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Opinions of Thursday, 2 January 2014

Columnist: Amuna, Paul

The Dilemma of ‘Knocking’ our Health Services

Dr Paul Amuna

In an article posted by Kwaku Danso, convener of the “Ghana Leadership Forum (GLU” posted on Ghanaweb on 31st December 2013, the writer related the ‘bad’ health encounters of some Ghanaian living in the Diaspora at Ghana’s foremost Teaching hospital, Korle-Bu. True and sad as in individual's experience with our health facilities may be when their loved ones fall ill and are hospitalised in a run-down hospital anywhere in the country, it is equally sad to hear blanket condemnation of our health service and especially the human resource / professionals who work there.

One empathises with those who have a bad health encounter in our health facilities and would wholly condemn all those who approach their work without the professionalism associated with what after all is a vocation, rather than a ‘get-rich-quick profession’. The sad truth is that there are those who simply do not care and cannot be bothered and we all have our experiences of 'mistreatment' by staff including my own mother being refused access to treatment by some nurses about 15 years ago. In my family’s case, one of the comments passed was that “why should we allow her when she cannot even pay for the treatment”. How very presumptive and pathetic!

That said, there are equally well dedicated, capable professionals - doctors, nurses, laboratory staff, even orderlies whose dedication to duty is most admirable in the very same hospital - Korle-Bu. I have witnessed this too, whilst I was myself training and working there and many years since. My caution therefore is not to generalise, but to rightly identify a bad situation and expose it for what it is.

Incidentally, Ghana's "Health System" / Structure has been praised by various people including no less a person as Bill Gates, during his last visit to the country earlier in 2013, and he is right (believe it or not). The fact is our national (public) health structure and access to health care in Ghana is generally far better and the ‘health encounter’ more rewarding than you can say of many of our neighbours. Furthermore, where people use private health services, depending on where you go, the services are often prompt, of a high quality and professionalism is shown all the way through.

So, what is the problem at Korle-Bu (and other public health facilities in Ghana)? To me it comes down to three issues namely:
1. Human resource capacity, training and professional code of conduct and ethics; how well resourced are we in terms of numbers relative to the patient : staff ratio, workloads, etc. and training in professional ethics
To this end, I would seriously question whether our hospitals and health care institutions have set up corporate and clinical ethics committees to address issues relating to the patients' (and their families’) experiences as well as staff complaints etc.
I will also question if the health service has a "Patient Bill of Rights” or a "Patients Charter" which in other countries, guide codes of practice and clearly spell out patient / staff rights and responsibilities, and therefore also provide a route to seek redress where these rights have been breached including ill treatment or abuse of patients, their families and even the dead (e.g. mishandling of cadavers sent to mortuaries etc) (and vice versa).

2. Infrastructure / facilities / equipment resources i.e. investment in the health care support structures to enable the trained personnel to function properly, professionally and hopefully happily and to enhance the patient experience;

3. Whether the trained workforce is adequately supported both in terms of their career / continuing professional development and conditions of service including career progression, remuneration etc. This third point is particularly important for staff morale and the lack thereof does feed into, and contributes significantly to staff attitudes (which unfortunately extend to patients and their families) and their morale overall. In 2007 I was one of a team of consultants who helped the Ghana Health Service to review its entire workforce structure and for the first time we produced a comprehensive job description structure across the sector from orderlies all the way to consultants across different disciplines with a career progression structure and incentives for further professional training and continuing education. I thought this was a major effort which if properly implemented, should put Ghana in line with developed countries in terms of standards of staff training, expectations and performance but the issue is always one of IMPLEMENTATION.

So, these are issues that clearly need fixing including ensuring that the health care budget is generous and ring-fenced to support projects in all three areas. Developing a Corporate ethics framework and patient bill or rights can easily be achieved (within 3 months of constituting the right team to develop these). Funny old world!!! - I find myself actually doing exactly this at this very moment for a health service in another part of the world!!!

