Hospitals in Ghana

Monday Jun 10, 2013 -

This week let’s talk about hospitals. The good, the bad, and the ugly. Again, I will emphasize that our aim for these discussions is to identify problems and offer suggestions for improvement. Criticisms are always difficult to hear, especially when they are directed at you or your institution. But I believe that they are extremely useful if one genuinely wants to improve and do well.

In previous weeks, we asked: What is wrong with our healthcare system? How do we take care of the seriously ill? Most of the responses pinpointed problems that occurred in hospitals but could also be referred to an inefficient healthcare system. This week, we are concentrating entirely on hospitals themselves and experiences within their four walls. Both public and private. No sacred cows (if you get what I mean)!

Are our hospitals clean or are they dirty? What about the registration process? How long did it take you, or your family member, or friend to be attended to by a doctor? The nurses and how they treated you or your loved one. The doctors? How was your room? The beddings? Your experience at the laboratory, at the pharmacy, at the X-ray department, at the Physio department? How did you get your drugs? At the end of your admission or clinic visit, did you feel good about your experience in the hospital? What was done well and what went wrong?

In short, did the hospital meet your needs both in terms of quality of clinical care and service delivery? What can we do to make things better?

On the flip side, let us also hear about the good things. It is not all doom and gloom out there. There are some hospitals that are doing their very best for their patients. There are doctors and nurses who are dedicated and who care and are providing excellent care even under difficult conditions. They need to be recognized and applauded. Was there a doctor who did his best for you? The nurse who went the extra mile? A hospital or clinic?

For the healthcare professionals on this blog, I have three questions:

  1. What do you think of grading all hospitals in Ghana? By grading I mean hospitals and clinics should be categorized into different levels (e.g. Level 1, 2, 3 or 4) based on the services and equipment they have. The clinical expertise and staff they have. Do they work 24/7 or not?Do they have emergency services? What clinical services do they cover and what do they not etc. This information should be publicly available (this is the most important part) especially to a patient in an emergency trying to find the right hospital to go to, say in Accra, or Kumasi. I believe that a publicly (and readily) available grading like that would save lives.
  2. What do you think about recommending autonomy for our healthcare institutions, especially the big ones? In previous comments, Dr. Asare (Disrespect, rudeness and irresponsibility) and K. Ennin (Doctors’ Strike) had hinted of or talked about autonomy for hospitals in order to improve quality, to give the administrators some control over bad physicians and nurses and to improve profitability, so that hospitals can employ their own doctors and improve their services. What kind of autonomy would you envisage?
  3. What will be your ideal hospital in Ghana? If you had to develop a hospital, de novo, in Ghana what will be your end product?

I suspect that there will be a lot to talk about hospitals. I will not be surprised if we go into next week with “Hospitals in Ghana, Part two!”

Dr. Joseph Boateng

About Dr. Joseph Boateng

Dr. Joseph Boateng is a Physician Specialist. He has practiced medicine for over 31 years. He has extensive medical management and leadership experience as Medical Director or Deputy Medical Director for several hospitals in the US, Ghana and Nigeria, and as the managing partner of a medical practice he founded in the US.

60 comments on “Hospitals in Ghana

  1. 1.Our hospitals are very dirty and ill equipped. The main problem with our hospitals is bad management, lack of supervision of staff , lack of knowledge and skill in usage of equipment , poor maintenance culture and apathy of staff due to no motivation from management.
    2.Autonomy in our hospitals won’t even solve our problems. We need to get some American
    health administrators to implement a complete haulage.
    3. None found here. Pity !!!

  2. I dont know about how the grading system applies or will improve on the situation at our mental health care institutionms such as Ankaful, Pantang, Asylum, etc.
    I have a personal experience where a family member with mental problem has been sent to one of these hospitals for care. The situation is bad! – this relative of mine is wild and attacks people and property, has had close shave encounters with vehicular accidents, etc
    It has become impossible to handle such a case at home and requires admission to a health facility – a point which the doctors agree and yet are unable to do so!

