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STATEMENT: Afenyo-Markin Lobbies NHIA Cover For Herpatitis B

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By Justice Dzido

INTRODUCTION

  1. Permit me, Right Honourable Speaker Bagbin, to precede my statement on the floor of this honourable House by thanking you and your office for granting me an audience to make this important statement. I am eternally grateful.

 

  1. Mr Speaker, for and on behalf of all persons living with Hepatitis B within my constituency, Effutu, and our national borders, I am on my feet this morning, hoping to achieve three main objectives by the time I resume my seat:

 

  • Firstly, I intend to persuade this honourable House that Hepatitis B is a significant public health crisisin Ghana and that this House speaks with one voice and requests an urgent scaling up of efforts nationwide to defeat the virus within our borders.

 

  • Secondly, I hope to persuade this honourable House to demand that testing, vaccination and treatment of Hepatitis B should be listed as part of the health services covered by the National Health Insurance Scheme (NHIS).

 

  • And thirdly, I hope to persuade you, Mr Speaker, to refer this statement to a joint committee on Health, Finance and Social Welfareto consider and recommend to this honourable House the most viable means by which the NHIS can bear the cost of testing, vaccination and treatment of Hepatitis B cases in the long term without crippling the seemingly already overburdened scheme.

 

  1. Mr Speaker, given the criticality of the issues I am about to raise in this statement about Hepatitis B, a deadly virus threatening and taking the lives of citizens, I appeal to colleagues to pay keen attention to what I have to say.

 

HEPATITIS B –WHAT IT IS

  1. Hepatitis, according to the World Health Organisation,“is an inflammation of the liver that is caused by a variety of infectious viruses andnon-infectious agents leading to a range of health problems, some of which can be fatal.”[1]The WHO calls Hepatitis Ba potentially life-threatening liver infection caused by the hepatitis B virus (HBV).[2] The global health watchdog regards the virusas “a major global health problem.”[3] The infection is often so deadly, causing chronic illnesses and can kill patients through a condition known as cirrhosis and liver cancer.[4]

 

  1. Some estimates suggest that Hepatitis B, the primary cause of liver cancer, is 100 times more infectious than the HIV/AIDS virus.[5]Indeed, the deadliness of the virus is portrayed by the fact that it isthe second-leading cause of cancer deaths in the world.[6] These facts seem to explain why the WHO considers Hepatitis B infectionas a public health burden in many countries. Data shows that the infection is most prevalent in the Western Pacific and African Regions.In these regions, the WHO projects that “116 million and 81 million people, respectively, are chronically infected.”[7]

 

SYMPTOMS OF HEPATITIS B

  1. The WHO states that most people exposed to the virus do not experience any symptoms when newly infected. Others, however, are not so lucky. They suffer acute illness with symptoms that vary. These include (but are not limited to) yellowing of the patient’s eyes, loss of appetite, mild nausea and vomiting, fever, fatigue, muscle or joint pain, pale or light colours stools, pain in the abdomen, and dark urine.[8]

 

  1. Where the condition is chronic, the patient suffers cancer, liver failure, or scarring.[9]Severe symptoms that demand immediate attention include severe nausea and vomiting, jaundice, and a bloated or swollen stomach. However, it is important to point out that some persons living with the virus, especially children, experience no symptoms.This explains why some experts consider the virus a truly vicious silent killer.

 

THE SCALE OF THE PROBLEM GLOBALLY

  1. Figures published by the Hepatitis B Foundation, a US-based charity committed to fighting the disease, show that two billion people have been infected with the hepatitis B virus across the world.[10]This translates to one out of three people. Also, nearly 1.5 million people become newly infected every year.[11] Further, almost 300 million people are classified as chronically infected, and only about 10% of infected individuals are diagnosed.[12]Further estimates are grim. An estimated 820,000 people died in 2019 from liver cancer induced by hepatitis B.[13] It is further estimated that approximately two people die each minute from hepatitis B – this translates to 1 person every 30 seconds.

