Free primary health care: From policy to practice

The government’s readiness to launch the free primary health care programme today has elevated national discussion about healthcare needs to the front burner, with focus on infrastructure, healthcare personnel and access.

The whole enterprise is about the effort to make health care accessible at the basic level to deal with issues that could be contained early to prevent them from escalating to a crisis level.

At the heart of this is the national distribution of medical personnel who will man the health infrastructure to dispense the necessary services to the population, as the country makes a bold attempt to tackle a major aspect of national needs.

As he addressed the Government Accountability Series at the Presidency last Monday ahead of the launch, the Minister of Health, Kwabena Mintah Akandoh, also gave a heart-warming picture of the national distribution of medical doctors.

He said as of the close of 2024, eight regions put together could boast of just 12 combined medical doctors.

These included the Western and North East regions.
Impressively, the story has changed for those eight regions where up to 100 doctors have now taken posts to administer service to the population.

“By 2025, through our postings — though the process is not yet complete — we are approaching 100 doctors across those eight regions, and we are still not done.

Immediately after the launch of the free primary healthcare initiative, those who refuse postings will forfeit their placement, and those positions will be reopened. This means that even newly qualified medical doctors can be posted to these areas,” he said last Monday.

Only recently, the minister had lamented the shortage of doctors in some regions and districts, while highly trained staff and specialists remained concentrated in a small portion of the country.

It is not as though the country has reached the best situation with the doctor-population ratio following the posting of about 100 doctors to underserved regions.

The World Health Organisation (WHO) generally considers a doctor-to-population ratio of 1:1,000 as a minimum benchmark to provide adequate primary care.

When expanded to cover other medical staff, global standards, however, indicate that a ratio of 2.5 medical staff, including doctors, nurses, and midwives, per 1,000 people is sufficient for quality care.

Ghana’s situation in the eight regions in the recent past was a disturbing reality of a mismatch between healthcare needs and available services.

For a country that has come this far in its developmental stages, the skewed distribution of critical health personnel is a major blot in terms of the fair distribution of national resources.

The situation undermined a balanced national distribution of health personnel, particularly medical doctors, portraying the vulnerabilities of a section of society in terms of access to quality health care.

If general medical doctors are not evenly distributed, the number of scarce specialists will be even worse in underserved areas already lacking quality infrastructure.

However, the Daily Graphic acknowledges that the problem was not limited to poor administration.

The unwillingness of doctors to accept postings to such areas, which is itself a product of the underdevelopment of those areas, has contributed to this attitude of neglect of some of these areas.

It portrays a nation with lopsided development, a concentration of resources in a few areas, while the others wallow in neglect and lack.

It also showed why health infrastructure was concentrated in some areas while vast areas lacked simple clinics.

It is good that national consciousness has begun to impact the distribution of human resources and infrastructure.

This distribution scale must be spread to other personnel — beyond nurses and midwives — in the healthcare chain.

For instance, laboratory technicians and pharmacists must also be distributed to facilities across the country to reduce the pressure on the few well-endowed ones.

The system must provide the necessary motivation for the doctors and other personnel to accept postings around the country.