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Opinions of Friday, 18 May 2018

Columnist: Elkana Amaglo

Shortcomings of healthcare delivery system in Ghana.

Healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical, mental and social impairments in human beings. Healthcare delivery system are organizations established to meet the health needs of targeted populations.

While the government has massively strategized a lot of policies to ensure health access to all, for instance, the national health insurance scheme (NHIS), community-based health planning and services (CHPS), which are key primary healthcare, access to quality healthcare is being denied. In that the primary healthcare (PHC) values to achieve health for all require health systems that: “Put people at the center of health care”. What people consider desirable ways of living as individuals and what they expect for their societies – i.e. what people value – constitute important parameters for governing the health sector.

PHC has remained the benchmark for most countries’ discourse on health precisely because the PHC movement tried to provide rational, evidence-based and anticipatory responses to health needs and to these social expectations. Achieving this requires trade-offs that must start by taking into account citizens’ “expectations about health and healthcare” and ensuring “that [their] voice and choice decisively influence the way in which health services are designed and operate”.

In as much as we are looking forward to achieving the highest attainable level of health and maximizing equity and solidarity in our health care system as a country, recently, some few shortcomings pertaining our healthcare delivery system has been identified and should be considered. They are discussed below; Inverse care: People with the most means – whose needs for healthcare are often less, consume the most care, whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor in high- and low income in the country. Impoverishing care: Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. Over 11 million people annually fall into poverty because they have to pay for healthcare.

Fragmented and fragmenting care: The excessive specialization of healthcare providers and the narrow focus of many disease control programmes discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation.

Unsafe care: Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health. Misdirected care: Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.

Possible Strategies

The PHC approach is based on the understanding that health improvement results from a reduction in both the effects of disease (morbidity and mortality) and its incidence as well as from a general increase in social well-being. The effects of disease may be modified by successful treatment and rehabilitation and its incidence may be reduced by preventive measures. Well-being may be promoted by improved social environments created by the harnessing of popular and political will and effective intersectoral action.

Of particular relevance to the development of comprehensive health systems is the clause in the Alma Ata declaration stating that PHC "addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly" Comprehensive health systems include, therefore, curative and rehabilitative components to address the effects of health problems, a preventive component to address the immediate and underlying causative factors which operate at the level of the individual, and a promotive component which addresses the more basic causes which operate usually at the level of society.

To conclude, our health should be prioritized over every activity we engage throughout and across the country. Let us therefore come together and participate in the prevention, and promotion of health as a nation, because without it involvement in any daily activities being it marketing, banking, politics, religion and even providing of care would be halted.