Long take! This is No Country for Old Men.
1. Over the past few years, Parliament has become a travelling circus of our national anxieties. Fisticuffs on the floor of the House. Ballot boxes being snatched like street loot. Drumming and dancing in moments meant for sober law-making. Accusations of murder flung casually across the aisle. Tables scattered. MPs jumping on desks. Others hiding under them. A legislature performing collapse as theatre.
2. It is a strange Parliament, for sure. But it is strange for a reason.
3. Something fundamental was broken the day soldiers were invited into the Chamber and nothing came of it. No real inquiry. No lasting consequences. No institutional reckoning. Once you militarise a civilian space of debate and get away with it, you alter the moral physics of that space forever. You tell power that it can bruise procedure and walk off without even apologising. From that day, disorder stopped being aberration.
4. Now look at the Privileges Committee. A disciplinary body that inspires no fear, no restraint, no introspection. It is asked to tame a political class that has never been taught consequences. How do you punish people who experience our democracy without consequences or home-training?
5. This is a politics of no consequences, and it now governs not just behaviour but expectations. Parliament moves like a spoilt child who has learnt that tantrums attract attention, and rarely discipline.
6. Which is why I laughed out loud when the Speaker announced he was instituting “awards of shame” for people and institutions in the country.
7. Awards. Of. Shame.
8. From where? From this House? The cackle!
9. You preside over a cesspool of national embarrassment and want to distribute certificates of disgrace to others. No, Honourable Members. If we are being honest, you do not award shame anymore. You normalise it. You ritualise it. You professionalise it. You turn it into performance art.
10. In this Parliament, even when you act the fool, you must still receive an award. Because in a political culture emptied of consequences, even disgrace must be honoured.
11. And so here we are. Give the awards to this Parliament and its superintendents.
12. This, truly, is no country for old men.
Shalom
"First we overlook evil, Then we permit evil. Then we legalize evil. Then we promote evil. Then we celebrate evil. Then we prosecute those who still call it evil." Fr. Dwight Longenecker
1. On Lightwave LHIMS & GHIMS.
2. Standard katanomics: "what is desirable" (digitalise healthcare) versus "how best to get there" (effective policy design).
3. Ghana doesn't only struggle with the "how," its elites simply can't keep track of why the "hows" always end up being a mess.
4.Even though IMANI flagged all the key issues in the LHIMS saga 4 years back, the current debate doesn't even feature the critical issues. (see: https://t.co/rwlhOiqsSX)
5. So, let me recap: Lightwave, a startup by a Ghanaian normally resident in the US, got a ~$100m contract to digitalise most of Ghana's major public hospitals & clinics, over 900 of them.
6. The company had no track record managing national-scale projects. But it partnered with Plus91, another startup, based in India, led by resourceful founders that began with ~$75,000 in funding and last year brought on board an angel (~$560,000).
7. Plus91 had deployed single-facility health-management systems in India under the MediXcel brand when it was tapped by Lightwave as its strategic partner.
8. Because there are over 236 major digital health app providers servicing over 150,000 clinical facilities, India created the ABDM program to deliver a "United Health Interface" (UHI). Digital Health apps approved by NABH (the regulator) can connect into the national ecosystem. MediXcel successfully underwent certification, connected to the UHI, and competes with many others for facility contracts.
9. But in Ghana, a Health Minister decided sometime in 2021 that such careful policymaking is too bothersome. Instead, he ruled that every single digital health app in public facilities be replaced by a white-labeled version of MediXcel called LHIMS, via the gigantic contract with Lightwave.
10. Innovators that had spent years building relationships with facilities and customising solutions to serve their unique challenges were thrown out into the streets.
11. Naturally, political fiat runs out in a democracy. The government changed in Dec 2024. The new government struggled to align with Lightwave, the favourite of its political rival.
12. The new government accuses Lightwave of delivering only 50% of the contract despite receiving 77% of the contract price. It accuses it of serious data breaches:
https://t.co/foqWbx2Cns
https://t.co/YM4rRUJPY4
13. To fix the issues, it has also contracted a company called Axon, with limited track record in digital health innovation, to build a new Super Health app to replace LHIMS at the reported cost of ~$50 million: https://t.co/MFFig2L51x
14. I call this whole trend of policymaking, "katanomic." Political decision-makers exercise power without real policy guardrails. They often make catastrophic mistakes, and yet there is no "national learning", so the same mess seems to loop endlessly.
15. Obviously, the sensible thing to do here is to separate the "national interconnection system" from the facility-level service delivery system when rolling out digital health?
16. The state should only get involved in licensing providers to offer interconnection to certified service delivery apps that meet standards set by a national regulator. All certified apps should be able to exchange data so that patient data would be accessible regardless which specific facility a patient attends.
17. In a country where national learning is happening, policymakers would easily recognise parallels with how financial payments and electricity access is managed and draw lessons. Interconnection and service delivery are separate functions in multiple contexts familiar to them.
18. Next, it should be obvious that the ~450 facilities that have been digitalised already, with all the reported challenges, should have the option to weigh among Lightwave, Axon, and others and decide which ones to use. Those that decide to move away from Lightwave should have a transitional plan monitored by regional health directorates and the national regulator.
19. The cost of digitalising a facility and ongoing subscription fees to keep the platform running for each facility would then be set as a matter of competition.
20. Only in such a model can private health facilities be brought on board. In pharmacy and lab services, the vast majority of providers are private. In the current katanomic arrangement, they are not catered for. Each facility gets their own solution that cannot interchange effectively with others.
21. In a proper arrangement, specialisations among facilities can also be properly catered for. In the current katanomic situation, specialised features of facilities (think of oncology, maternity, vaccination etc.) are entirely subject to the feature roadmap of a centralised app provider selected by fiat by Ministers with virtually no input by any "critical audience." Ministers with no prior exposure to public or digital health.
22. Because health is such a vast and complex field, digitalisation is equally very complex, even in the richest countries like the United States. It requires a large number of innovators working on different segments and levels, but with common communication interfaces, to bring an ecosystem close to full digital coverage.
23. The last thing you need is a monopoly player hand-picked by a politician.
24. Ghana has had a national digital health innovation policy for a decade and half. There is clear political will to invest large amounts of money and power in its name. What is lacking is actual "policy momentum". The money and the power is not invested for policy traction but for "state enchantment" (the semblance of great progress). Buzzwords like "digitalisation" thus merely provide cover for more parochial interests. That is how come $77 million can be spent with no durable improvement.
25. The situation will only change when enough citizens can look beyond the often meaningless political disputes and see the hard neglected policy choices underneath. That is how a society transcends katanomics. Read another case study here: https://t.co/PC017EtWRw
And he’s doing so with a straight face.
Ghanaian politics is a comedy show with dire consequences on a populace who are yet to figure out that the joke is on them.