Bright Simons throws mud at Agenda 111, which builds district hospitals at half-cost

The COVID-19 pandemic revealed that an estimated 101 districts in Ghana had no proper hospital and, moreover, that seven regions besides were in need of regional hospitals.

President Akufo-Addo set out to fix this problem and, armed with an environment-friendly design from the world-renowned architects Adjaye & Associates, managed to deliver a prototype 100-bed district hospital for $17.9 million.

This is roughly half the cost at which district hospitals are usually built, ranging between $35 million and $45 million.

It is these hospitals that are the basis of the Agenda 111 programme.

However, Bright Simons of IMANI Africa, in a recent critique, described Agenda 111 as an essentially wasteful and expensive project.

“The government used COVID-19 as a pretext to embark on a massive hospital and clinic building spree even though no budgetary provisions had been made for such in the medium-term expenditure framework,” he wrote.

“The Health Ministry was not directly involved in strategy, so there are no plans on how to stock these ‘111’ large hospitals/clinics, staff them, or provide for their maintenance. Nor is it clear from which department’s budget these costs will be serviced.

“Everything was done in the Chief of Staff’s office within the Presidency. Favoured contractors were handpicked and blessed with the juicy multibillion-dollar opportunity. Two in particular: famed Ghanaian architect, Adjaye, and luxury estate developer, Buena Vista,” Simons claimed in his piece.

“⁠No one really knows how much the whole spread will cost. In 2021, $100 million was released to get things started and pay ‘mobilisation’. Since then, reports say a further $300 million has been released to contractors.

“None of the hospitals have been fully completed and certified as built to the requisite clinical standards. It is up to the next government to foot the bill.

“The pending liability has usually been estimated at $1.45 billion, and contractors are waiting for large disbursements to keep the work ongoing. Promises to complete by September this year were of course completely arbitrary and driven by nothing more than the electoral campaign calendar.

“What is frightening is that the Ministry of Health has suddenly taken a look and now claims that about $7.5 billion is required. You heard that right. 250% more than the entire IMF package of [$3 billion], which required the painful DDEP [Domestic Debt Exchange Programme] to happen before Ghana could qualify. But even if it is the $2 billion some analysts assumed, it is still bigger than the energy sector arrears some fear might trigger a bigger round of dumsor. Yet, no one is talking about it,” Simons further wrote.

Due diligence
Asaase News checks have identified inaccuracies in the article by the IMANI vice-president.

Defending the project, a senior source at the Office of the Chief of State describes Bright Simons as demonstrating an inability “to distinguish between contractors and consultants and their roles” and said that he “conjures his own figures on project costs to support his malicious claims”.

Investigations by Asaase News show that since 2021, the government has presented the scope of the programme and costs to Parliament, presenting the programme in the 2021 Budget and subsequent Budgets each year, supported by documentation. It appears, however, that Simons did not take time to do proper due diligence before publishing his article.

Simons says the project was hijacked by the Presidency. But documents show that the Ministry of Health (MoH) and Ghana Health Service (GHS) were full and active participants in the project development committee for Agenda 111 from the beginning. And in every year since 2021, the Ministry of Health has led a team to present project information to the health committee of Parliament.

The Agenda 111 programme is being implemented as a special initiative under the Office of the President and the Minister of Health is a member of the project implementation committee, which is chaired by the Chief of Staff.

MoH and GHS developed the employers’ requirements for the programme, reviewed and approved all architectural and engineering designs, as well as specifications and medical equipment, to ensure that the hospitals meet the high clinical standards and specifications of the Ministry of Health.

One hundred and eleven sites, on pieces of land across the country varying in size from eight acres to 40 acres, were identified and surveyed, and geotechnical investigations were undertaken by the consultants. The hospitals (district, regional and psychiatric) were designed by a team of 12 Ghanaian consulting firms and their construction is being supervised by a further eight Ghanaian consulting firms, comprising architects, structural engineers, MEP (mechanical, electrical and plumbing) engineers, quantity surveyors and biomedical engineers.

In all, 20 Ghanaian consulting firms are involved in the pre-contract and post-contract phase of this very complex programme covering 111 sites.

The various design and supervision consultants as individuals and firms have several years of experience in health-care design between them and have consulted widely for the MoH, GHS and other health-care institutions in Ghana over the past decades.

The cost of the fully equipped, standard 100-bed district hospital under Agenda 111, at $17.9 million, is the lowest cost at which any government has delivered a standard MoH/GHS 100-bed district hospital in Ghana in recent memory.

These hospitals are being delivered to the highest clinical standards and specifications across the country to bridge the yawning gap in health-care infrastructure in Ghana.

“How can Bright Simons intimate that the same MoH which has not been part of the project now posits that the project needs $7.5 billion to complete? He goes on to say no one knows the project cost and yet concludes by indicating a value as a pending liability,” a source in the Office of the Chief of Staff who is familiar with Agenda 111 told Asaase News.

“Simple maths will show that this is a figment of his own fertile imagination, and statements like this best serve his own interest.

“There has been no doubt that, because Ghana entered into an IMF programme, securing funding for the project has been a major challenge and has severely affected completion of the hospitals. Nevertheless we would encourage the writer to apprise himself of the facts and not rush to expose his ignorance about matters he knows little or next to nothing about,” the source further said.

Emphasising his point, Asaase News’s source quizzed: “Did the writer [Bright Simons] in his research not come across data that suggests there was a huge infrastructure gap – that over 88 districts and the newly created regions did not have district and regional hospitals?

“That the Middle and Northern belts of Ghana do not have a single psychiatric hospital?

“Is he aware that GHS raised these as a key issue in health-care delivery? Does he know that this was a key input in the Agenda 111 programme when the president announced the programme in his ‘Fellow Ghanaians’ speech to the nation on 20 May 2020, at the height of COVID-19?

“Of course it goes without saying that Agenda 111 will address many more health-care delivery challenges beyond COVID.

“Health-care delivery knows no political colours. Ghanaians are the beneficiaries. The Agenda 111 hospitals programme is an initiative that both the outgoing NPP government and incoming NDC government have publicly committed to completing in the shortest possible time to bridge the health-care infrastructure gap.”

Making care accessible
Our checks show that 30 hospitals have achieved completion rates of more than 70%, including three that have achieved completion/commissioning and are being prepared for operationalisation.

Roughly another 26 have achieved completion of between 50% and 69% and are expected to be completed/commissioned next year if funds are made available.

When fully completed, it is expected that Agenda 111 hospitals will employ a minimum of over 33,000 nurses, doctors and allied health-care professionals in the country.

A huge health infrastructure gap impacting the delivery of care will be improved as an estimated four million Ghanaians all over the country will be brought closer to accessible health services.

“We urge the public to disregard the outright lies, half-truths and mischief Bright Simons seeks to portray in his article”.