 

THE SCALE OF THE PROBLEM IN GHANA

  1. The situation in Ghana is equally dire. For example, in my constituency, Effutu, a survey I commissioned in 2019 showed the prevalence rate of the virus at 8.5 per cent. This situation is not only unfortunate but troubling. Indeed, the problem around the country is equally frightening. It is estimated that the national prevalence of chronic Hepatitis B Virus stood somewhere between 8.36% (in 2020) and 12.30% (in 2016).[14]On the whole, some 3 to 4.6 million people are said to be suffering from chronic Hepatitis B infection in Ghana.[15]Unfortunately, the majority of those living with the virus do not know their status. This is the case even though science and medicine have developed to a point where it is possible to eliminate the virus.

 

PREVENTION

  1. The WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, “preferably within 24 hours, followed by 2 or 3 doses of hepatitis B vaccine at least [four] weeks apart to complete the vaccination series.”[16]The resulting protection lasts at least 20 years and is probably lifelong.

 

  1. Further, the WHO recommends the use of antiviral prophylaxis for the prevention of Hepatitis B transmission from mother to child.It also suggests that countries implement blood safety strategies and safer sex practices, including minimising the number of partners and using barrier protective measures like condoms to guard against or prevent transmission.[17]

 

TREATMENT OF HEPATITIS B

  1. According to the WHO, there is no specific treatment for acute hepatitis B. What is generally done by way of care is the use of medical interventions aimed at “maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea.” Emphasis is placed on the need for medical professionals or caregivers to avoid “unnecessary medications.”

 

  1. Patients are treated with medicines, including oral antiviral agents, in chronic situations. This helps to tame the progression of cirrhosis, slash the risk of liver cancer and enhance or boost the chances of long-term survival. Experts say that once put on treatment, most people living with the virus must continue it for life.

 

  1. In low-income countries like Ghana, most people with liver cancer die within months of diagnosis. In high-income countries, however, early diagnosis ensures patients receive surgical intervention and chemotherapy, helping to “prolong life for several months to a few years.” [18] Also, patients sometimes receive liver transplants to contain “cirrhosis or liver cancer in high-income countries, with varying success.”[19]

 

WHO’S RESPONSE

  1. In May 2016, the World Health Assembly adopted the first Global health sector strategy on viral hepatitis, 2016–2020. The plan emphasised the vital role of universal health coverage in the fight against the virus and laid down targets based on the Sustainable Development Goals (SDGs). The strategy proposed the elimination of viral hepatitis as a public health threat by 2030. This is defined as “a 90% reduction in new chronic infections and a 65% reduction in mortality, compared with the 2015 baseline”.[20]

 

  1. The strategy included a roadmap towards the elimination of Hepatitis B by implementing key strategies for prevention, diagnosis, treatment and community intervention. The 75th World Health Assembly, in May 2022, took note of a new set of integrated global health sector strategies on HIV, viral Hepatitis and sexually transmitted infections for 2022–2030. The combined effect of the two primary approaches has guided Member States in developing comprehensive national Hepatitisprogrammes and elimination strategies.

 

  1. Unfortunately, the Coalition for Global Hepatitis B Elimination suggests that Ghana does not presently have a national Hepatitis B (HBV) or C (HCV) elimination plan.[21]Although the country released the Ghana National Policy on Viral Hepatitis,[22] this was before the WHO elimination goals came into force.[23] Therefore, Ghana’s national policy does not define the country’s plans to eliminate the virus. However, it is very relieving to note that the Ghana Health Service, its allies, and partners are working towards establishing a revised national policy highlighting specific Hepatitis elimination goals.[24]

 

WHAT GHANA MUST DO URGENTLY

  1. The scale of the burden imposed by the prevalence rate of the Hepatitis B virus in Ghana is daunting. However, it is possible to confront the problem and defeat it. Indeed, there is a huge chance that if we act NOW, we can save many of our compatriots from the jaws of the virus. Permit me, therefore, Mr Speaker, to propose three urgent measures to tame the virus.

