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Pulse Cares: GMA speaks about how to make healthcare delivery better

The challenges bedeviling Ghana’s healthcare system are many; no-bed syndrome, lack of or malfunctioning equipment, ineffective National Health Insurance Scheme, low doctor-patient ratio, and low remuneration for health workers are just a few of the major bottlenecks.

Dr. Justice Yankson, GMA Vice president

The country’s healthcare system is always lagging behind in terms of meeting the needs of Ghanaians, let alone meeting the World Health Organisation standard.

As part of Pulse Cares, a Pulse Ghana campaign for the month of May, the media organization has been shedding light on the challenges, the experiences and frustrations of the people of Ghana with the system, and the possible solutions to the problems.

In order to make the country’s healthcare system worthy of patronage by politicians and other wealthy people, so that it wouldn’t be necessary to seek medical treatment abroad at the expense of the poor taxpayer, Andreas Kamasah spoke to the Ghana Medical Association (GMA), to solicit their views from the practitioners’ standpoint, on how the system could be improved.

Dr Justice Yankson, the Vice President of the GMA, giving his general overview of Ghana’s healthcare delivery system, said it is not entirely a hopeless one.

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"The healthcare delivery system in Ghana is arguably of some good standard. The unfortunate thing is that along the value chain, there are a lot of problems; some as a result of lack of investment, some as a result of the lack of the right human resource in terms of numbers - adequacy I mean who have the professional skills that are required. It happens both in the private and the public sectors," he said.

Doctor-patient ratio

On the specific issue of the low doctor-patient ratio, Dr. Yankson agrees that there is indeed an inadequacy of doctors, but adds that the situation is worsened by their inequitable distribution.

According to him, the doctor-to-patient ratio is better in the country’s urban areas, such as the national capital and other regional capitals, while it is terrible in the rural areas.

"We’re still not close the WHO standard, but I would want us to look at it in terms of the sectorial or regional distribution. Because there some districts in the country that you go and they have only one doctor serving the whole district. If you come to a place like Accra or Kumasi, you realise that the ration becomes relatively better. But that is not what it is supposed to be. Ideally, we should be able to get equitable distribution of both skill and personnel. There are some specialized skills that are needed everywhere but unfortunately in some regions or some districts you don’t have them at all," the GMA boss cried.

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Motivation for health workers

The general perception is that doctors are one of the highest-paid professionals in Ghana and globally. But Dr. Yankson says it is a misperception in respect of Ghana.

He argued that doctors and health workers generally are overworked and not compensated commensurately with the kind of services they render to the public.

He added that the intensity of their work makes them have no social life because, unlike other professionals, they’re more or less working 24/7.

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"We’re generally underpaid for the kind of services we render. And if you look at the sort of compensation that goes on in other countries, you will realise that elsewhere let’s take place like the United Kingdom and the US, here I’m not talking about the quantum, but if you’re to put them on a leg in terms of what people earn you’ll almost always find doctors in the top three. But here it is not the case.

"Here, you are also overworked – you don’t work the standard 40 hours a week for normal work as per our labour laws. You work on weekends, holidays, at night. If you are the only district doctor in a facility, any time of the day, technically speaking, you’re on duty. Sometime you cannot even leave the locality to attend to personal things that affect your very existence."

Medical Negligence

Usually, when a patient dies or suffers a post medical treatment condition as a result of alleged misconduct or error on the part of a health worker, it is easily described as medical negligence.

But Dr Yankson disagrees, saying what constitutes medical negligence can only be determined by the law courts or the Medical and Dental Council.

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In his view, the term is wrongly used interchangeably with errors or misconduct, which he says are bound to occur once in a while, partly due to many factors, including the inadequacies in the healthcare system. He admitted that some health workers conduct themselves sometimes in ways that could amount to medical negligence if put to judicial trial. He blamed a lack of or inefficient communication between health workers and patients for most of the medical errors.

As to how the errors can be minimized, the GMA says it keeps giving training to its members on best practices and implementing quality control measures.

Ineffective National Health Scheme

Politicians always go back and forth about the effectiveness, or otherwise, of the National Health Insurance Scheme. But what do the health practitioners make of the NHI? Dr. Yankson says although the policy is a good one, the delay in the payment to service providers has been the biggest problem.

Some hospitals, both public and private, are sometimes compelled to resort to what is referred to as ‘cash and carry’, because the NHIS owes them so much that they are pushed into financial difficulty – patients who hold the NHI cards are made to pay cash or they will not get the service they seek.

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The GMA has advocated over the years for the creation of a separate account from the consolidated fund into which all NHI levies are deposited for easy disbursement rather than mixing them with other funds, in order to avoid bureaucratic processes that delay the release of funds to health service providers. Dr. Yankson believes strongly that it is the best remedy for the problem.

No-bed syndrome

Some avoidable deaths have occurred in various hospitals across the country due to a situation where there are no hospital beds available.

To address the terrible situation where patients who require admission to Ghana’s hospitals can’t have beds to rest on and get treated, Dr. Yankson recommends the expansion and equipping of health facilities in the country as well as the training of more doctors to match the ever-growing population.

He added that hospitals have nothing to gain from turning away patients if there are available beds to accommodate them.

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"We need to expand and equip health facilities properly. We also need to train a lot more personnel to man these places, especially when it comes to places like emergency medical care."

Ineffective ambulance system

The Ghana ambulance service has been revamped to some extent after the procurement of over 300 ambulances by the government, which makes it possible for each constituency across the country to have one.

However, one of the challenges that still militates against its effective running is the fueling of the ambulances. Patients and relatives who require ambulance services are made to pay between GHC300 and GHC450 if they are being transported to a hospital outside the constituency they live in. This situation has resulted in the avoidable deaths of some Ghanaians who could not afford the fees on time.

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To address this phenomenon, Dr. Yankson is calling for a system where the state bears part of the ambulance service fee. He is also advocating that the patient be allowed to enjoy the much-needed service of the ambulance service first before he or she is made to pay later as part of the general treatment cost at the hospital.

"Ideally, it shouldn't be the case that the one who needs the urgent referral from one facility to the next whether has money or not should be denied the services. We should be able to have a situation where somebody takes care of the bills after the patient has received the service."

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