Feature Article of Wednesday, 24 October 2012

Columnist: Poku, E. K.

NDP Policy on 21st Century Health Care System in Ghana

(by Dr. Edward Kwame Poku)

We have read both the policies of NPP and NDC about the policies of
their health care system they would like to introduce into Ghana. We
reject both these policies because they are archaic and if these
policies are pursued it is going to lead into a catastrophe.

What Ghana needs is a reform of our present health care system and not a
review of our old system. I wish to remind President Mahama at this
junction that the delivery of health care is not only about the
financing of health care but more importantly about the quality of
health care you are about to deliver to the people. It must at the same
time be emphasized that no amount of resources or management will alone
suffice in solving the problem of the delivery of care but also the
life-style of the people who are supposed to enjoy the quality of health
care. At this junction however I would like to remind President Mahama
that people like him and all those privileged Northerners will do their
people good service if they can go to the North and Upper Regions to
help their people solve the environmental problems they have there
instead of exporting it to the south.

Personally I think it is not even worth mentioning the NDC- and
NPP-policies, because it is a continuation of the old system which has
not served us well over the years.

We want to remind our readers that we are in the business of still going
to win the election with our leader, the flagbearer Nana Konadu
Agyeman-Rawlings, despite rumours which cannot substantiated about her
and the intention of the Electoral Commissioner not to give her the
green light to stand for the presidential elections. We are of the
opinion that in the final analysis it is only the quality of policies
that is going to see our party through, not the primitive allegations
about her.

Please, I wish you a good reading.


_*21*__*st*__* Century Health Care in Ghana*_

We will put people first in our health care. In order to pursue the
21st century health care in Ghana, we must adopt what the advisory
commission on consumer protection and quality in the health care
industry in the United States recommended in 1998.

_Recommendations in General_

1. All health care organisations, professionals groups and private and
public purchasers should adopt as their explicit purpose to
*continually reduce the burden of illness, injury and disability and
to improve the health and function of the People of Ghana.*
2. All health care organizations, professionals, private and public
purchasers should pursue six major aims:
1. Health care should be safe,
2. should be effective,
3. should be patient-centred,
4. timely
5. efficient and
6. equitable.
3. Progress must be constantly assessed by creation of a National
Quality Report.
4. Local efforts to implement innovation and achieve improvement
through simple rules.
5. Care based on continuous healing relationship that means 24 hours a
day, every day.
6. The care must be designed to meet the patients' needs.
7. Shared information with patients.
8. Evidence-Based decision-making will be focused on disability
adjusted life-years (DALYs).
9. Safety as a system property.
10. Transparency.
11. Using information technology and internet.
12. In the regions, we have to have regional health care financing
administration and a special agency for health care research and
quality with input from private payers.
13. Increase in chronic conditions and changing mortality patterns
should be taken into account.
14. Mental health should be taken seriously.

_PAY - Structure_

There is bound to be wide variations in the pay of GPs throughout Ghana.
Regional governments must take advice from various doctors and dentists
review bodies.


Pays must be specified by GMA, and not by the government. All doctors
must have contracts with the administration of the hospitals they are
working for.

The basis of the pay should be hourly rates. Doctors or junior doctors
should work 8 hours daily with 30 minutes break for lunch.

Consultants should be paid consultant fees, should be given 30 beds in
the hospital where they are directors as private practice. They in turn
should be on duty for emergencies in case the junior doctors go on strike.

Consultants thus though employed will be allowed to do private work but
only in the hospital they are employed, e.g. insurance examinations and
reports, private medical examinations.


_*Checks and Balances*_

*The complaints procedure in general practice and in the hospitals*

1. Local resolution
2. Independent review
3. Ombudsman
4. Disciplinary procedures

*The structure of the Health System*


Dept. of Health

1. Social services
2. Public Health GP
3. Executive agencies
1. Medical devices
2. Medicine control
3. Health Authority Estates
4. Pensions
5. Purchasing and supply
2. The health system shall be an autonomous body running as business
with CEO, etc.
3. Ministry of Health will have nothing to do with it, except for
matters relating to Public Health.
4. All other issues of Health will be fully decentralised, e.g.
University hospitals, Nursing,.etc.,etc..

There shall be Health Services Agencies in

* Ashanti Region
* Brong Ahafo
* Upper West- and -East
* Northern Region
* Central- and Western Region
* Volta Region

All the regions shall be autonomous in all decisions about Health,
including the need for Health Posts, Hospitals, Training of nurses,
doctors, specialists.

The Central Government in Accra will have nothing to do with decision in
various regional centres.

Transfers of health workers shall be abolished.

In Scotland for instance you have Minister of Health and Community Care.

* Management Executive
* Health boards
* Trusts, Acute Hospital Trusts
* Primary Care Trust

It will be up to Volta Region to plan their Health System as they deem
fit. The usual budget support from the Central Government will be given
to them.

This is where development starts.

All hands-on-deck attitude. No begging the Central Government and no
thanking the Central Government for doing their job!

