Africa’s population was put at 1.2 billion people in 2016, placing the continent of 54 nations as the second most populous in the world. Over the last year, the continent’s population recorded an increase of 30 million. By the year 2050, annual increases are projected to be more than 42 million people per year, with a total doubled the population of 2.4 billion, according to the UN.

In an exclusive interview with Amazons Watch Magazine, Dr Leticia Appiah, a Physician, Senior Public Health Specialist, and Executive Director of Ghana’s National Population Council, said Africa’s greatest problem is the high population growth rate and population momentum, which fuels corruption and frustrates capital deepening. She also opined and discussed a model Ghana and the continent, at large, can adopt to stabilize its growth for accelerated economic development. Excerpt:

Thank you for this opportunity to interact with you. Please tell us about yourself and some of your experiences, growing up as a girl.

I grew up in a polygamous family and as my father had other children, my mum who was a high school teacher, was the sole carer of my two sisters and I.  My mum was my main support and role model and her intervention when I was in primary school prevented a crisis that would have had an adverse impact on my education, probably making me a school drop-out. The challenge I had as a child was that I was born left-handed; a condition that was frowned upon in the early 70s, leading to children such as myself being forced to write with the right hand in order to conform. I found it very hard to write with my right hand and I began to play truant in order to avoid the challenge. I played truant until my teacher met my mum at a meeting and asked about the reason for my long absence from school. My mum asked me what the problem was and I told her about my predicament. The following day, she took me to school and asked my teacher to allow me to write with my left hand. At times, I wonder if my teacher would have noticed my absence if it were today considering the huge class sizes today in public schools in Ghana and wonder how many such children are loitering around unnoticed. I credit God and my mum for my success today.

You have had experiences working in various public health institutions, as a physician and public health specialist. Please tell us about your career journey in the medical profession.

I completed medical training in June 1993 from Donetsk Medical School in Ukraine and came home immediately fired up to make my contributions to the development of my nation, Ghana. During my training in Donetsk, the maternity ward was the happiest of all wards because; there was joy, flowers and smiles when babies were born. This led to my decision to specialise as an obstetrician gynaecologist because; I wanted to be there to always welcome new precious citizens into our world.  However, when I started practising medicine in Ghana, I realised to my dismay and sadness that not all babies in Ghana are received in the world with joy, laughter and smiles. Some parents are ill-prepared to receive them whiles some are just not wanted and end up abandoned, malnourished or simply maltreated. Therefore, I decided to pursue a Master’s in Public Health to enable me get closer to the community since health or diseases are manufactured in homes which are the best places for health interventions for maximum effect.  In 2003 I completed my Master’s in Public Health and will be completing my PhD in public health this year.

You were the Director of Health Services for Ledzokuku-Krowor Municipality (LEKMA) of the Ghana Health Services. During this phase of your life, what were some the health challenges in the district you made remarkable efforts to address? 

I was appointed as the Director of Health Services in 2008 when the Municipality was established. There were many health challenges but key among them was: low TB case detection despite documented high incidence and prevalence rates. I realised that majority of the over 350,000 inhabitants had as their first point of calling the numerous chemical shops and few pharmacy shops (seventy-five such shops). I, therefore, decided to train all shop attendants in TB case detection using a simple screening tool. This subsequently, increased TB case detection in the municipality and a success story for other districts to emulate; other challenges identified were low immunizations coverages for children under one year and low family planning uptake in the municipality. This was because; public health services were mainly delivered only in public health facilities despite, the fact that private health facilities outnumber public ones. There were three (3) public health facilities and more than 10 private health facilities. I teamed up with the private health providers and extended immunization and family planning services to all our clients accessing services from private facilities by assigning staff to the various facilities. LEKMA became the centre of excellence for private-public partnership in the health care system in Ghana.

One of your campaigns in recent times has been towards reducing the annual growth rate in Ghana, proposing a government policy to limit the number of children of a couple. However, some experts have opined that an increase in education will play a more important role in population control than enforced rules or even contraception. What is your take on this?

I believe that every pregnancy should be wanted and every child cherished and nurtured to be a productive and proud citizen. That is the only way any nation can develop since the quality of the human resource is key for manufacturing durable assets. Adequate Investment in children from infancy through adolescence till they become productive is expensive and time- consuming. Ghana’s National Population Policy 1994 has a Total Fertility Rate target of 3 by 2020 which I think should inform all population-related policies. Contrary to this, deliveries are free irrespective of the number, we therefore have many uneducated women and or those with basic education and no employment having more children than their finances can adequately cater for thereby, driving these children into misery with negative outcomes through no fault of theirs. Apart from that, the higher the birth order the riskier the pregnancy, the higher the maternal mortality, the more children become orphans, less women get into productive employment, the worse-off families, communities and nations become. Investment in contraceptives and acceptance of small family size is a necessary ecological counterbalance in the advances in medicine and hygiene leading to reduced mortality.

Yes, education plays a role in population management and subsequently economic development but the link is very weak and there is little empirical evidence to support the case. For education to have a significant impact on population growth, girls should stay in school up to secondary+ level which in Ghana, takes 12 years. However, it takes only 9 months to conceive and deliver a term baby which makes it extremely difficult to manage population growth through education only. An aggressive family planning program as was implemented in Matlab Bangladesh, Iran, Tunisia, South Korea, Malaysia and recently, in Rwanda and Senegal leads faster to both demographic and economic dividends than investments in education without family planning. For most countries, these dividends start accruing when the total fertility rate is between 3 and 2.1. Therefore, delayed fertility decline in any country is delayed economic development. In my opinion, Africa’s greatest problem is the high growth rate and population momentum which also fuels corruption and frustrates capital deepening. Africa needs to stabilize its growth for accelerated economic development. After all, even in nature, mango trees and other fruit-bearing trees bear fruits only when growth is stabilized.

What are some of your efforts aimed at inspiring, developing and empowering people, which has been your philosophy?

As humans we all depend on each other for support. As John Donne said, “no man is an island”. Human beings do not thrive when isolated from others. Our health professionals take care of our health needs, our seamstresses make our clothes, and engineers manufacture cars, phones, electricity among others for our consumption. To that end, inspiring and encouraging people to excel in their professions invariably improves the quality of life of all including mine.  I also have a duty to those who depend on me as a professional, a mentor, mother, sister, friend and wife to offer my best and with passion. I think the best way to inspire others is through your work; only then will your words mean much to them. The leadership that inspires best is one that is based on example.  

How do you balance your career and family obligation?

Much as I love my job, the family is where you retire to at the end of the day and also seek solace when things go bad or finally retire to at retirement age so it is important that the balance is maintained. Daily exercise and spending time with my husband and my daughters are my favourite pastimes. I have three daughters; two are graduates and the youngest one is in her second year in university.

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