 

  1. Firstly, Mr Speaker, Ghana must prioritise and scale up Hepatitis B elimination prevention, testing and treatment programs to ensure that no one is left behind.Indeed,estimates released by the Ghana Health Service in 2020 show that an average of 120,000 newborns will be exposed to the Hepatitis B virus by their mothers during delivery. Also, up to 90% of Ghana’s newborns may end up being infected at some point. The reason is thatinfected pregnant women who are actively incubating the virus have a 90% chance of transmitting it to the newborn. There is, however, a solution. Experts say that the most potent means of stopping mother-to-child transmission include the use of Hepatitis B Immunoglobulin (HBIG) and vaccination with a birth dose of the Hepatitis B vaccine. It seems that these interventions are yet to be deployed in Ghana.

 

  1. Again, estimates suggest that the immunoglobulin intervention costs up to 1000 Ghana cedis. This is well beyond the economic power of the average pregnant woman in Ghana, meaning the risk that underprivileged but infected pregnant women will pass on the virus to their newborns is very high.We must, therefore, double our efforts and quicken the introduction of affordable and easily accessible vaccines and drugs for the prevention of mother-to-child transmission of Hepatitis B.

 

  1. In our effort to rump up an assault on the virus and ultimately defeat it, special attention must be given to the most deprived communities of this country, including those in my constituency, to help protect them against the virus. Similarly, we must ensure that our schools, markets, prisons and jailhouses receive special attention to prevent them from becoming fertile grounds for the virus to explode.

 

  1. Secondly, Ghana must take a bold decision to make viral Hepatitis B prevention, vaccination, testing and treatment part of the package of services for Universal Health Coverage (UHC) programs.In short, the NHIS should bear the cost of testing and treating Hepatitis B cases in the country.This approach is vital because most citizens, particularly pregnant women in rural communities, do not get routine, reliable and affordable access to Hepatitis B testing facilities during pregnancy.

 

  1. As earlier explained, early diagnosis and treatment help suppress the virus and save lives that would otherwise have been lost in delayed diagnosis and treatment of cases. In many deprived communities, including many in Effutu, only a few peoplecan pay for diagnosis and treatment services which are often expensive and, therefore, prohibitive. The reason appears to be that diagnosis and treatment of Hepatitis B is not captured as part of the list of conditions and treatment covered by the NHIS. This isregrettable.

 

  1. More so, the entire Effutu Municipality, like many other districts and metropolitan areas in Ghana, has no Hepatitis B viral load testing centre. Such a centre is central to any effort to manage and defeat the virus. Only the teaching hospitals in Ghana, including Korle Bu, are said to be equipped to handle Hepatitis B effectively. On my part, I will work tirelessly with stakeholders interested in the health of the citizens of Effutu to provide both the Effutu Municipal Hospital and the Trauma and Specialist Hospital,Winneba, with the necessary facilities and expertise to test, diagnose and effectively manage Hepatitis B cases within the constituency and surrounding communities. I urge my colleagues to also do the same in their respective constituencies.

 

  1. As earlier stated, Mr Speaker, viral Hepatitis B is the leading cause of liver cancer worldwide. Its elimination, therefore, will help us reduce the rate of liver cancer-related mortality. However, we can only eliminate the disease if we can implement policies, measures and programmes to diagnose and treat cases early.

 

  1. It is in this breadth that I urge this House to cause the testing, diagnosis, vaccination and treatment of Hepatitis B to be put on the list of services covered by the NHIS. This will help make such services affordable or accessible, as is the case in Rwanda[25] and Uganda,[26] and therefore accessible to patients. This has already been done here in Ghana for infections like Tuberculous (TB) and HIV/AIDS to benefit underprivileged and marginalised citizens.

