Strengthening Primary Healthcare in Ghana: A Call for Honest Framing and Practical Implementation
Primary healthcare (PHC) has long been the backbone of Ghana’s health system. Services such as maternal health, well-being clinics, adult wellness corners, reproductive health education, and health promotion have always been provided free of charge under the Ghana Health Service. These services are, in essence, the pillars of PHC.
Given this reality, recent policy language describing PHC as “free primary healthcare” is problematic,since these core services have always been free. The true value of the policy lies not in pricing, but in strengthening service delivery and raising public awareness. If our goal is to improve PHC, then the policy should be named to reflect that intent — “Strengthening Primary Healthcare” or “Universal Access to PHC” would be more accurate and less misleading. Such framing builds trust and properly credits the system’s existing foundation while acknowledging the need for scale-up.
The Case of ‘Aboboyaa’ Tricycles:
The proposed use of motorised tricycles, or “aboboyaa”for health outreach appears to draw from the CHPS PLUS research piloted in Nkwanta South and its environs. While these vehicles are undeniably cheap to procure and maintain, describing them as suitable for bad roads is incorrect.
Tricycles have clear limitations in hard-to-reach areas: they become stuck easily in muddy terrain, are too heavy to push when bogged down, and cannot safely cross rivers or navigate steep, gullied paths. They are best suited for good roads and peri-urban routes. For truly poor roads and remote communities, two-wheeler motorcycles remain the more practical option. They are lighter, more maneuverable, and can reach areas where tricycles cannot. If bad roads are the justification, then motorcycles — not tricycles — should be the primary choice for outreach. Tricycles work best as community connectors on passable routes, not as all-terrain referral vehicles.
The Root Challenge: Unregulated Human Settlement .
The current pattern of how we allow people to create communities without regulation is unsustainable. A farmer identifies fertile land, moves there with family, and within years a new settlement emerges demanding roads, clinics, and schools — often in locations far from existing infrastructure.Usually named after the first settler(Mahama akura, Adabo kurom, Al Hassan akura).
This reactive model stretches resources thin and leaves health workers isolated, contributing to absenteeism and poor service quality. We cannot build a hospital for every farmstead.
Government must Regulate Human Settlement to Enable Service Delivery
To address this, government must make a conscious effort to separate farmland from designated residential zones. Human settlement should be concentrated within planned areas where roads, health facilities, schools, and other social amenities can be provided efficiently and equitably.
This would require two key measures:
1. Zoning enforcement: Citizens may farm beyond designated settlements, but permanent residence outside planned zones should require special permission. Those who choose to live remotely would bear greater responsibility for accessing services.
2. Protecting children’s access to services: Children should not reside permanently on isolated farms. They should live in designated settlements to access schooling and healthcare, joining families on farms only during vacations.
Regulating settlement patterns will allow government to plan and distribute health infrastructure strategically, ensuring that facilities serve viable population clusters rather than chasing scattered homesteads. It is the only way to make PHC truly accessible, sustainable, and staffed.
In sum, strengthening PHC is necessary and commendable. But we must be honest in our language, practical in our logistics, and bold in addressing the settlement patterns that undermine service delivery. Only then will the policy deliver real benefits to citizens.
Pious Afrane
University of Health and Allied Sciences.
