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The bad, old days in Upper West

06.04.2018  15:06
Ghana’s poorest region, Upper West, is where Danida’s health support has contributed to the most dramatic and visible improvements.

Child welfare clinic at Kulfuo Health Centre. Photo: Jesper Heldgaard.

Akuah Alandu stands out among the people queuing up at the Jeffisi Health Clinic in Sissala West District in Upper West Region. For one, she is older than most of the others in the queue, who are mainly pregnant women and young mothers with their babies. She also has the aura of a person who has had her share of both joy, but even more tragedy in life. And indeed, she has:

“I have given birth to 12 children, but six of them passed away. When I was young, health services were poor. Most mothers gave birth at home without skilled birth attendants. Of course, this is very differ¬ent now,” she says. Without bitterness. Akuah Alandu is happy that health services and condi¬tions have improved:

“These days, children start to walk even long before they are two years old. In the past, children could reach the age of three and still had not taken their first step. Health services are so much better now, patients come to the clinics and get the treatment and the medicine they need.”

The words of Akuah Alandu are echoed by many health staff in the Upper West Region. At Kulfuo Health Centre in Sissala East District, midwife Luriwie K. H. Sala-matu on a busy Saturday morning with lots of mothers and babies attending the Child Welfare Clinic under a mango tree takes time to describe the change, she has seen during her almost 10 years of service in the region:

“When I first came here, I had to run out¬reach services alone to 7 communities without roads. Now, staffing is much better. As you see today, we are able to provide regular health education and immunization to all. We don’t see measles any more. Attendance has increased, and peo¬ple have more faith in our services.”

Dr. Zakari Bukari is District Director of Health Services in Sissala West and Medi¬cal Director of Tumu Hospital:

“When I came to this hospital in Novem¬ber 2006, I promised myself, I was leaving the following month because health ser¬vice delivery was at the worst I have ever seen. The place was so deprived in terms of equipment and human resources. The patients that came had to pay, ‘cash and carry’, for services, but few could afford it. As a result, many malaria patients only showed up too late. 50% of the pregnant women were being delivered by tradi¬tional birth attendants. So I thought there was no hope.”

The clinic funded by Danida in the 1990's is now used for health staff accommodation in Jeffisi. Photo: Jesper Heldgaard.

Still, Dr. Zakari Bukari stayed on, and today he has no plans whatsoever of leaving:
“I have seen so much progress and I am keen to see more: Malaria fatality is down, ante-natal attendance is up. I could go on and on.”

More health clinics, more staff, and more equipment are all factors, which have contributed to the improved health system in the Upper West Region – and have been supported by Danida as part of the first two phases of the Danish health support: Danida-support to the Upper West Region amounted to DKK 65.2 million (USD 9.3 million) during phase 1 of the health support programme (1994-1998) and DKK 14.7 million (USD 2 million) in phase 2 (1999-2003).

“This support went directly to the beneficiaries and had a huge impact,” says Alex Bapula, Sissala East District Health Director. “Unfortunately, Danida then decided to put its money in a common pool, controlled by central go-vernment, and that has created challenges for us at local level.”

Barriers removed
“But as important is the roll out of the National Health Insurance,” Dr. Zakari Bukari stresses. “In the Upper West Region more than 85% of women aged 15-49 years are covered by the insurance. This shows you that the in¬surance has removed the most important barrier to health services for the poor and vulnerable, that is, the financial barrier. That is probably the main factor behind the drop in the malaria fatality rate, to give just one example. People now come for early treatment, because it is free.”

Dr. Zakari Bukari sees the fingerprint of Danida on most of the improvements in the region:
“Danida has for more than two decades been a staunch supporter of the Upper West Region and provided support to infrastructure, running costs, capacity building etc. Danida was also instrumen¬tal in the development of the National Health Insurance and pushed for the inclusion of the poor and vulnerable in the scheme. It is sad that Danida now phases out health support, but the capacity that Danida has helped build up in the region will stay on.”'


The Upper West Region is the poorest and most deprived region in Ghana and was from the onset of Danish aid to Ghana’s health sector a focus region for Danida. As early as 1993, Danida embarked on a 10-year programme of strengthening the health care delivery system of the region. A starting point was improvement of the health infrastructure. In the first phase of the Danish programme, 41 health institutions in the region were constructed or renovated. In many cases this included staff accommodation to attract health staff to remote locations.
Danida-support also included motorbikes to allow health staff to reach remote areas with poor roads. This alone resulted in a two-fold service coverage increase.
Support to radio communication also contributed to improving working conditions and connectivity of health staff.