Ghana

When Mr Baffour Ahmed Haruna arrived at the Nature4Health workshop in Tarkwa, he expected to stay only long enough to deliver his opening remarks. Instead, the Municipal Coordinating Director sat down and stayed for the entire day.

‍Around him, farmers, veterinarians, forestry officers, traders and local government representatives worked side by side, bent over large sheets of paper, sketching their own communities, the forest edge, the animals they lived alongside, and the paths a disease might take from one to another. The scene made it clear how the workshop was unfolding.

‍"He said this is so key to him; he's not going back," recalls Prof. Richard Suu-Ire, who was in the room. For Robin Breen, watching from the side, it was the moment the process seemed to land: "That was one of the times when I was like, okay, it seems to be resonating with people."

‍Moments like that came to define Ghana's Nature4Health scoping process, showing that the knowledge needed to prevent the next disease outbreak already existed within communities. From there, the process shifted to creating space for that knowledge to be heard and applied.

The decision not to decide

Rich picturing in Tarkwa, Western Region of Ghana

The exercise is called rich picturing. Participants are given markers and large sheets of paper and asked to draw the places they know best, mapping where people, animals and the environment meet and where the risk of disease might emerge. This simple exercise became a powerful way to surface local knowledge and trace the pathways by which a disease can spill over from animals to people.

Rich picturing was one part of Nature4Health's scoping process, conducted across Ghana in the first half of 2024, covering four ecologically distinct regions: Kumasi in the middle belt; the savannah around Mole National Park in the north; the forest and mining country of the Western Region; and Accra on the coast, home to the country's national ministries. Each region provided a different setting for the same process.

The purpose behind it is more complex than the markers suggest. Ghana has six priority zoonotic diseases, including anthrax, avian influenza, and the haemorrhagic fevers Marburg and Lassa. In 2022, the country confirmed its first outbreak of Marburg virus disease. These illnesses arise where people, animals, and a changing environment intersect, which is why the workshop focused on that area.

Nature4Health – a multi-partner trust fund hosted by a Secretariat within UNEP – is built on the premise of reducing health risks by addressing anthropogenic environmental stressors. Following the COVID-19 pandemic and subsequent calls to focus on ‘upstream’ or prevention-at-source measures, the German government provided 50 million euros in seed funding to Nature4Health.

With growing evidence that prevention measures are cheaper than responding to pandemics, and with expertise from intergovernmental and civil society organisations, including the Secretariat of the Convention on Biological Diversity, the United Nations Development Programme (UNDP), UNEP, the World Health Organization (WHO), the World Organisation for Animal Health (WOAH), and the International Union for Conservation of Nature (IUCN), the fund aims to reach 18 countries across three staggered phases. 

Prof. Suu-Ire, a veterinary scientist at the University of Ghana, has spent years on upstream prevention. Mr Breen, who joined the project, initially provided close support to the Ghanaian team for EcoHealth Alliance before UNDP and IUCN became the lead Nature4Health partners. Their account of what made the scoping work, in the end, is a single idea told two ways: prevention cannot be handed to people but has to be built with them.

The four-region approach was not the initial plan. The decision emerged only as the process unfolded.

“That wasn't the original plan to have four regions,” he says. He and the University of Ghana team arrived at the first meeting in Accra with proposals but no decisions. “We had ideas, but we didn't make any decisions, and it was really up to the core team.” As the discussion continued, the map took shape in the room. Someone pointed out that if the project was serious about covering the country's diverse diseases and ecological zones, it could not remain in the capital. “We're not going to get the lived experiences from the central ministries,” Breen recalls the argument. “We need to go to the local governments and the places where people and animals interact daily.”

Elephants bathing at the pool site, Mole National Park - the savannah zone anchored in the northern sector.

For Prof. Suu-Ire, collective ownership was the method, not a nicety. “We insisted on teamwork,” he says. “All the members were involved, and we communicated the next steps to everybody, so that people were in tune with what was going to happen. It's a team where we all decided.” The zones followed the country's own contours: the northern sector anchored on Mole, the middle zone on Kumasi, the forest and mining zone in the west, and Accra kept for last, deliberately, so that “the big directors” could be brought in to close the process where government sits.

