Quality of health care and national development
Recently, a good friend asked me if my insistence on, or as he called it, “your crusade” about the quality of healthcare delivery in Ghana was not putting the cart before the horse.
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That is to say, how can an underdeveloped country such as Ghana be able to provide quality healthcare outcomes comparable to what pertains in developed countries?
According to him, we do not have the calibre of physicians and nurses as pertains in the developed countries. We do not have high-tech equipment such as MRIs, PET-Scans, Gamma cameras, Catheterisation Labs, etc. as they have them in developed countries; so how can we have comparable quality?
Implied in his questions was what he did not say: that I probably am advocating this quality in healthcare outcomes because I have worked for a major part of my career in the United States (US) so I am being unrealistic, and that we should wait until we are “developed” before we can realistically expect to have the quality health care that I am talking about.
He is wrong. First, talking about and insisting on improvement in the quality of healthcare delivery has nothing to do with comparing Ghana to any other country. We are talking about improving what we have so that patients do not die of absolutely preventable causes even in our current health system.
A patient dying or suffering because of negligence or an emergency room turning him or her away has nothing to do with national Gross Domestic Product (GDP). A patient dying because a major hospital does not, as a practice, check oxygen saturation with a piece of equipment that costs less than a US$100 has nothing to do with underdevelopment.
We can do better, much better, with what we have and we cannot wait because life should not wait.
What we have done and what is the core problem is that we have, as a society, accepted mediocre healthcare quality as the norm.
We are not shocked by preventable deaths and patient suffering.
We have become immune to poor quality.
Most doctors, nurses and health managers seem to go to work day in and day out and do the same things without asking and, more importantly, challenging the system to do better, to improve.
As a society, we are not shouting enough about poor healthcare quality. A shout from one or two aggrieved patients or family members gets drowned by the silence and inaction of a fossilised, unresponsive system.
We are all to blame for this acceptance of an unacceptable situation. It is when we demand quality that we can search for and find the solutions, home grown, Ghanaian solutions that do not involve some overly expensive equipment. Even where we have to increase budgetary spending, we will know where to spend in order to maximise quality and efficiency if we are focusing on the quality solution.
It is true that we do not have as many highly skilled specialists as there are in developed economies. It is true that we have horrendously high patient-to-doctor and patient-to-nurse ratios. It is also true that we do not have some of the high-tech equipment my friend alluded to.
Yes, the percentage of our budget that we expend on both public health and institutional care is very small compared to, say, the US. And yes, we are not a rich country, but the fact that one is poor does not mean one has to have a dirty home. You can have a clean thatch-roofed hut in rural Ghana and also have a dirty mansion in Trasacco Valley, in Accra. It all depends on the occupants.
Well trained health personnel
We train our doctors and nurses very well and that is why they do so well when they go out there to work. Of course, we can always improve the training but we do have good medical schools and nursing training colleges, so the quality of training is not the problem.
We need to train more doctors, nurses and allied healthcare professionals. We need to train tonnes of them. We need to continue to train them well. Most importantly we need to train them to develop a sense of enquiry, yearning for improvement and caring deeply about their patients’ welfare, enough to become advocates for improvement in healthcare quality and the safety of patients.
Of course, we also need more tertiary hospital beds and high-end medical equipment and services. We need more specialists, even the exotic ones. That will be great but that will not help us in the least if we continue to accept mediocrity and be apathetic to this quality question and not develop innovative, native solutions to the challenges in healthcare delivery.
We do not need to become a rich nation first.
Our cart is rightly placed behind the horse. We just need to know in which direction we should pull it.
The writer is a Physician Specialist