A PARADIGM SHIFT IN HEALTHCARE DELIVERY: LETS BE BOLD.

The Rot in the health sector
There is massive rot in the health sector. Anybody that doesn’t agree probably doesn’t live in this country or is probably such a beneficiary that he/she doesn’t see anything wrong with it. In other words , it has become the new normal for such people.

WHETHER in the big hospitals like KorleBu Teaching Hospital, Ridge Regional Hospitable, Tema General Hospitable, Konfo Anokye and Tamale Teaching Hospitals OR in the smaller hospitals like Nandom, Jirapa, Nadowli, Mampong or Nsawam, the rot is massive and deep rooted.

This rot exists in different forms at varying levels. At the lowest levels, the players include laborers , ward maids, and drivers. Some of these are known to have acquired many properties through extortion. The commonest practice is to collect money from patients in order to facilitate their seeing a consulting doctor who, in all honesty, has no knowledge of what is going on. These patients are then presented to the consulting doctors as their relatives or friends. And because the doctors know these laborers and ward maids who sometimes run errands for them, they would proceed to attend to these patients. These patients leave the hospital assuming that the doctors indeed attended to them speedily because of the money they paid. Ambulance drivers are notorious for determining where a patient should be sent for an investigation outside the hospital depending on what arrangements he has with particular facilities and not necessarily what the doctor wants.

The next level consists of the revenue collectors. Their practices range from non-issuance of receipts to issuing fake receipts, writing of different amounts on the original and duplicate/triplicate/quadruplicate receipts as well as outrightly not accounting for collected revenue.

Another level involves the technical staff . These mostly work in the laboratory, physiotherapy and radiology departments. Most hospitals are not computerized and therefore it is easy to walk into the radiology department and have an X-ray done just by paying money to a radiology technician and walking out with your X-ray. It is even worse in the laboratory where technicians are known to collect money from patients and issue them with fake results.

At the level of the pharmacy , it has to do with diversion of hospital drugs to privately owned pharmacies, conniving with pharmaceutical companies to supply either expired or almost-expired drugs to hospitals and shortly thereafter writing them off and selling of highly-controlled drugs like pethidine, codeine, morphine and other painkillers to drug-addicts at very lucrative prices.

The doctors and nurses also have their litany of sins. Some doctors are known to extort money from patients through the use of fear. Sometimes more expensive but unnecessary procedures are performed simply because of the higher price. But the commonest sin of doctors in public hospitals is , not staying long enough at work but rather spending more time doing ‘locums’ or in their private practices. Some senior doctors even coerce junior doctors to work in their private hospitals instead of in their hospitals of employment. Patients from public hospitals are frequently diverted to these private hospitals. And of course, there’s the proverbial collusion between prescribing doctors and pharmaceutical companies as to which medications to promote over others but that is a topic for another day.

Finally, Hospitable administrations are at the highest level. Most hospital administrations are not transparent. They hardly consult the end users as to their preferred consumables. Most times very low quality consumables are dumped on doctors who are unable to use them. Hospital equipment are acquired without due consultation and therefore end up being white elephants. Hospitable administrators are so powerful that it is not surprising some very good doctors, including rare specialists, decide to abandon their practices and also jump into the bandwagon. It appeared that was the only way to also control a budget and make good money for themselves. In jurisdictions that work, a surgeon is happy proving his worth in his theater not as an administrator . In any case, he earns more as a surgeon than as an administrator so there is no incentive to abandon his practice.
But still the biggest scams occur at the level of the Ministry of Health. A few years ago a multi-million dollar contract was given to a party faithful to provide hospital equipment for all the regional and some district hospitals and I can say on authority that MOST of them have not worked from day one.
If we think the scandal surrounding the Aayaalolo buses is gargantuan, I’m inviting Manasseh Azure Awuni and his team to investigate this broad daylight thievery of our scarce resources by people who don’t care about the rest of us.

What is the root cause of all the Rot?
I’ve long diagnosed the problem of corruption in this country and in one of my articles that was published in the Daily Graphic in 2015 , I titled it “ Corruption in Ghana: our Culture is to blame”. In that article , I listed several examples of our local practices that tend to promote corruption. Since Osagyefo Dr Kwame Nkrumah left the scene, Ghana has not functioned as a nation in the true sense of the word. In Ghana , and maybe Africa as a whole, we are more attached to our families, followed by the clan , then the tribe, and maybe finally to our district or region. As a result, the nation Ghana is a foreign entity, in fact a big elephant , which everyone is struggling to cut for his family, tribe, clan and so on. There is no sense of ownership of the nation Ghana. And this explains why when people commit glaring crimes against the state, you would always find people who don’t see anything wrong with that person and would do everything possible protect, defend or intercede. So in the end, nobody gets punished. And once nobody gets punished, more and more people are emboldened to follow suit, as long as their deeds benefit their family, clan or tribe. Therefore, anything with the label ‘government’ on it will NOT work. It is alien, it does not bring out the optimum in people.

