Making the case for improved healthcare delivery in Ghana

Dr Joseph A Boateng, MB, ChB, MPH, FGCPS Opinion Jun - 26 - 2014 , 19:15

As a country, we need to start talking openly about the quality of the medical care that is given to patients in our hospitals and clinics and patient’s satisfaction of that care.

Many a patient has a sad story to tell about a visit to the hospital. Stories range from doctors and nurses who will not communicate with patients about diagnoses and treatment plans to patients who have been harmed or have died from preventable deaths.

System problems

There are system problems when it comes to poor healthcare quality. These include difficulty in getting access to healthcare facilities due to deplorable roads, unavailable hospitals or clinics, unavailable medical equipment and or supplies, poor management of our healthcare facilities, overworked medical personnel because of abysmal doctor and nurse to patient ratios. The list is long.

Because of system problems, some of our doctors, physician assistants, nurses, pharmacists, laboratory technicians, radiographers etc. are working under very difficult and challenging circumstances, especially in the rural areas.

Non system/attitudinal problems

But there are also non-system problems, a lot of which are attitudinal problems. When a nurse insults a woman in labour because she is crying because of pain or a doctor arrogantly refuses to explain what he has found on examining a patient, these are not system problems in the true sense of the word, they are breaches of the tenets of the medical profession.

When medical personnel discuss a patient’s confidential health information with each other as a form of gossip, that is not a system problem but a blatant abuse of patient confidentiality.It is definitely not “innocent” gossip.

We should be careful not to try to defend these indefensible non-system problems by trying to rationalise them.

It is important for us to clearly identify them and separate them from the system problems. Non-system problems are easier to correct. System problems require a little more ingenuity, focus and boldness to solve; but solve both we must and urgently. I am not saying it will be easy but we must start the process.

Hitherto, poor quality in health care has almost been treated like a taboo subject. Patients discuss them with family and friends and lament in private. Once in a while, a rather vile story becomes newsworthy; but only for a fleeting moment.

Public debate

We need to raise the topic to the level of a legitimate public debate and discussion. Why? Because it deals with life and death, literally. I do not know of any human story that is more serious than that of life and death.

Apart from the obvious human distress stories, poor healthcare quality has significant social and economic costs to individual families, industry and the nation. Poor healthcare quality, especially when it results in preventable deaths, is expensive and wasteful of both material and human resources.

As a nation, we spend resources on healthcare delivery — not enough — I agree, but we must maximise the results of that investment. Poor healthcare quality and preventable deaths are a waste of those resources.

As much as many would like to make the poor quality of healthcare a national developmental issue, I disagree that money is the primary problem. No.Poor management is, lack of leadership is, lack of ingenuity is, rationalisation and defending the indefensible are.

If the national GDP was the only problem, some Indian hospitals will not have medical outcomes and healthcare costs which are better than those of hospitals in the US. Cuba will not have the healthcare system that it has. Rwanda will not have the improvements in infant and maternal mortality that it is reporting.

We should not confuse the presence of expensive, sophisticated equipment in hospitals with simple, much cheaper cost effective equipment, better maintenance culture and old fashioned common sense.

Responsiveness (especially to emergencies)

The most harrowing stories of an unresponsive healthcare system and examples of when the medical profession utterly fails the patient is what happens at night to seriously ill patients who are sent, usually in taxi, to the accident and emergency rooms of our major hospitals in Accra and other large cities.

These are emergency patients who require urgent, dedicated and very active interventions to save their lives. That they receive apathy, the least effort and absolute disinterest is quite mind-boggling. It is a direct antithesis of what the medical profession should stand for. Quite a number of these patients die after going from one hospital to the other and meeting the same apathy and non-response.

How many of these patients have been sent to the mortuary still alive? Do we really not care that much? The medical profession fails these patients anytime one of them dies because an emergency room turned them away or did not lift a finger to save their lives.

Inefficiency and waste

There is massive waste and inefficiency in the clinical care process. Because of a poor referral system and poor information transfer between hospitals and doctors, laboratory tests are wastefully repeated.There is delay in starting appropriate care and outcomes are compromised.

The National Health Insurance Scheme is a uniquely important component of healthcare delivery in Ghana. In addition to improving access to medical care, it also has the ability to improve the quality of healthcare delivery. It must be strengthened.

Attitude to quality

The aspiration to give quality medical care should be ingrained in the thinking of all healthcare workers and administrators. It should be the legitimate expectation and demand of all patients. We need to strengthen the regulatory bodies, the Medical and Dental Council, Pharmacy Council, Nursing and Midwives Council and Complaints Department of the Ghana Medical Association.

Patients and family members should know how to contact these regulatory bodies easily when they need to. The work that these bodies do on behalf of the welfare of patients should be made more public and the medical profession should reiterate its commitment to the welfare of patients. At the very least to do no harm.

Recommendations

Let us make healthcare quality part of the psyche and operational activity in our hospitals and clinics. Let us make compassion central to how we take care of patients. Let us respect our patients and their rights. Let us train more nurses, doctors and other allied health workers.

Let us train our medical and nursing students to become highly knowledgeable and safe doctors and nurses. We should also teach them that compassion, empathy and respect for patients are important; that patients have rights.

Let us start using clinical protocols and pathways in our hospitals to standardise care, improve outcomes and reduce waste. Let us explore the use of electronic medical records in our hospitals and electronic health records in our public health system. We have the infrastructure already in place to, at least, start.

Let hospitals, especially in large cities, improve emergency care for emergency patients, especially at night. We can do much better even with what we already have. Yes, we really can if we want to.

Let’s do it……. and……please, no excuses!