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Opinions of Monday, 2 July 2018

Columnist: Anthony Nsiah Kwame

Health care in Ghana: A real jungle to reckon with

The quality of a country’s human capital determines to some extent, its level of development. One factor that can considerably affect the quality of a country’s labour force and hence, suppresses its development is the standard of health of the people living in it.

Any country that has unhealthy population is bound to suffer in the implementation of development programs to improve the quality of life of the people. It is an undeniable fact that countries with easy access to improved healthcare systems have high life expectancy ratio. Quality health is a key to development and therefore should not be toyed with by any serious nation.

Health, which is mainly the relief or cure of ill health, is universally vital and this results in the imperative to provide high-quality services in response to developments in medicine and the desire of the caring professions to aspire to clinical excellence (Sewell, 1997).

In Ghana, accessing timely quality healthcare services in public health facilities has become a nightmare and therefore a disincentive to many people who look elsewhere for alternative solutions to their health needs. In an attempt to address this canker, I would first refresh our minds with the background to the health system in Ghana today to ascertain whether indeed it has lived up to expectations.

In the 16th century, traditionally, village healers and clerics were the primary caregivers, offering herbal remedies. Though herbalists have traditionally offered the most ready treatment of illness, pre-modern traditional beliefs stressed the combination of spiritual and physical healing. Western medicine was introduced by Christian missionaries to the Gold Coast in the 19th century. This region was most involved in the development of a new health care system.

A pre-medical department was formed initially, and in 1878, the Towns, Police, and Public Health Ordinance was enforced under its direction, initiating the construction and demolishing of infrastructure, draining of the streets, and issuing of fines to those that failed to comply with the heads of the colony. In 1893, a Public Works Department was introduced to implement a working sanitation system for the colony.

In the 1880s, a Medical Department was formed, bringing about an introduction to a formal medical system, consisting of a Laboratory Branch for research, a Medical Branch of hospitals and clinics, and the Sanitary Branch for public health. The central government made a concentrated effort to expand western style medical facilities; and after World War II, both the World Health Organization and the United Nations Children’s Fund had been active in providing money and support to provide additional western medical care in Ghana.

In Ghana, most health care is provided by the government and largely administered by the Ministry of Health and Ghana Health Services. The healthcare system has five levels of providers: health posts which are first level primary care for rural areas, health centres and clinics, district hospitals, regional hospitals and tertiary hospitals.

These programs are funded by the government of Ghana, financial credits, Internally Generated Fund (IGF), and Donors-pooled Health Fund. Hospitals and clinics run by Christian Health Association of Ghana also provide healthcare services.

Health care is very variable through Ghana. Urban centres are well served and contain most hospitals, clinics, and pharmacies in the country. Rural areas often have no modern health care. Patients in these areas either rely on traditional African medicine or travel great distances for health care.
Ghana has a universal health care system, National Health Insurance Scheme (NHIS), and until the establishment of the National Health Insurance Scheme, many people died because they did not have money to pay for their health care needs when they were taken ill. The system of health which operated was known as the "Cash and Carry" system. Under this system, the health need of an individual was only attended to after initial payment for the service was made.

Even in cases when patients had been brought into the hospital on emergencies, it was required that money was paid at every point of service delivery. When the country returned to democratic rule in 1992, its healthcare sector started seeing improvements in terms of service delivery, human resource improvement, and public education about health condition. Even with these initiatives in place, many still could not access health care services because of the cash and carry system.

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former president John Kufuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the “cash and carry system” of health delivery. Upon becoming president, former president Kufuor pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment.

In 2003, the scheme was passed into law. Under the law, there was the establishment of National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of its citizens. Since its inception, the country's health facilities have seen constant rise in patient numbers and a considerable reduction in deaths.

Although death is inevitable, a lot can still be done to drastically reduce the unnecessary deaths that are registered particularly in our public hospitals day in and day out. Frankly speaking, it’s unacceptable considering the times we are in where there is a tremendous improvement in medicines and health equipment.