Please note that all of the rot i have described above is not only in the health sector. Indeed it permeates through all MMDAs. If not, why do you think the current government, after coming to power through the anti-corruption crusade, is finding it difficult to prosecute anyone? The government’s own Minister of Justice and the Attorney General is frustrated that other ministries are not
Cooperating and forthcoming with documents to facilitate prosecutions.

How all governments, after Kwame Nkrumah, failed Ghanaians.

Because our first president had a concise vision for Ghana, he made sure he sent hundreds of students to various countries to train in all the relevant professions in order for them to return to help build the nation. He therefore took special interest in their studies and ensured their return.

Unfortunately, after his overthrow , we made no attempt to bring back our foreign trained professionals. Those that returned on their own were treated like they were not needed. Overtime, most of them refused to return. Yet these were people we spent our scarce resources to train. They remained in the developed countries to help them develop even further whilst we stagnated.

Even worse is the situation where we trained doctors for so many years in GHANA virtually for FREE and helplessly watched them leave in droves to travel out to work in the developed countries without making any effort to get something back. So, whilst there are whole districts without a single doctor , we can boast of hundreds of Ghanaian doctors all over the world helping other countries achieve quality health care for their citizens. It is almost as if for us quality life doesn’t matter.

Two reasons why Government cannot continue to be the major provider of health care.

0. Currently, there are numerous health facilities in this country that are not operational , yet there are hundreds of nurses wasting away at home. To a lesser extent, it also applies to doctors who have to stay home for several months before being posted. The recurring cause of this is the lack of financial clearance to employ them.

0. Some health professionals don’t put in their BEST in government hospitals. This is partly because there’s no sense of ownership. So, why would they kill themselves? After all , whether they spend one hour or the whole day in hospital, whether they attend to five or a hundred patients , the pay is the SAME. The result is that most of their time is spent either in their parallel practices or in doing locum. Ultimately, the hospitals and the nation lose.

What is the way forward? My prescription , the paradigm shift.

Having noted that anything with the label ‘government’ on it does NOT work, that it is alien and does not bring out the optimum in people , it stands to reason that we should be looking at reducing the involvement of Government in running services in this country, especially in the health sector. Government should play the role of a facilitator, the ‘ engine of growth ‘ and let private people take over.
0. Government should encourage doctors to form partnerships/practices to take over the completed but idle health facilities to run for themselves. These practices would employ their own staff and be responsible for their salaries and the equipment. Government would collect rent or a percentage of revenue and also collect taxes from the workers. This arrangement encourages a sense of ownership and responsibility and this in turn would bring out the best in them. Whatever they earn is theirs but government doesn’t lose anything.
0. There are several Ghanaian doctors abroad who want to return home but don’t want to work for government because government cannot pay them well . Meanwhile they cannot build their own hospitals because that’s capital intensive . Government has the resources to provide the infrastructure for them to operate.
0. Some people argue that if we allow private sector driven health delivery it would be too expensive. I say , that is why the government should ensure that the National Health Insurance scheme works properly. Every Ghanaian must be encouraged to pay towards his health care. Healthcare cannot be free especially in a situation of competing demands. Ghanaians must be educated to know that without good health they cannot enjoy their families, good cars or big houses or whatever. We can also find ingenious ways of taxing everyone for health insurance. In GHANA , even so-called poor people use mobile phones and make calls. The talk tax should be given to health insurance.
0. Government should also discipline itself by not dipping its hands into the coffers of NHIA. It appears because it is an easy source of income, there is always the temptation for government to divert the accrued money for other unrelated projects. Why should MPs have access to this money?
0. Government can handover its hospitals to the NHIA to manage since they deal directly with the service providers and together they would be able to agree on charges acceptable to all.
0. Above all, our public officials MUST patronize our local health facilities as a show of faith. I insist that once one decides to become a public official , it should be compulsory. Otherwise remain a private citizen and no one would bother if you decide to go to MARS for healthcare.
0. I know it can be done if we put our mind to it, educate the people and demonstrate political will.
0. This arrangement would also minimize the incidents of outright corruption . Presently, because everything is government, people can use their political connections to obtain contracts to supply non-functioning medical equipment throughout the country worth hundreds of millions of dollars . This is more than murder. This cannot happen if the hospitals are privately run.
0. Let’s be BOLD. Let’s think outside the BOX.

By Andrew Kaminta.

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