by Dr Ishma Harford
Recently, we welcomed a brigade of Ghanaian nurses onto our shores and into our health system.
When the agreement was signed last year, Ghana’s President John Mahama himself called the partnership a model of South-South cooperation. It reminded me of a project from my studies that afforded me not only profound satisfaction, but bursting pride. The moment now provides an opportunity to discuss a very particular flavour of strategic collaboration, one perfectly suited not just to Grenada, but to all developing countries.
My class was split into groups and tasked with reverse innovating Ghana’s Community-based Health Planning and Services (CHPS), a robust and well-studied primary care initiative meant to deliver care to Ghana’s communities. The objective was to analyse its strengths and weaknesses, but most importantly, the opportunities to improve England’s own primary care. I was genuinely moved by the reality that a country of the so-called “third world” could offer valuable lessons to one of the most progressive systems known today.
The “South” in South-South cooperation is not about geography; Grenada and Ghana both sit north of the equator. It describes developing countries of the global economic south (developing countries) working with one another directly, rather than through initiatives led by the wealthy nations of the economic north (developed countries). Where traditional aid flows from donor to recipient, South-South cooperation is a partnership of peers. It allows not only the sharing of resources, but of strategy as well. Opportunely, for our present discourse, Ghana provides examples of both. The nurses who recently arrived are the resource. The thinking behind a system like CHPS is the strategy.
Strategy offers the greater prize, circumventing the need to reinvent the wheel. CHPS itself is simple in principle. Communities are divided into zones of a few thousand people. A community health officer is posted to each one, and the community helps steer its own care. Care meets the people where they are instead of at the hospital doorstep, where care is more expensive and when the damage has already been done.
Grenada is particularly suited for such an initiative for many reasons. We have strong communities. Hospital-centric care is unsustainable for both economies. And, by design rather than providence, Grenada already has the physical health infrastructure to support it, possessing 36 primary care facilities so distributed that no home is further than 3 miles away.
The idea is not to adopt this system wholesale. No system is perfect, and each has had its victories and its challenges, both offering valuable lessons. Other prominent examples such as Costa Rica’s EBAIS and Cuba’s family doctor model are nearer to home geographically but offer equally important opportunities. South-South cooperation is particularly useful because countries such as ours often face similar barriers, providing even greater opportunities for learning.
If England, with all its resources, found something worth borrowing in Ghana’s communities, then a small island state that shares so many of Ghana’s constraints, and already has a working relationship with Ghana, stands to gain not only better strategies and outcomes, but shared victories, legacy and new proud history.
Dr Ishma Harford is a medical doctor and a Commonwealth Scholar who holds a master’s degree in Health Analysis, Policy and Management. The Health Imperative is an educational, non-partisan column about health, the system that delivers it, and all the implications in between.
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