The elimination of the cash and carry system alone is not enough. In fact, health care can be made entirely free but without proper management of time by health practitioners combined with other good work practices, the quest for quality health care in Ghana will continue to be a mirage. It is a common knowledge that the amount of time spent when one visits a public hospital in Ghana is too much and does not worth it. As a matter of fact, it leaves the patient with dozens of questions in mind.

In most cases, I am tempted to ask myself if this is really a hospital or not? Is that really a nurse or a doctor, how long must I wait and how long must I suffer? Do we visit the hospital to recover or to die? I believe most of us have asked these questions over and over again each time we have visited a healthcare centre within the country especially the public ones.

It is sometimes really sad and unbearable when we have to sit, watch and listen at a hospital reception, emergency room, or at the out-patients department as people suffer in pain. Most often, their silent cries, tears, moans and groans are the unmistakable and lasting memories we take home with us at the end of the day. The cries of little children as they cry their little hearts out to the helpless parents can be a heart-breaking experience. Others in critical conditions, unable to take this pain any more, have in the end given up ghost. The worse experiences most people have shared have had a health institution as its venue.

Each day in hospitals and clinics in the various regions within the country, patients die either on admission or at the out-patients departments respectively. These deaths have in a lot of cases been as a result of negligence on the part of medical personnel within these health centres.

This negligence has most often been large as a result of delays. Several people have varied experiences and stories to share on this issue of negligence in hospitals. It would be quite intriguing if a platform was provided for people to share their various experiences. I believe many people are yearning for appropriate platforms to vent their spleens but none exists.

The situations in our wards most especially cannot be overemphasized. Most patients on admission are usually at the mercy of some heartless attendants who ignore, verbally abuse or compound the medical conditions of these helpless victims. People go to the hospital in the event of an illness to seek relief and not dejection.

People visit the hospital to seek remedy and not condemnation. The healthcare profession is indeed a noble one! In fact, it is a religious one! It is however unfortunate that some unscrupulous people have taken this platform to perpetuate their own evil intents of inflicting pain on people instead of relief.

The general atmosphere in our hospitals is one of helplessness and hopelessness. From the old and rundown furniture, congested wards, outdated equipment, to the tired, angry-looking, and depressing faces of nurses and attendants, hospitals in Ghana have become the most dreaded places for most people.

I have had several encounters with health care practitioners for quite some time especially in the past three years as a result of ill-health, and I can conclusively say that the situations in our public hospitals are very abhorring. In fact, it is worse in the Ashanti region. I have received rude treatment from nurses, experienced unnecessary delays on several counts, and so many other unbearable experiences.

My own mother passed through a worse ordeal before her unforgettable demise in a renowned hospital in the Ashanti region. The memory of my mum’s demise triggered some hatred in me for any health care practitioner until my encounter with an extraordinary nurse called Doreen Mensah, in Aboaso Government Health centre, in the kwabre-East district of Ashanti in the year 2015.

She is indeed, an epitome of a true nurse based on her level of professionalism. This is an indication that we have a handful of better elements within the system. A friend revealed to me how a nasty attitude of a nurse drove him away from receiving treatment from a particular hospital after wasting his precious time there because he could not stand the annoying scene any longer. Sometimes I wonder if health workers value time at all.

It has been truly said that time is one of those indispensable realities that simply are, whether one acknowledges them or not. There is no human being who is not affected by time. It is a fact that
the acknowledgement of time is not what makes time matter. If that were the case, time would stop when we are asleep, unconscious, or dead! Indeed, time, even if we are not cognizant of it, will still be. And instead of the individual using time, or reckoning it, others will still be able to say “He’s been unconscious for ten hours”; “She’s been asleep for a day” or “He’s been dead five years”. In other words, not even our inability or refusal to recognize time, and not even death, stops time from marching on. (Afful-Broni, 2008).