    Reason: “Government moneys” have ceased being payed so all patients are being discharged and new ones are NOT going to be admitted.
    The family is prepared to pay what it takes to secure a better medical care but to no avail!
    In this circumstance, we are at a loss. Whether these proposed schemes will help in this regard is hard to tell for a layman like me, but clearly, human dignity requires us to do better than we’re doing to our mentally challenged folks…

  3. Another great topic for discussion from Dr Boateng.I am sure we are going to hear a lot of heartbreaking stories this week with people’s experiences in our hospitals.Unfortunately the bad experiences end up staying with us for a long time.We should not forget also that there are doctors and other allied health personell doing a great job in Ghana with the limited resources they have at their disposal.
    I recently had a first hand experinece with the health care system in Ghana specifically at the 37 millitary hospital in Accra.Upon the recommendation of a friend a we met 2 specialist(ENT and Neurologist) who evaluated my mother.I must say that I could not ask for anything better.They took their time to get her history and examined her thoroughly. They were very kind to her too as she is in her mid 70s.
    By Ghana standards i thought the registration process was efficeit at 37 and the ladies were polite.We finished that in less than 20 minutes.The only problem was the MRI place was less efficient as they sent us back to the pharmacy to get the contrast material while my mom was waiting .They could have easily stocked some of that in their office to prevent such delays.Overall I was VERY IMPRESSED with the care my mother got and I will make sure she follows up with those same doctors next time.
    I think people doing good jobs like this should be commended.Its not all doom and gloom out there.There are bright spots and so the same way we criticize the problems in the system we must also bring out the good stories.Thanks

    • DrAlebi, thank you very much for this comment! Your comment brings out the essence of this topic.

      I have also met some really great doctors and nurses, in Ghana, who really care, are very professional and excellent clinicians. Then I have met some atrocious and arrogant doctors and nurses who could care less if Jesus was a patient. Unfortunately the impact of the bad ones on the public perception of doctors, nurses and hospitals seems to set the “norm”. They are the experiences that patients remember and talk about.

      It is very important, therefore, to “out” the bad nuts. Let us sensitize the public so that they will refuse to accept the poor service, the unprofessionalism, and the irresponsibility of the bad guys.

      Our medical system has challenges but it is not broken. It needs tweaking through better administration, as the first commentator noted; patient protective legislation (Patients’ Bill of Rights); through increased responsibility of hospital maintenance crews; administrators, housekeepers etc. and everybody who works in healthcare. We need to craft innovative ideas to improve efficiency, quality and reduce costs.

      The solutions are there. Whereas some are complex and difficult, a lot of the solutions are pretty simple. We just have to become motivated as a society, as a profession, and as a government to find them.

      My hope is that subsequent comments will further illustrate this paradox and help us shape ideas to make things better.

  4. I look at the topic and I do not know where to start!!!!

    First emergency care for is practically non existent for most people.

    Second, people die needlessly because of poor or non existent preventative health care.

    Third , the diagnostics tests have improved but are very expensive; the man on the street( Yaw Berko) cannot afford it.

    Fourth,accountability of staff , doctors and nurses particularly is none existent. People die from poor practice without anyone being held to account for these deaths through the length and breath of the country, including the so called good hospitals.They make life look so cheap!!!!

    There do not seem to be nationally acceptable policies and procedures to guarantee best clinical practice, standards against which best practice can be measured. This is not taught in our medical schools and nursing colleges.It should be taught as a matter of urgency. I know attempts in this area by a doctor friend and his wife whose is a nurse was badly frustrated by their colleague professionals.Clearly its unthinkable for those of us who work in health care system abroad to comprehend this madness.

    Further, there is no ombudsman system for aggrieved families to complain about poor clinical practice to. Some doctor friends tell me stories about quack and dangerous practices they have seen or have been parties to that have gone unpunished.

    Finally a coroners court system is needed. This would seek explanation for avoidable and unusual death following care in any hospital.

    I am not sure these are unheard off ideas. The problem is no one seems to have the political and professional will to implement measures that will hold health professionals accountable for good and poor practice.This must change!!!!

    • Very good points, we need to make these changes to protect our loved ones. The push back from some of our colleagues should not halt our efforts. It is my hope that these discussions results in major changes for a better healthcare system in GH.

