by Audra Gold, MS

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At JPHMP, our mission is to advance and disseminate impactful, practice-based evidence to inform initiatives and policies to improve population health. The public health researchers, academics, policy makers, and practitioners who contribute content to the journal support this mission and strive to improve public health for all communities through their research. Our Author Q&A series provides a closer look at the challenges and motivation behind the research and gives readers an opportunity to hear directly from our experts.

Dr. Simpson A. Boateng (BWA-teng), Accra Metropolitan Assembly (AMA) Director of Public Health (2007-2016), is an integral stakeholder of the cross-sector collaboration project in Old Fadama. He organized and promoted government participation, coordinating the efforts of multiple units within the diffuse city agency and within the Metropolitan Public Health Department. Dr. Boateng spent 27 years in the AMA. He served as a physician at community hospitals in Accra for over ten years prior to joining the District Health Services.

Audra Gold: What were your priorities as Director of Public Health at the AMA?

Dr. Simpson A. Boateng: My main priorities were to make sure every individual felt safe, physically and mentally. The public health department was set up to support public health in Accra by protecting the environment, food safety, making sure the food vendors were clean and making safe food for people, and ensuring sanitation policies by making sure everyone had a toilet in their home. Lack of toilets is a major problem and results in people defecating into plastic bags and throwing them into the streets and nearby river.

Gold: What was your motivation to support the project?

Boateng: Sodom and Gomorrah was not meant for human habitation, and all attempts to remove the people failed. It was an un-organized community; for example, there were no sanitation facilities, and there were illegal electrical connections that were fire hazards. I wanted to enter the cross-sector collaboration to help improve the conditions and standard of living. And there was a need to collaborate effectively with the community in order to achieve something. The project provided an environment for the Ghana health service, judiciary, police, and other stakeholders to meet so that we could discuss the problems that were confronted.

Gold: How did the collaboration work with the AMA and approach the community?

Boateng: We were able to start approaching the community by involving a community health officer, Imoro Toyibu. He was from the Sodom and Gomorrah community and trained in environmental health in the North. I had just hired him when I met Jessica, and I was excited to have a link into the community. He led us into the community and convinced the people (because he was one of them) to enter into conversations with the government and Jessica. When Jessica came to Accra, we had a meeting in my office with Imoro, the Catholic Sisters, and the community leaders. This first meeting was very tense, but, gradually, they have become our friends.

The project had the full political support of the former mayor and current mayor, as well as the new Minister of Sanitation. The Sodom and Gomorrah community was fierce and violent and did not trust the government at all; it was a no-go area. This is because the government made a lot of promises that were not fulfilled. The people also felt insecure because they thought the government was bent on getting them out of the area they occupied.

Gold: You have mentioned that this project was the only one to be effective, even compared to others that were very expensive; why do you think that is?

Boateng: Normally, the AMA would make a decision and impose it on the people. The cross-sector collaborations approach involved everybody and made them part of the decision-making process; therefore, they see it as their own. And the government showed good faith and inclusiveness by coming to the meetings and discussing the projects with the community. That is one reason why this project is working.

Also, including the Catholic Sisters helped because they are respected and are seen as leaders. As I’ve mentioned, the community had a high level of mistrust of the government, but including the Catholics and involving the community in the initiative allowed for an effective collaboration. And it is working very well.

Gold: How did you convince other government stakeholders to buy in and support the project strategy?

Boateng: I have been working at the AMA for 27 years and was Director of the Metro Public Health Department for nine of those years, when most others only lasted three. I know the system; if you don’t push it, it tends to not move. Because of my experience, I was able to build trust with the stakeholders. The stakeholders were looking up to me, and I routinely called meetings with every sector to discuss ideas and to collaborate. So they trusted me. For a collaboration to work, there needed to be somebody leading and somebody who knows the people already. In that way, the confidence is mutually beneficial.

Gold: Why do you think the community responded as strongly as it did?

Boateng: This project got the attention from the people because of how it was entered, the Catholic involvement, government engagement, and the number of meetings that they had with them. People realize that this project is unlike the others; it is a very serious project. Also, trust was built progressively. Before this, things were never worked out because of mistrust. Therefore, the community and government committed their time. That is why this project is working.

Gold: How do you see the collaboration improving the state of Sodom and Gomorrah?

Boateng: Sodom and Gomorrah is a disorganized community. It lacks sanitary amenities, water, soap, and electricity. This project has helped with the toilets, and people are supporting it. The area is transforming, the toilets are well maintained, and now trees are being planted to help the look of the community. The people are very down-to-earth people that want to survive, but they need to be guided. With this project, people see light at the end of the tunnel, that their lives can be improved, which is different. The last meeting, I was so impressed– even women were allowed to come to the meeting. It felt open and free, there is a high level of trust in the project, and you can see that in the discussions. The project is a godsend to the area.

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Audra Gold, Global Health Research Associate for Georgetown’s Initiative on Health and Peace, provides strategic global health guidance and research support for the cross-sector collaboration project in Accra, Ghana. Her professional interests are in international health policy, and health system strengthening through strategic public-private partnerships to improve the public health of vulnerable populations. She previously supported the publication of articles in The Lancet, The New England Journal of Medicine, and JAMA, regarding the Global Burden of Disease for the Institute of Health Metrics and Evaluation. Audra holds a Master’s of Science in Global Health from Georgetown University.

Read previous posts in this series:

• Building Partnerships with Government Agencies: Video with Dr. Simpson Boateng
• Using Participatory Action Research to Overcome Public Health Obstacles
• Introducing a New Series: Cross-Sector Collaboration in Accra, Ghana
• Video: Utilizing Cross-Sector Collaboration to Improve Community Health in an Urban Slum in Accra, Ghana