According to Afful-Broni, time once lost is gone forever. It is, humanly speaking, impossible to turn back the clock. Time is such that if we allow it to slip away, we can never retrieve it. A fuller understanding of the tragedy of losing precious time would prevent us from waiting to do tomorrow that which can be done today. Therefore, healthcare workers should realize that lives lost out of their negligence can never be brought back. Even the scriptures give us the solemn reminder that we must do the work assigned us “while there is still light, for the darkness comes when no man may work.” (John 12:35).

An observation I have made from my constant visits to hospitals in the recent past three to four years has given me a fair idea about the processes and procedures involved in accessing health care when one attends hospital with a normal Out Patient Department (OPD) case. At first, one must get a folder based on which a hospital card is prepared for him. You then proceed to check your vital signs after which you go to the consulting room to meet with the physician. Depending on the nature of your case, you may be required to go for a laboratory test and bring the test results to the doctor. The doctor will then prescribe medicines for you to be collected at the pharmacy department.

So approximately, about five steps should be followed before one exits the hospital. If that is the case, why then should one spend an average of five to six hours just to go through the afore-mentioned processes? For example, on September 6, 2017, I accompanied a friend to the Suntreso Government Hospital in Kumasi and for about five hours, we had not seen a doctor.

Meanwhile, the facility could contain more than three doctors at a time for consulting. It was annoying seeing the only one doctor present moving about unconcerned about the plight of waiting patients. It is disheartening to see how these doctors commit to duty when they are working in private hospitals.

Must we all accept the reality that until we run to these same doctors in their private health facilities, our relatives will continue to meet their untimely deaths at where they are supposed to receive treatment? Is the time spent not a disincentive to people who would want to patronize public health facilities? Are health workers exhibiting professionalism at work? Do patients even know their rights at the hospital? These and a couple of other thought-provoking questions remain unanswered, which I will make an attempt at.

People end up contracting infections at the hospitals as a result of the long periods of waiting in queues, with other patients with all sorts of sicknesses some of which could be highly contagious but they themselves may not even be aware of because it has not been diagnosed yet. Patients come with varied sickness ranging from malaria, typhoid, cholera, hepatitis, chicken pox, tuberculosis, and HIV/AIDS and they mix up in waiting for treatment. Again, others prefer over the counter drugs to attending hospitals due to the delay and waste of working hours, thereby resulting to self-medication in most instances. Now, to talk of professionalism of health workers, I would want to highlight the code of ethics of the Ghana Health Service before I continue.

The Code of Ethics for the Ghana Health Service (GHS) defines the general moral principles and rules of behaviour for all service personnel in the Ghana Health Service. The Service shall be manned by persons of integrity, trained to a high standard to deliver a comprehensive equitable service for the benefit of patients/clients and society as a whole.

1. All Service personnel shall be competent, dedicated, honest, client-focused and operate within the law of the land.

2. All Health Professionals shall be registered and remain registered with their Professional Regulatory Bodies.

3. All Service personnel shall respect the Rights of patients/clients, colleagues and other persons and shall safeguard patients'/client' confidence.

4. All Service personnel shall work together as a team to best serve patients'/clients' interest, recognizing and respecting the contributions of others within the team.

5. All Service personnel shall co-operate with the patients/clients and their families at all times.

6. No service personnel shall discriminate against patients/clients on the grounds of the nature of illness, political affiliation, occupation, disability, culture, ethnicity, language, race, age, gender religion, etc. in the course of performing their duties.

7. All Service personnel shall respect confidential information obtained in the course of their duties. They shall not disclose such information without the consent of the patient/client, or person(s) entitled to act on their behalf except where the disclosure of information is required by law or is necessary in the public interest.

8. All Service personnel shall treat official discussions, correspondence or reports obtained during official duties as confidential except where disclosure is required by law.

9. All information obtained from patients/clients shall only be used for the prime purpose of their management. Any other use of such information shall only be done with the prior consent of the patient or person(s) entitled to act on his/her behalf.

