Let's Deepen Private Sector Participation in Health Care Delivery

A GNA Feature by Kwode Paul Achonga

Tamale, July 31, GNA, - It has been said the wealth of a nation is in the health of its people and Ghana as a State deserves good, quality and affordable health care for its people to contribute meaningfully to its socio-economic development to achieve national aspirations. The Government plays a central role in establishing the institutional framework for the health sector and provides broad policy directions as well as defining the terms and conditions of public sector employment and the relationship between central and local government and providers of health services. It also legislates and enforces regulations to prevent dangerous practices and to protect the public against negative health practices.

Again the Millennium Development Goals (MDG) and the Ghana Growth and Poverty-Reduction Strategy II (GPRS II) had indicated among other things quality healthcare delivery and the elimination of diseases and poverty as a major factor in achieving a middle-income status. However, there have been frightening statistics about the health of Ghanaians especially with regard to maternal mortality, fertility rates, malaria, guinea worm prevalence, which Ghana is rated second in the World, and equal access to health care. Besides, the ratio of nurses and doctors to a patients as well as hours of waiting before a doctor attends to a patient are major obstacles to efficient health care delivery.

It is in the light of these and many others that the Government had put in interventions to improve on the health sector. Some of these interventions included the introduction of the National Health Insurance Scheme (NHIS); increasing the pay and service conditions of health workers; building and rehabilitation of some health Centres, hospitals and clinics and malaria preventions among other things.

The health service in Ghana is debatably the sector that had received much attention in recent times in terms of infrastructural development in a bid to reform it. There were many agitations that had led to some improvements in the conditions of services of health workers yet it seems not to be enough and the perennial problems in the health service still persist. Some of these improvements also came as a result of the strikes workers in the sector had embarked on in recent times. Each time such a strike occurs, hundreds of Ghanaians die painfully. Productivity also suffers and the national budget dislocates because the Government would have to cough money from anywhere including sourcing funds from other sectors of the economy. Though health workers have rights as stipulated in the Labour Law, such rights must not be over stretched against the interest of the State and the life of the ordinary man whose taxes are used to educate the doctors, nurses and other health workers.

Won't it, therefore, be prudent to advocate the extra participation from private organisations to invest in the health sector in Ghana so as to curb the frequent agitation for increase salaries and better conditions of service by health workers? This would also ensure the workers deliver quality health care services to the ordinary man and the vulnerable. It must, therefore, be pointed out clearly that until the destitute and the neglected in this country have access to quality healthcare, malaria, HIV/AIDS, tuberculosis, and other pathogenic as well as chronic diseases would continue to be the major headache to the Government.

The Government should deepen its partnership with the private sector. For instance, Uganda and India are among a few countries that have public-private partnership in their health services and the partnership had increased efficiency and equity in resource distribution and allocation, an open market for health services, not restricted by changes in the governments policies and budget constrains. Also the partnership had strengthened the health system in those countries such that even where there were no public health facilities, access had been provided through the partnership.

Again, the private hospitals in Ghana are doing efficiently well and they hardly go on strike and their salaries are paid based on input and output. The Government could incorporate the efficiencies achieved at the private sector to partner with it for a viable organizational structure with the Government having greater percentage of health care delivery for an improved and problem free system. Already, the Government had recognised the private sector as the engine of growth and could therefore formulate policies to incorporate these gains into the health sector.

When well structured, a lot of private investors are likely to be attracted into basic healthcare delivery as well as training of more personnel; doctors, nurses, pharmacists and other paramedics to reduce the work load on a few personnel, which had contributed to the inadequate access and equity in healthcare delivery. Besides, the National Health Insurance Scheme (NHIS), another positive initiative to improve on the health sector deserves the collaboration of private participation to the achievement of the desired results. The teething problems the policy was currently faced with would come to the barest minimum if for instance a private organisation took over the registering and issuing of "ID" cards to people. Invariably a new reform on the public sector including the Fair Wages Policy would soon come to replace the comprehensive salary structure which, had in one way or the other given priority to some organisations and individuals with the same qualifications in the public and civil services but the trepidation entertained by experts was that there would still be salary disparities in the country even if the policy were implemented. Some had argued that the health workers might not agree to collect the same salaries comparable to other civil and public servants in the country.

The Former Minister of Public Sector Reforms, Dr Paa Kwesi Nduom's efforts at restructuring the public sector as well as his vigorous campaigns on fair and equal wages salary structure was laudable and must be given serious attention. At least journalists would not have resorted to "soli" as a dire need for survival when such a policy is efficiently implemented.

Privatization would also curb a variety of illegal practices that have become prominent in many public health systems. These include requests for under-the-counter payments, sale of drugs, acceptance of kickbacks from suppliers of drugs and equipment. Their impact was to make access to healthcare less equal and to reduce the impact of Government's health policies. These practices could also be reduced by strict enforcement of laws.

Centre for Global Development on Global Health Policy said: "Despite the significant role of private spending for and delivery of healthcare services in poor countries, most development assistance focuses almost exclusively on the public sector. So, engaging the private sector is surely needed."

Bringing the local private health sector in to solve the profound health problems was an exciting idea that must be pursued by governments.

The International Finance Corporation (IFC), a part of the World Bank, points out a big task in investment that: "Any investor, to make an investment, it must be large enough to cover the cost of preparation and supervision." Using itself as example, it says: "IFC equity investments in health average about 10 million dollars. In other for the IFC to minimise the risk associated with investment, we need to have other co-investors or lenders-so the total project size must be larger and yield a rate of return sufficient to merit the investment bankable". It has, however, advocated a paradigm shift in the business model to get investments in Africa (Ghana) and in such a way as to achieve a real development impact by improving access of services and reducing "out-of-pocket" payments of health services and products for the poor. Some had argued among other things that the predominant migration of nurses and doctors in the country in their quest for greener pastures might have been the factor behind the major attention being given to the health workers but attention to workers must also go hand in hand with quality healthcare delivery with much emphases placed on the poor and making it affordable as well as access readily available. The number of teacher trainees deserting their courses to join the Nursing Training Colleges due to improve conditions of services at the sector was alarming and could be a defect in that sector. Not only, most teachers as a result of lethargy, were alleged to have abandoned teaching students but instead go to school only to sit with their colleagues to chat. The looming danger to the government about this shift is that in a few years to come, the country would produce more than necessary nurses to the disadvantage of other sectors like the educational sector

For mutual interest and a consensus to be achieved by the Government, health workers and Ghanaians in general, there should be the need for a concerted effort by the Government and its development partners to consider engaging the private sector to invest more to improve the quality of the health care in its ongoing reforms to put smiles on the faces of Ghanaians.