1. Care for the most vulnerable and the seniors and juniors and infants
shall be free.
2. Care for the mentally handicapped and mentally ill shall be free.
3. We shall introduce “Health on Wheels”, Testing for Glaucoma, Blood
pressure checks, Blood sugar testing, minor surgery, wound
treatment, driving to remote villages.
4. Entrance exams for trained nurses shall be abolished. Exit exams
shall be only practical exams. These nurses shall man remote centres.
5. Dentists on wheels to help the rural folk.
6. Helicopters to transport emergencies to nearby hospitals.
7. 24-hours pharmacy shops open – with police protection.
8. Ambulance service with well-trained paramedicals, not paediatricians.
9. These measures will be started immediately our Flagbearer is elected
as the President.
10. We recognise that conveying the sick to the hospitals will be a
problem because of traffic jams. It is therefore important to start
the skill training to help de-congest the cities.
11. The economic activities must be dispersed into other rural centres.
This is important!

_*Re-structuring the Health Care System*_

1. National Health Insurance system in Ghana shall be abolished. Free
medical care shall be introduced for all.
2. Creation of medical Centres for diagnostic purposes could be
privately owned.
3. Immunisation.
4. Treatment of acute malaria.
5. Treatment of anaemia and its related blood transfusions.
6. Screening for BPH, Glaucoma.
7. Creation of Medical Academy where weekend Master-Classes will take
place (mandatory).
8. Essential drugs can be cheaply produced in the country and joint
ventures with neighbouring countries should be our goal.
9. Emergency rooms at the airport.
10. 153 dentists for 24 million people is a shame, so train more dentists.
11. We need to train more Psychiatrists.
12. Hospital wards shall not be big halls like in WW II.

Because there is a lot to be done there must be division of labour.
There must be proper decentralisation where all these measures mentioned
above could be dealt with by the regional elected ministers efficiently.

_*This will be our road to success*_

So far, nothing has happened. The people are being choked in inefficiency.

This list of what I have described above is quite impressive. The Public
Health aspect will have to be tackled by the Ministry of Health of each
region. This is democracy at work.

Our previous governments have chosen not to live the mandate bestowed
upon them by the electorate to transform the fortunes of the economy but
have instead been engaging in misdirecting their effort and energy in
petty squabbles and insulting dignified Icon leader of our nation,
ex-President Rawlings. Allegations are making rounds that some ministers
and officials of this government are corrupt. We shall investigate and
if found guilty, they will loose their citizenship. Rawlings and the
wife do not have shares in NDC, they have the interest of the people at

_*Pharmacists in Private Practice*_

Registered pharmacists and no one else will deal in pharmaceuticals. The
pharmacists will be assisted by pharmaceutic technical assistants who
should be well trained and certified after a 3-year course to work in
the pharmacies. They all shall wear white overalls with their name tag
or gadge for identification.

All the pharmacy shops will have to satisfy new governmental
specifications and pharmacists shall be helped to get a loan for
purpose-built shops – state-of-the-art. They shall be made liable for
prosecution if any fake drugs are found in their stores.

They will have to liaise with Food and Drug Administration to ensure the
quality of the drugs on sale.

Those working in hospitals will have to satisfy the requirements of the
individual hospitals.

_*Grants for the Health System*_

1. Each region gets so-called block grants.
2. These are not related to need but can be spent as they choose.
3. The funding in each region must relate to their expenses. This
however must be justified.
4. There must be divergence.
5. The NDP politics must have value professionalism as well asThere
will be the need for our Flagbearer to meet personally the
professionals, region by region, for mutual discussion.

6. The objective of NDP will be to improve the environmental condition
and thus improve Public Health.
7. Public latrines and sewerage system shall be dealt with. Underground
sewage treatment plants shall be introduced.

_*Drug Misuse and Dependence*_

NDP-Guidelines for Ghana on Clinical Management

1. Clinical Governance
1. Principles of clinical governance
2. doctors training
3. non-medical prescribing
4. confidentiality involving patients and carers
2. Essential Elements of Treatment
1. assessment, planning care and treatment
2. delivery of treatment
3. drug treatment
4. drug testing
3. Psycho-Social component of Treatment
1. principles of psychosocial intervention etc.
4. Pharmacological Interventions
1. prescribing
2. introduction onto methadone and buprenorphine treatment
3. supervised consumption
4. opioid maintenance prescribing
5. detox
5. Health Consideration
1. blood-borne infection
2. preventing drug-related deaths
3. alcohol
4. diazepam dependence
5. tobacco

This information is based on clinical guidelines on the treatment of
drug abuse in the U.K.

We shall introduce this to Ghana to save our young people from addiction
deaths. In Ghana, the newly formed Public Health will have to deal with
HIV-infections, Hepatitis A, -B, -C infections, Hep. E infection. We
shall make it a responsibility of the General Practitioner, GP, to
provide medical services for drug misusers. That is why GP-position and
function will have to be reviewed and upgraded. Drug related overdoses
must be prevented. It becomes clear therefore that the NDC Government is
totally incompetent and not only criminally corrupt, but abusive.