10. All Service personnel shall provide information regarding patient's condition and management to patients or their accredited representatives humanely and in the manner, they can understand.

11. All Service personnel shall protect the properties of the Service including properties entrusted in their care.

12. All Service personnel shall respect the rights and abilities of disabled persons and the aged and work together to serve or safeguard their interest.

13. All Service personnel shall keep their professional knowledge and skills up to date.

14. No Service personnel shall demand unauthorized fees from patients/clients.

15. No Service personnel shall accept any gift, favor or hospitality from the patient/public which might be interpreted as seeking to exert undue influence to obtain preferential consideration in the course of their duty.

16. All Service personnel shall refrain from all acts of indiscipline including drunkenness, smoking, immorality, abuse of drugs and pilfering in the course of performing their duties.

17. All Service personnel shall avoid the use of their professional qualifications in the promotion of commercial products.

18. All Service personnel shall act in collusion with any other person for financial gain.

19. Service facilities and resources shall not be used for unauthorized private practice.

I am very much concern about the point number one (1), especially the aspects which talk about dedication and client-focus. Most health workers, particularly nurses, sometimes behave as if it is a mere favour that they are doing to the patient without receiving salaries at the end of the month. They simply do not work with passion. In fact, until you find yourself in award, you might not better understand how rude some nurses could be towards inmates. It is high time some nurses realized that the patient is a client, a customer, and a partner in business without whom their profession is useless.

The point six (6) stresses on acts of discrimination. Discrimination on religious and ethnic grounds is a common thing that we always experience. It is not strange for you to see somebody come late, yet leaves the hospital before you simply because of his affiliation with a worker there.

If the code of ethics is observed and things are done in an orderly manner, I do not think that one has to be given a preferential treatment before he/she becomes satisfied with services accessed. Some practitioners talk to patients in a manner that is so intimidating that the patients are not able to ask relevant questions regarding their condition. This, therefore, puts a limitation on the point ten (10) above.

With point sixteen (16), I have witnessed a doctor working whilst watching a movie on his laptop in a consulting room during one of my numerous visits to hospitals in Kumasi. This doctor would finish prescribing medicines for you, even before you are done with your complaint simply because he has to get back quickly to the movie. Again, it is very common to see health workers playing with their mobile phones at work, totally disregarding the presence of their clients. The rate of indiscipline within the Ghana Health Service is alarming.

The hospital should be a place where patients would go and receive treatment and come home with a free mind. Access to quality healthcare shouldn’t be the privilege of a selected few due to the negligence on the part of some health professionals. However, this can only be achieved through a concerted effort of all the major stakeholders in the health sector.

The code of ethics of the Ghana Health Service must be followed religiously. Then again, health professionals should always remember that their clients are mostly people with physical, emotional, and psychological challenges and therefore should be handled with much love and care.

Aside from the fact that the time wasted at hospitals should be reduced drastically for the betterment of us all, there should also be excellent human relations between health professionals and their patients. I am a living testimony to the fact that, there is a positive result out of a good relationship between health professionals and patients.

I refuse to side with those nurses who attempt to justify their actions because of stress emanating from over-work for the simple reason that, each one had an idea about the profession before venturing into it. In addition, they are paid for over-time if they exceed the normal eight working hours. Then again, if the number of nurses is inadequate, why must we have a huge number of trained nurses on the street unsuccessfully searching for jobs?

On May 13, 2016, which happened to be International Nurses Day, a very stunning revelation was made by Tony Goodman, the public relations officer of the Ghana Health Service on GH Today, a morning show on GHOne TV. According to Goodman, “it is not the responsibility of the ministry to employ all trained nurses and that private employer must help to absorb the excess.”

He continued to say that “the government is bound to employ only those who received training from public training institutions, and even with that, it has been discontinued effective 2016 due to the abolishing of the nursing trainees allowances.” I find this shocking knowing very well that such a move will encourage brain-drain thereby worsening the nursing deficit in the country.