The dilemma for me is that it is sometimes truly heartbreaking when you read the impressions, comments and utterances of some of ‘our brothers and sisters’ in far flung industrialised countries with the high tech health facilities and their ‘moaning and winging noises’ about everything Ghana - including their encounter with our health service. The truth be told, some of these ‘overseas visitors’ can be very vitriolic in their comments and communication with hospital staff who after all are doing a ‘thankless job’ in poorly resourced facilities and under trying conditions, given the sheer volume of the task (I speak from firsthand experience).
There is no doubt that our health infrastructure needs urgent upgrades, and that the facilities in our most prestigious referral hospitals are still "third world standard" in the 21st Century. However to characterise the country as a "Failed State" for these reasons is most unfair and quite frankly troubling. By all means let us point out what is wrong and advocate through Civil Society e.g. ‘Patient Welfare Groups’ and “Think Tanks” such as GLU for change and improvements. Let us use social media forums such as ghanaweb to initiate and promote INTELLIGENT AND OBJECTIVE/BALANCED AND CONSTRUCTIVE debate about how we can exert civil society pressure to get politicians (of all parties) and policy makers to act in our collective interests. But to 'throw our hands in the air' and to condemn/dismiss the system outright to me is defeatist and most unhelpful.

For the sake of our readership and for those of our compatriots in the United States of America, It is worth reminding them that despite the huge mountain of 'teething problems' of president Obama's flagship health care policy and the implementation of the new health insurance provision in the United States (Obamacare), only for the first time in 2014, tens of millions of people living in America now have access to affordable health care coverage irrespective of status and stand to benefit from what was otherwise a very distorted, unequal health care system in America in which 'if you do not have, then you do not get' - simple as that!!! I wonder how many of our ‘complaining brothers and sisters’ in the Diaspora can say that they have good access to treatment in places like the USA where they live and work.

That the “greatest nation on earth" (as is often characterised by Americans led by the president, Obama) has over 40 million of its people lacking access to basic affordable and decent health care is both a scandal and shocking for uninitiated Africans like us who continue to wonder, and despite all the mass of expatriate health care personnel that country continues to attract (poach) to 'feed their system' including dare I say, countless Ghanaian health professionals of a high calibre who have made it in their various fields in America. Of course there are those places 'for the poor masses' where you can go and queue for a whole day to get seen by a general physician (if you are lucky) and where the quality of treatment is by no means guaranteed. Only this year in one of the States, a black woman who was not feeling well, was left sitting on a bench in the health centre reception until she dropped DEAD!!! in front of staff and everybody. Now that’s what I call a scandal!!!

If the experiences of falling ill as narrated by friends of mine who live in that country are anything to go by, it appears one has to pay for everything from the ambulance which picks you up through to every single "health encounter" from registration, through nurse consultation, doctors, laboratory etc. You see, that is what is captured when you have an electronic health insurance system and the trouble is, if you are not insured, you are at your wits end just to get by every single one of these stages and the bill at the end is something many an average African or Latino living in the USA can ill afford.

Therefore the dilemma again is that if you live abroad and your relatives are in Ghana and they fall ill and need treatment, if you choose to access our health services you might (with your meagre earnings abroad) be able to afford a more decent health care treatment in Ghana compared to the same (equivalent) treatment e.g. for malaria in the USA.

Therefore my take home message is this: we should always temper our frustration, anger, disappointment during a ‘personal encounter’ with the local health service with a tinge of reality and a dose of humility and rather seek ways of helping our system do better and hopefully flourish some day soon.
'Knocking' the system down and somehow characterising it as "failed", "hopeless", "a disgrace" etc. does nothing to change it, and certainly does very little to boost the morale of the hard working staff in those facilities. In my view there are far better ways of tackling our problems and seeking to exert pressure for a better Ghana. I quite agree with those who have expressed sadness at the fact that every little matter such as this one is often seen only through political lenses in Ghana and is yet another opportunity to bash the ruling government of any colour. As far as I can remember, our health sector challenges have been there from 'titi' including when I was a young student of the health professions in that very institution, and my impression is that fixing it will need a more concerted and collective effort by all of us.