Seven years before the advent of Obamacare, the Republic of Ghana undertook an ambitious plan to create universal health coverage: a bold move for a country with a GDP the size of Wyoming and issues from malaria to maternal mortality to confront. But as Americans know well, even in rich countries, major health reforms aren’t easy.
Irene Agyepong, one of Ghana’s leading health experts and the March 11 Grand Rounds speaker at the Mailman School, has an understanding of her country’s transition to universal coverage informed less by abstract theories of health systems than by her decades of real-world experience as a physician, administrator, and researcher.
In the early 1990s, Agyepong was the district director of health services in the rural Dangme West district in southern Ghana and founding head of the Dodowa Health Research Centre. There she met James Phillips, professor of Population and Family Health, and they collaborated on tackling problems like rampant malaria and the need for improved family planning services. (Phillips continues to work in Ghana as part of the Ghana Essential Public Health Intervention Project and Advancing Research on Comprehensive Health Systems.) Agyepong went on to oversee health in and around the country’s most populous region, Greater Accra, where she addressed a double-whammy of infectious diseases—especially in urban poor living in precarious slum conditions—as well as growing rates of chronic disease among the relatively affluent. “Urban health, rural health, poverty, malaria, health systems, and hospital management: Irene’s experience is incredibly broad,” says Phillips, “and she has translated this expertise to improve health in Ghana and beyond.”
Agyepong now serves on the faculty of the University of Ghana as a part-time staff in the School of Public Health in its Department of Health Policy, Planning, and Management. Her research in the field of health policy and systems includes work on the experience of the frontline health worker in the context of a health insurance system that Phillips says faces “a collision course with reality”; as costs outpace the ability to finance them on a timely basis. Agyepong in also interested in health sector leadership and leadership capacity building programs at all levels.
As board chair of Health Systems Global for 2012-2014 and through her work in several other global initiatives and collaborations, Agyepong travels the world, organizing and attending scientific meetings. But her attention is always on Ghana and how to make the country’s ambitious health policies work for the people in delivering people-centered health systems and care. Her lesson: Neglect of health systems development and strengthening, and ideas imposed from afar without adaptation to context will almost always lead to failure down the line.
"There is a Nigerian proverb that says: 'a goat that belongs to the whole village belongs to nobody.' Health Systems many times unfortunately are in that situation... Implementation of interventions, attainment of program targets, goals and outputs depend on strong and well functioning health systems. Paradoxically national governments, development partners, communities and individuals all hesitate to invest in something that is not easy to measure, hold and claim as 'my output,' precisely because of its shared nature."
- Irene Akua Agyepong at the opening plenary of the 3rd Global Symposium on Health Systems Research, Cape Town, South Africa, October 2014
Attend Agyepong’s Grand Rounds talk on March 11 at Alumni Auditorium, or watch it on LiveStream.