It was revealed that currently, the nurse to patient ratio in the country is around one nurse to seven hundred and ninety-five patients, which is quite high. I think the government too has not done enough to improve the health canker in Ghana.

The change of government in December 2016 has however reversed the government’s policy intended to scrap nursing trainees’ allowances which bound government to offer them direct postings after school. Despite this, the first half of 2017 has witnessed series of picketing by unemployed nurses at the premises of the Ministry of Health (MOH) demanding that the government should offer them employment. This is a clear indication that we have more than necessary number of trained nurses to effectively work in our hospitals and clinics.

Most politicians are quick to argue that the high unemployment rate is attributed to the fact that, students are not reading employable courses which I find absurd. How can one blame a nurse or a teacher for being jobless after several years of professional training? Are politicians not playing on our intelligence? Is there any specific field in Ghana where there is a massive demand for certain skills which these graduates are lacking? Let the politicians brief us on that.

Although we all have a stake in making the healthcare system in Ghana very attractive, but without government’s commitment to dealing with the realities, all efforts would be rendered fruitless. I want to remind the government of Ghana that, our graduates who find themselves in the western world easily get jobs to do despite the fact that their citizens also school.

Ghana is not populous than Germany, U.S.A, or U.K, neither do we have more nurses than any of these nations yet they are able to absorb our excesses who find their ways into these countries. Our political leaders should be up their game and stop the unnecessary loose talks in the media. In addition, civil servants and heads of institutions, especially, in the health sector should exercise their supervisory roles effectively to save lives, time and make access to healthcare in Ghana attractive.

The inadequacies in the public healthcare system have created a room for new crop of self-acclaimed traditional herbal practitioners (herbalists) who are blowing their own trumpets, courtesy the mass media, to exploit and extort monies from helpless patients who are tired of the frustrations endured in the public hospitals. Most of these herbalists make juicy promises to their victims, charge exorbitant prices, drain them financially and leave them with disappointments.

To add salt to injury, in their quest to run to a safe haven, they land themselves in the hands of self-acclaimed men of God, once again, popularized by the media. These so-called prophets feed them with a host of superstitious beliefs, create problems for their families and completely drain them financially.

When all hope is lost, these patients most of whom are either Christians or Muslims abandon their faith and secretly run to fetish priests and shrines. What happens there is not something we are all oblivious to, so let me hold my breath on that.

Should these continue, until when are we as a nation going to achieve the Sustainable Development Goal 3?

NSIAH KWAME ANTHONY

0249483214

nsiahkwameanthony@yahoo.com


REFERENCES

Afful-Broni, A. (2008). Principles and Practice of Time Management (Accra: Yamens Press Limited).

Challenges of Ghana’s Health System; Akosa & Quashigah Diagnose! Feature Article 2008-10-17. Retrieved from https://mobile.ghanaweb.com/GhanaHomePage/NewsArchive/Challenges-of-Ghana-s-Health-System-Akosa-Quashigah-Diagnose-151163

Code of Ethics of Ghana Health Service. Retrieved from www.ghanahealthservice.org/ghs-subcategory.php?cid=2&scid=45

La Verle Berry, ed. (1994). “Health and Welfare.” Ghana: A country Study.
“National Health Insurance Scheme (NHIS)”. nhis.gov.gh. retrieved 5 June 2003.

Sewel, N. (1997). “Continuous quality improvement in acute healthcare”, International Journal of Healthcare Quality Assurance, Vol. 10, No. 1, pp. 20-6.

Canagarajah, Sudharshan; Ye, Xiao (April 2001). Public Health and Education Spending in Ghana in 1992-98 (PDF). World Bank Publication. P. 21.

Awuah, A. P. (January 2014). “Determinants of Patients’ Satisfaction at Sunyani Regional Hospital, Ghana”, International Journal of Business and Social Research (IJBSR), Volume 4, No. 1, pp. 96-106.