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Opinions of Sunday, 14 April 2013

Columnist: Ofori-Asenso, Richard

This bullying in the health sector must stop!

It is often said that ‘without health life is not life, it is only a state of languor and suffering-an image of death’. It is based on such understandings that for many years, health has been regarded as a basic human right.This conceptualization of health as a basic human right has been enshrined in many international instruments of which Ghana is a signatory to. For instance,Article 12.2d of the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) highlights that

‘The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:The creation of conditions which would assure to all medical service and medical attention in the event of sickness’

Moreover, our national constitution highlights that ‘The President shall report to Parliament at least once a year all the steps taken to ensure the realization of the policy objectives contained in this Chapter and, in particular, the realization of basic human rights, a healthy economy, the right to work, the right to good health care and the right to education’.

Nevertheless, the current situation in our health sector characterized by chronic strikes among health professionals has meant that for many Ghanaians, the enjoyment of this fundamental right remains a mirage.

Following the debates in the media and on many social platforms, what I have realized is a situation where employers (FWSC/government) and employees (Doctors, Pharmacists etc) have taken entrenched positions regarding what needs to be done to address the current crisis. In fact, both groups have resulted to using all sorts of bullying and diversionary tactics to gain public sympathy and to drive home their demands.

Nevertheless, whatever the outcome of this whole process, what is certain is that only one group of people will suffer and that is Patients! As a country, we all recognize our inherent socio-economic challenges. Access to safe drinking water, electricity and proper sanitation remains challenging for majority of Ghanaians. With all these challenges, it is unrealistic for any category of workers in the public sector whatever service they provide, to think that the state can meet all their demands!

However, it is a well documented fact that many workers in Ghana’s public health sector are under-paid and staff motivation remains terribly low. This for many years has contributed to our country’s chronic shortage of health staff. It has been estimated that, Ghana has less than 50% of the healthcare workforce it requires and the country has been classified as one of the 57 nations with most acute shortage of health staff. This has primarily been driven by the very high emigration rate among Ghana’s health workforce to countries like the US, Australia and Canada in search of better conditions of service. For instance, according to the International organization for migration about 56% of doctors and nearly 24% of nurses trained in Ghana are working abroad. Moreover,nearly two-thirds of Pharmacists trained in Ghana in 2003 migrated to other countries particularly in the global north. Many studies have indeed highlighted wages as the key factor underlining such trends. Many more studies have underlined that indeed small changes in remuneration can have a profound impact on health worker motivation and retention in Ghana.

Moreover, it is generally recognised that a high emigration rate among health workers in Ghana is economically unwise for a country with limited resources in view of the massive investments the state makes in training these professionals. It is therefore implausible not to argue in favour of the provision of better conditions of service for Ghana’s health workforce.

Although, the argument by government that the demands of these professionals cannot be met and are unsustainable seems convincing to me at times, it is tainted by the recent media reports of the payment of huge sums of monies to groups such as Members of Parliament. Such purported practices perhaps only solidifies the stands of the health workers that maybe ‘they are just been neglected’.

Regardless, if there are limited resources to meet the demands of health workers in Ghana, it is not just a creation of the government but to some extent a contribution also by even the health professionals themselves. The 2010 World Health Report indicated that inefficiencies such as poor coordination and administrative flaws in the health sector in many countries are creating wastage of about 20-40% of resources. Some reports have highlighted that for the case of Ghana this may even be higher. Such wastages if curbed can be channeled to good use such as improving the salaries and conditions of service of our health workforce. To do this will require a reasonable level of commitment from both the government and health professionals.

Going forward, it is imperative that both government/FWSC and health professionals come to the negotiation table with open minds all seeking for a realistic yet fair resolution! It is also important that international negotiation standards such as the World Health Organization (WHO) code of practice for ethical recruitment of health workers be utilized. This will enable the country to establish reasonable demands and a good-faith commitment from both sides to avert unnecessary future strikes.

The government must know that it has a responsibility to provide the necessary conditions for every Ghanaian to receive care when sick. This is a right not a gift! It must do all it can to eliminate the many barriers that impede the enjoyment of this right. Improving conditions of health workers is surely one of those means. For the health professionals (Doctors, Pharmacists etc), as much as they may have many concerns, they need to put their demands into context and be realistic. As much as we all want them to have the best conditions to deliver quality health care, in building our nation we all need to make some sacrifices. They must know that by resorting to constant strikes, they do not hurt the government, but rather the patients for which ‘they have taken oaths to protect’.

The resolution by the two groups to use bullying and diversionary tactics will not only destabilize our health system but will also put at risk, the lives of many innocent people in need of care, who ultimately are the victims of any health worker strike. This bullying must certain STOP!

Richard Ofori-Asenso

The Author is a Global Health Student at the Centre for Primary Care & Public Health,

Queen Mary, University of London