Failures and delivery challenges of Ghana’s health system
Health researchers everywhere look for that right combination of health services – the holy grail of the delivery of health services with the requisite structures (hospitals, etc) and processes (prevention programmes, etc) to improve the health status of everyone in the community.
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What unites us all around public health and the health delivery system is the organised focus on society as a whole. This involves organised community effort.
It is hard to do
In the case of Ghana’s health system, the successes or desired outcomes continue to be undermined by system outputs or the unintended and undesired results of the structures and processes.
The first Ghana Health Quality Forum that occurred on November 27 and 28, 2013, was not so much revelatory as it was documentary. As far as we know, some aspects of Ghana’s health system are getting better:
1. Ghana has a well-established national, regional and district system of hospitals, clinics and health delivery centres.
2. Ghana is producing more doctors; the training of nurses is on the upswing.
3. The public health infrastructure has achieved full immunisation coverage.
4. The government health service delivery structure is supported by a robust non-governmental sector (e.g. Christian Health Association) that provides preventive and curative services and a private healthcare sector that provides some emergency services.
The challenges remain: not enough providers (physicians, nurses and other trained caregivers), mal-distribution of providers, lack of professionalism on the part of some providers, broken equipment and technology or lack of requisite equipment. Healthcare financing is being tackled by the national health insurance scheme (NHIS), but the NHIS is underfunded and needs to be revamped to make it a viable programme. In 2012, Ghana’s infant mortality rate was 49 deaths per 1,000. This is too high for a country that aspires to be progressive among its peers.
Infant mortality
Infant mortality is a key indicator of health system performance.
Ghana does a poor job of delivering care to the most vulnerable of the population. Libya, Tunisia, Algeria, Eritrea, Tanzania and Botswana have better infant mortality rates – the North Africans have significantly better rates. Ghana’s performance is comparable to Sudan and the Gambia.
Another important indicator of health system performance is life expectancy. A man or woman in Libya, Tunisia, Vietnam, Cape Verde, West Bank and Gaza, Suriname or Algeria can expect to live longer than a man or woman living in Ghana.
New data from the NHIS, reported by J. Mensah and others, show some of the recent successes of the Ghana health system: Pregnant women who are enrolled in the NHIS are more likely to receive prenatal care and deliver at a hospital. But to be impactful, the NHIS has to reach more beneficiaries.
Dr Arthur Kennedy has written that the health system should facilitate the recruitment of approximately 10,000 physicians in the diaspora who are willing to provide their services but are hindered by bureaucracy in the Medical and Dental Council. This might be a short-term objective if the government could muster the will to recruit these doctors.
Community service
In conversations about improving public health, I am impressed by the community service process called ‘umuganda’ in Rwanda which involves activities to improve the social health of the community. This community service idea is not novel.
Public health will be enhanced if community cleaning of neighbourhoods and surroundings is made mandatory in every community once a month. The community service will also create awareness of public health.
The recommendation for long-term solution requires government spending. A particular type of skilled health worker is needed. I think it is very important to train health outreach workers who will act as social epidemiology surveillance officers – they will focus on communities with the greatest need, identify their immediate and direct needs and then become advocates to channel services to these communities.
All the experts say the government should be spending more on health – at least 15 per cent of the government budget. The Mahama government is not doing this. Why not?
We are willing to help; many health researchers like me are working to find solutions to the myriads of problems that beset health delivery systems. But is the Mahama government listening? Can the Minister of Health hear us?