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 Patients wait long hours for their turn  at  Out-Patients Departments
Patients wait long hours for their turn at Out-Patients Departments

Need for national health dialogue now!

The country's greatest resource is the human population and their ability to operate at a level that improves every fabric of society. There are many countries who are blessed with nothing other than the people who have been trained to such a level that the lowest common denominator may function at a level that will overshadow what other countries' middle-level manpower can do.

The wealth of a nation is the health of its people. This mantra of the Ghana Medical Association many years back is indeed a truism. No one functions creditably if they are not in tip-top form, and to be in tip-top form requires both an individual effort and a properly-functioning health system whose only raison d'être must be to make patients better. Do we have such a system, if not, why not? That is the question we must attempt to answer in the health dialogue.

 By any known and acceptable indicator, the health of the nation and its people leave a lot to be desired. The five arms of health, preventive, promotive, curative, rehabilitation and research are all not working properly and together. In addition, there are many extraneous players who have jumped into the fray and invariably confused the system for their benefit. There is no serious supervision at any level and the indiscipline of the general society have found its way into health-care delivery with disastrous consequences.

Problems

 There are difficulties with all the building blocks of health systems strengthening; health care financing, service delivery, medical technology and drugs, information and data, human resource for health and leadership and governance. It is important to accept that all the building blocks are underpinned by research and in our part of the world, especially by community participation.

 Health financing continues to exact considerable toll on families, leaving many out of pocket. Even middle-class families can be knocked off easily should illnesses such as chronic kidney disease or any of the cancers befall any family member. We must be working towards universal coverage where health shall be free at the point of service delivery at least at the primary-health care level which is service at or below the district hospital. It is easy for the elected officials to abandon the health sector in Ghana and seek services elsewhere at Ghana's expense. If they all had to use our services in Ghana, they may give it a better attention than they do now.

Alternate sources of income

 Ghana currently spends less than $100.00 per capita on health and this includes contributions from the donor partners. The National Health Insurance Authority's (NHIA’s) 2.5 per cent  value added tax (VAT) contribution and 2.5 per  from the Social Security and National Insurance  Trust (SSNIT) contributors add up, but total quantum is still woefully inadequate. The discussions must look at alternate sources of income. Contributions from relevant sections of the wider social determinants of health must be boldly explored. These are areas that impact on the health of the people and must, therefore, make contributions to improve health. Bad roads and bad vehicles of all sorts lead to accidents, the victims of which will have to be cared for. Vehicular pollution also contributes to poor air and ill health. Road fund and vehicle import levy must pay into the NHIA fund. Driver's licence fee must also make a contribution. Import levies on food, toys, second-hand clothing and all products that remotely can cause injury, tax on alcohol and tobacco, sugar tax and many others.

 Service delivery in Ghana is fragmented, the legacy of cash and carry. The public health system must be such that no money changes hands within the hospital premises. All who attend must be duly registered with the NHIA and or Private Health Insurance as required by law which will reimburse for all services provided at the community-based health planning service (CHPS), health centres, polyclinics and district hospitals, including feeding the malnourished child. Cash payment for health services must only occur at the private clinics and hospitals. Services at the regional and teaching hospitals will only be reimbursed if they are referrals. Chronic ailments should be sent back to the primary facility once the acute phase has been stabilised.

 In the arena of medical technology and drugs, Ghana must be innovative. We must begin to create or build patient monitors, hospital beds and lockers, regulators and stabilisers and work with manufacturers for the assembly of some items of equipment in Ghana to drive cost down. Primary health care must only use generic drugs, all of which must be manufactured in Ghana. The issue of fake drugs which are not only sold on the move but also in pharmacies and chemist shops must be confronted. Branded drugs can only be provided on a private prescription which will not be reimbursed. Herbal pharmacopoeia can be a win, win, win for Ghana and the nation must be prepared to invest in it. Every facility must have an equipment replacement schedule and some reimbursed money must be set aside for that.

Improving data system

 We have a good data capture system that must be worked on and improved. It must however capture work in teaching hospitals and private hospitals to give it a national character. The data must be properly analysed and provided as an annual State of the Nation's health report.

 The area of greatest challenge is human resource for health. It is a disaster by any stretch of the imagination. We have set no targets and are not working to achieve any approved indicators. At least the World Health Organisation (WHO) has set some indicators for doctors, pharmacists and nurses patient ratios and by extension we can create the ratios for biomedical scientists, radiographers and all other categories of health staff. Even the few we have produced are not being employed because of International Monetary Fun (IMF) conditionalities. Any system that ties the hand of Government to employ health staff must be described as unsafe.

Patient-to-doctor ratio

 A doctor colleague of mine who qualified like me in 1979 and started work in Malaysia for many years looked after far more than he could stand physically and temperamentally. He has seen the health system in Malaysia change to such that he looks after a maximum of 10 patients devotedly everyday. Malaysia has moved from one doctor to 10,000 patients to one doctor to 500 patients and are closing in on the European average of 1:300. We in Ghana are still dancing around the 1:10,000. There has been little progress. There has been no target set and no concerted effort to achieve anything.

Corruption in health sector

 Governance and leadership are what have kept us in our sorry state. Health ministers are appointed and do not set any milestones to achieve. Most come to make money and paper over cracks. The fire at the Central Medical Stores has been whitewashed but has caused irreparable damage, purchase of ambulances through sole sourcing and without the right equipment is not being investigated, creating a Health Institutions Directorate and over- charging poor health students and using money for private and unsustainable activities such as creating a tertiary institution in Brong Ahafo Region and a television station are being hushed up. Money for health must be money to improve what is a very poor sector and anybody who corrupts themselves must be severely dealt with. Misuse of money throughout the health delivery chain must incur stiff punishments. Anas must consider jumping into the health sector to unearth filth at many levels.

 There is such a dearth of leadership in the health sector it defies any understanding.

 Community participation and ownership in our part of the world must be integral to the success of every endeavour. The naming of hospitals was a passion of mine. All district hospitals must be district and not government hospitals because the latter absolves the community from even a monitoring role. Any facility built within a district must have community members playing a role at every stage, including acceptance and design etc.

Pastors, alternate and traditional health practitioners

 Finally is the role of pastors, alternate and traditional health practitioners and the many others without appropriate designation who are not complimentary but obfuscate in the general running of healthcare delivery. Ignorance and superstition are driven into patients all the time and delay seeking proper health care till it is too late. Some tell outright lies and deceive patients and fleece them of money while doing nothing for them. The role or otherwise of all these sometimes nameless players must be identified and factored into the equation. People who cannot pay national health insurance premium will find money to buy all sorts of concoctions that in the end may cause kidney and liver damage and ultimately result in death.

 

 Many issues have been thrown up in a rich bowl of soup that must be isolated and discussed for the benefit of the people of this country. The health of the people of this country is bad and needs to be improved if we are to build a high middle income country. It is not the natural resources that will move us into that bracket. It is a healthy and highly educated citizenry. The ball is in the court of the Ministry of Health, we need the dialogue now.

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