Breen's own role, as he told it, was mostly to hold back. The most important thing the global partner did was to decline to make the decisions itself. “Giving the decision-making power to the core team to make that decision collectively, I think, was the most important part.”

Workshop in session at Mole

The overlap nobody had named

One key insight from the cross-sector approach emerged late, in Accra. The final workshop revealed what many in the room had not seen before. There, the workshop shifted from shared mapping to an unexpected discovery.

‍Ghana's environmental work is split across more than one government body: the Ministry of Environment, Science, Technology and Innovation (MESTI); the Environmental Protection Agency; and, in places, local government. In the final workshop, people who did not work in the environmental sector discovered this in real time.“Oh, okay, there are different branches of the environment that all do related things,” Breen says. What the discussion revealed was not conflict so much as blind spots: we didn't know you were doing this; we do this. Suu-Ire, who collaborates with those same bodies through Ghana's One Health platform, frames it as a balancing act rather than a turf war. “They look like different authorities, but each one is very important to a particular area. We don't want to drop any of them. They have diverse interests.”‍ ‍

Why ministries showed up and stayed

Getting MESTI, the Ministry of Food and Agriculture, the Ministry of Health, the Forestry Commission and the national disaster-management body genuinely engaged in the same process is rare, and both Suu-Ire and Breen were asked how it was achieved. Their answer lay in the steps that brought them there.

Breen's answer was brief: relationships. “The short answer is that it's because Suu-Ire has worked hard to maintain strong relationships with people.” He added that it helped that the convener was a university rather than a ministry, which could approach the others “from a more neutral standpoint.”

The conference hall at Mole, where participants from across the northern regions gathered.

Prof Suu-Ire's own answer was fairness and formality. “The approach that made me very strong is that I'm being fair to all of them.” He insisted on going through official channels, including letters to directors and written nominations, precisely so that those who turned up would own their place in the room. “We don't just go and call friends. Even if we know somebody influential, we make sure it's officially documented.”

He tells a brief story to make the point. At the Accra workshop, the Director of Public Health attended in person and ensured the department was represented. His presence mattered. The representative later became one of Suu-Ire's most steadfast and closest collaborators; "Today I still work with him," he says. The lesson he draws is unglamorous and specific: when the head of an area shows up in person, "they see that it is serious business," and the room follows.

What the people already knew

Ask Prof. Suu-Ire what upstream prevention looks like when you start with people. He does not reach for a framework. He starts with what he has seen.

“When we went out there, we realised that the people knew what prevention is all about,” he says. “That is the knowledge we draw on. The locals themselves know. We only need to mobilise and gather information from them. You don't go and tell people, ‘This is what you are supposed to do.’ The people tell you where they are. It is their knowledge.” For him, prevention is “taking preventive measures from the source and then moving up to the control.”

A mother, her baby on her back, presents her group’s rich picture.

Breen sheds light differently. What people lack, he says, is not understanding; it is vocabulary. “People know, but they don't know technical jargon. They're familiar with the fact that if you make changes to the land, there'll be changes to the wildlife around them, or to their livestock. But they don't necessarily know ‘land-use change as a driver of zoonotic disease.’ That doesn't click.” And it doesn't need to. “You don't need the technical lens to know that if you change the environment, you change the way animals and humans meet.”

That is the quiet argument beneath the markers, the letters, and the four-region map: the expertise most needed in the process was already in the room, held by people who had never been asked for it in these terms.

What comes next

The scoping is complete; the implementation plan has been written, a blueprint shaped activity by activity by the people who will carry it out.

Prof. Suu-Ire says the officials and community members who filled those rooms still reach out to ask what happens next. "They are still asking: Nature4Health was so nice. What are we doing? What are the next steps?" Now that the funds have been released, the team has their work cut out for them. 

According to Ghana's account, prevention was never something handed down to communities; it was something built with them.