The recent incident of the 70-year old man, who eventually died in a car at a hospital in Accra after several attempts to secure admission at seven different hospitals failed due to lack of beds, left the nation in an uproar. May his gentle soul rest in perfect peace. However, the popular cliché of lack of beds is just but a few of the challenges with our health system that get into the public domain. Many do not get the media report and highlights and since most victims are not “big” people in society whose voices can be heard, the chances of losing a loved one to a painful, undeserving and avoidable death is certainly higher in the country.
Day in and day out, citizens of our dear nation die without anyone hearing about their ordeal irrespective of the kind of the health system challenge that aided their bitter passage. Even those who get to know about the wrong done their beloved, end up having their cases swept under the carpet in few days. Painful to say, but imagine if you had a loved one almost at the brink of death, but yet close to a place where perhaps he could have been saved and right in your arms/eyes, he or she dies.
Unfortunately, a lot of people making waves with the recent brouhaha want to either make their names through this current situation or take it as a means to materialize their propaganda. However it is worth to note that taking reactive measures to situations like this will not solve the ever rotting health system we have created for ourselves. The entire Ghana health system is a sick one and needs an emergency saving. Health is and should be for all, irrespective of social class, economic standing, or affiliation.
Health is a fundamental human right. It is the state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. Health is the most important world-wide social goal. Health is wealth. Sadly we neither give our health nor the health of others the attention it desire. Why can’t we aspire to create a robust and functional health system?
A functional health system is accessible, ensures high quality of care and service delivery, equitable/fair, safe, efficient, effective and ethical in ensuring rights-based approach in the delivery of its services. Healthcare has become more of a privilege than a right in our country. I wonder how a nation can grow if it does not value the health of its citizens.
In this current case of the passing of the 70 year old man, I find it very fascinating that the Ghana Health Service (GHS) has promised to act swiftly to improve the situation. Should we always be quick to provide “reactive solutions’? And for what period will this swift emergency solution as I like to call it last? A day, a month, or a year, and then what, we are back to our old route of redundancy and ineffectiveness. Will the swift emergency solution include going after the seven health facilities and the personnel who spoke on behalf of those facilities that there were no beds? Some of these personnel are diligent at what they do but for lack of resources. Will they try to provide these facilities the needed resources including the beds to work with?
Lekma hospital, the last hospital where the victim passed away is originally a 100 bed capacity facility. Most of the public health facilities in the Greater Accra region apart from the Korle-Bu Teaching hospital are not high bed capacity facilities. For instance, the 37 Military Hospital has a bed capacity of about 400, the La General Hospital has about 100 and Trust Hospital, about 87 beds. Moreover most of these facilities do not even have the good and sufficient beds they need to operate to ensure good quality care. However over the past few years, new facilities have been built to augment the deficits. What is the state of the new facilities? The Greater Accra Regional Hospital (formerly, Ridge Hospital) which was originally built to operate at 600 bed capacity currently runs at only 400 bed capacity, the controversial state of the art University of Ghana Medical Centre, a 650 bed capacity is deteriorating all by itself, the 60-bed ultra-modern Bank of Ghana Hospital which was completed in 2017, is yet to be put to use and many others.
Every health system is built on six basic building blocks including service delivery, health workforce, health information, medicines and technologies, health financing and leadership and governance. All these blocks are interconnected. In Ghana all these building blocks are in crisis. Service delivery is poor mainly due to lack of resources and the health workforce is inadequate. Meanwhile there are so many doctors, nurses/midwives, allied health professionals, pharmacists etc. who are ready to put their good skills to use but cannot find jobs and are wasting their knowledge home.
Moreover, the knowledge gap in terms of medical treatment especially the less common conditions continue to widen. There is under usage of health information and medical technologies as well as inappropriate usage of medicines due to lack of treatment guidelines and inadequate regulations. Our healthcare financing system; the National Health Insurance Scheme is struggling.
However, all these challenges could be solved if there is good leadership or governance system. The lack of good governance, lack of visionary and systems thinking approach to our health issues has crippled and continues to cripple our health system. The health leadership is supposed to be the steward that ensures strategic policy frameworks combined with effective oversight, coalition building, accountability, regulations, provision of incentives and attention to system design. This can hardly be said about our health system. From the top most government official to the supervisor in the health facility, if these qualities are exhibited, we wouldn’t be where we are today as a nation.
Criminalization of “no bed syndrome” and its associated factors like refusal to give first aid is just a true sign of how deteriorating our health system is. Criminalization is good but it wouldn’t solve our health system crisis in its entirety. Solving one aspect without recourse to the others will only have partial positive effect if not ripple negative effects. I believe this is a good time to do proper evaluation of our health system so together we can build a formidable robust system for ourselves and generations yet unborn. We can do it. No one can do it for us. GFA is being restructured to suit the goal for its establishment. Same way our health system can be restructured to fit its original purpose of promoting, restoring and maintaining health.
Gadeka D. Dominic
(BSc, MPH, Doctoral candidate, FYDG, FISQua)
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