomes when they have no guarantee of tenure? This concept of tying health leadership to the executive is one we must fight to change with all our muscles if we expect to see health improvements commensurate with our health investments. Leadership at the technocratic level should be based on meritocracy and not political allegiance.

We should care less about the political affiliation of our health leaders and more about their competency. As Deng Xiaoping famously said, “It doesn't matter if a cat is black or white, as long as it catches mice.” To whit when it comes to health all that matters is value for money health inputs that yield optimal outcomes. That’s what pragmatism teaches us.

The pursuit of better health outcomes demands a multi-faceted approach that transcends mere rhetoric and short-term gains. Instead, it necessitates the establishment of robust processes and frameworks that promote inclusivity, cooperation, and the wise allocation of resources. To achieve this, we must:

1. Engage in Inclusive Conversations: The development of a sustainable health policy should be rooted in conversations that include voices from all levels of society. Inclusivity ensures that the policy framework addresses the diverse needs and challenges faced by different segments of the population. The era when politicians come out with a plan and sell it to us as the solution without understanding what our pain points are must be buried. Our leaders must first listen, think and then dream. It is only after having a dream should planning commence. Martin Luther King during the Civil Rights Movement talked of a dream, not a plan. We cannot aim for the skies if we fail to be utopian.
2. Prioritize Research and Data-Driven Decision-Making: The journey towards better health outcomes must be guided by data and evidence. Rigorous analysis of health indicators, comparisons with similar nations, and regular assessment of progress are essential for informed decision-making.
3. Embrace Long-Term Vision: While politicians often seek short-term victories, the dividends of a functional health system manifest over time. Policymakers must adopt a long-term perspective that prioritizes sustainable improvements in health indicators.
4. Focus on Prevention and Well-being: A true health dividend lies not only in treating illness but in promoting preventive measures and overall well-being. Investment in public health education, disease prevention, and healthy lifestyle promotion can lead to substantial gains in health outcomes.
5. Transparency and Accountability: Holding political leaders and policymakers accountable for the outcomes of health investments is vital. Transparency in resource allocation, performance evaluation, and reporting fosters a culture of responsibility and continuous improvement. As citizens, stop accepting tinkering around the edges as improvements.
6. Strengthen Collaborative Efforts: Health challenges are multifaceted and require collaboration between various sectors, including healthcare, education, and social services. Cross-sector partnerships can amplify the impact of health investments and deliver holistic benefits to citizens.
7. Continuous Learning and Adaptation: Policies and strategies should be flexible enough to adapt to changing circumstances, emerging health threats, and technological advancements. A commitment to learning from successes and failures ensures the constant refinement of health interventions. A good understanding of this could help with addressing one of the main drivers of health worker migration which has become an existential threat to our health system delivering desirable health benefits.
8. Public Engagement and Advocacy: Citizens play a crucial role in holding governments accountable and advocating for their health needs. Active engagement and informed advocacy can push for sustained investments and improvements in the health sector.

As we reflect on the legacy of Ghana's first President, Kwame Nkrumah, his vision for accessible and quality healthcare resonates strongly in our pursuit of better health outcomes. The road ahead is illuminated by the lessons of our past, and it is our collective responsibility to ensure that Ghana's democracy flourishes not only in politics but also in delivering tangible dividends in health.

Let us embark on this journey with a shared commitment to fostering a nation where the well-being of every Ghanaian is the bedrock of progress. By embracing collaborative processes, evidence-based decision-making, and a long-lasting policy framework, we can leverage our democratic values to achieve transformative improvements in public health. As we move forward, let our actions reflect the aspirations of our democracy, equality, inclusivity, and the well-being of all citizens.

We must always remember this quote from George Bernard Shaw, “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.” If we want improvements in our health dividends we need to be unreasonable and become more demanding of elected political officeholders. It is too dangerous to sit on the fence or to be a praise singer.

Daddy, as I retire to my seat, I hope I have been candid with my views and never held back. It will be disingenuous to your memory if I failed in that endeavour. If I have kept charge of what your advice would have been, I can only say thank you. Our regards to Mummy, you have both left your mark. May your non-conformist soul rest.

Ladies and gentlemen, thank you for the audience.