 

  1. Thirdly (and finally), I respectfully urge you, Mr Speaker, to consider Ghana’s grim situation, as highlighted here, and kindly refer this statement to a joint committee on Health, Finance and Social Welfare. Their task should be to consider and recommend to this honourable House the most viable means by which the NHIS can bear the cost of testing, vaccination and treatment of Hepatitis B cases in the long term without crippling the already overburdened scheme. Their report will guide legal and policy response to the plague in a way that helps Ghana decisively defeat the virus.

 

CONCLUSION

  1. Mr Speaker, the global response to the Hepatitis B burden started in an organised and intense fashion in 2016. Ghana appears to be late or needs to do more to fight and defeat the virus. The time to act meaningfully and decisively, therefore, is NOW. We have the rare opportunity to eliminate the virus, considered the second deadliest and most infectious, in the world, and avert millions of deaths by 2030. Therefore, I urge this House to speak with one voice and demand that the State of Ghana launch a robust program which takes on board some or all of the preceding proposals to help us save lives.

 

  1. We must confront the virus head-on and defeat it. We have a lot to do to win against such a deadly infection. However, we will take a giant step in the right direction if we decide today to do the things I have proposed. Indeed, without a concerted effort by the Government, partners, citizens, and all other stakeholders within the health, social welfare and security spaces, our country will most likely miss the 2030 deadline to eliminate the virus.

 

  1. Once again, Right Honourable Speaker, thank you for the opportunity. I also wish to thank my colleagues for listening attentively to me in utter silence.May God bless our Homeland Ghana, her people and this Parliament.THANK YOU!

[1] “Hepatitis” (World Health Organization)<https://www.who.int/health-topics/hepatitis#tab=tab_1&gt; accessed February 14, 2023

[2]“Hepatitis B” (World Health Organization) <https://www.who.int/news-room/fact-sheets/detail/hepatitis-b> accessed February 14, 2023

 

[3] Ibid

[4] Ibid

[5]“Hepatitis B Facts and Figures” (Hepatitis B Foundation | Baruch S. Blumberg Institute)<https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/facts-and-figures/&gt; accessed February 14, 2023

[6]Ibid

[7]“Hepatitis B”, (n-2)

[8] Ibid; see also “Hepatitis B Facts and Figures” (n-5)

[9]“Hepatitis B Facts and Figures” (n-5)

[10]Ibid

[11]Ibid

[12]Ibid

[13]“Hepatitis B” (n-2)

[14]“Ghana National Hepatitis Elimination Profile: Key Takeaways” (Ghana National Hepatitis Elimination Profile: Key Takeaways | Coalition for Global Hepatitis EliminationJanuary 26, 2022) <https://www.globalhep.org/news/ghana-national-hepatitis-elimination-profile-key-takeaways#:~:text=The%20prevalence%20of%20chronic%20HCV,and%2012.30%25%20(2016)> accessed February 14, 2023

[15]Ibid.

[16]“Hepatitis B” (n – 2)

 

[17]Ibid

[18] Ibid

[19] Ibid

[20]Ibid

[21]“Ghana National Hepatitis Elimination Profile: Key Takeaways” (n-14)

[22]Ministry of Health, Republic of Ghana, “National Policy on Viral Hepatitis” (Globalhep.org, November 2014)<https://www.globalhep.org/sites/default/files/content/resource/files/2021-08/National_guidelines_for_the_prevention_and_management_of_viral_hepatitis_b_and_c_-_2019.pdf> accessed February 14, 2023

[23]“Ghana National Hepatitis Elimination Profile: Key Takeaways” (n-14)

[24]Ibid

[25]Nyirahabihirwe F and others, “Implementation of Refugees’ Inclusion in National Viral Hepatitis B and Hepatitis C Screening Campaign in Mahama Refugee Camp, Rwanda” (2022) 10 Global Health: Science and Practice.

[26]“Uganda Leads the Charge against Viral Hepatitis” (World Health OrganizationJune 18, 2019) <https://www.afro.who.int/news/uganda-leads-charge-against-viral-hepatitis> accessed February 14, 2023

 

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