  5. Interesting topic and am happy for the platform. The system is actually broken but fixable. At the top of my list is the political system. The politicians and their families do not use the Ghanaian healthcare system so they could care less about therest of the population. Secondly the nursing training is bad. Most of the Ghanaian nurses are not knowledgeable because they are trained as secretaries to the doctors. They do not understand any rationale for any procedure, poor assessment skills , and are definately not a patient advocate. Most of the doctors are also not knowledgable and that could have something to do with residency. Do remember that medicine is a practice with evidence base. A lot of diseases the doctors have no knowledge of because they simply have not come across it. Citizens of the country are ignorant and our medical system still have a paternalistic approach so we can’t question a doctor.The other aspect of healthcare is not thought anywhere in the world but a matter of will. Basically we cannot teach anybody to care but we can teach them to be a docteor or a nurse. To be a little bit soft i think that there are some healthcare workers who care and thats whoom we are referring to as good workers. The grading system is a little bit too sophisicated for our system and i personally think a baby step should be taken . For example i dont think workers are oriented properly and also given a job discription. Somebody made mention of human lives being worthless and that sum it all. We do not need touch on the wage distribution because thats rediculous. A health care worker is nothing but a civilian in uniform and after a long days work they still face the economic problems of the country. it is very difficult to retun the same favour the following day. Management is totally non existance, accountability is absent. Licensing of these healthcare workers should be thighten up but how i dont know. Frequent in service should take place in the hospitals. The fetish priest and herbalist are held in high esteem because at least they have good listening skills as well as good communication skills. Another sad part was the guy who talked about mental health. What i see in Ghana is that all mental health diagnostics are bad. We cant differentiate between schizophrenia and bipolar disorder. We cant seperate mania from alcohol or street drug induce psychosis. No psychological services but just a wholeale medicine. I took a child with asthma attack to a clinic and the nurse just told me to wait in line. The shorter part of the story is that i told her about triaging she thought straight up that i was a fool. Any way i insisted that if you dont take care of this child sooner it will change into cardiac problem then death. A young doctor overhead me and came to my aid. What about the rest that die from this nonsense. Sir there is to much to talk about and thanks for this forum. Lets educate the masses and collectively we will have a better healthcare system.

    • GF, i agree with you that the system is broken down. But TOTALLY disagree with you about our educational system. Until the inception of the JSS/SSS system, Ghana has one of the best educational system in the world and abound in some of the best doctors/nurses in the world who were trained in Ghana. Apathy, arrogance and indiscipline are some of the reasons to the chaos in our health system. Management will remain toothless as long as the board of directors will be made up of politicians who have no background and experience in healthcare, but are appointed by the president.

      • Thanks much for your response. Your opinion is well noted and much respected but not accepted. We from the third world country always praise our education which is very good because we are full of self esteem. The truth of the matter is that we don’t produce anything and am using production in the broader sentence. My point is, education is useless if the application is absent. You went back to the olden days and that’s fine . we had some great doctors and nurses per your claim but health care didn’t improve. Cholera, typhoid and simple surgeries like hole in heart were performed abroad. My friend higher education is relative depending on the standard set by the people. there is no doubt Ghanaians thrive when put in the right situation but we are talking about the situation in Ghana. If the masses don’t know the symptoms of malaria then you can always diagnose them as malaria ,give them a paracetamol and antibiotic and that lead to a good doctor. You get my point? The problem here is that the clinician in question is now creating another problem with the prescription of antibiotic which is a whole different story. That’s why medicine is called a practice. The person could have a good education but not a knowledgeable practitioner. The knowledge base of nurses are poor that’s why the system have shifted to degree nursing at the university. There is a fine line between the nurse and the doctor but the nurse spends 90% of the time with the patient and is required to know early symptoms and early intervention of disease process. This is vital for recovery, prevention of death and life of the doctor is made easier. Please do understand that this is a constructive criticism to help us achieve a common goal. am looking forward to reading and learning some new things from you thanks.

        • 1. We from the third world country always praise our education which is very good because we are full of self esteem. The truth of the matter is that we don’t produce anything and am using production in the broader sentence.
          This is not about SELF-ESTEEM. I would rather praise the American educational system that gave me my degree for FREE and sometimes with surplus from my financial aid. Although a ghanaian, the system qualified me for TAP, PELL and others. I would give you a practical example, during my first semester in College in USA, i had to take elementary algebra. This was a major pre-requisite to my intended program. I would never have been admitted into my major without elementary algebra. Guess what, elementary algebra is taught in JSS in Ghana. All the Ghanaian in my class had to show up in class for attendance and then leave for the library. Same go for english language. I lived both worlds and walked thru both educational systems, without apinch of self-esteem.
          How can we produce, when everything in Ghana is politised? Debateablly had we continued from where Kwame Nkrumah left us, we would have been producing, we rather sold everything that our pioneers left behind. Ghana gained independence around the same time with Malaysia, can you put the two countries on the same scale today? Malaysia had selfless and patriotic citizens while we are surrounded with selfish leaders who are bent on raping the nation by hook or crook. All they care about is to build posh HOUSES and own a couple of gas/petrol station. Every sensitive position in our country is occupied by a beaurocrat and not a technocrat. How do you expect us to be creative when half of the grant is split by politicians in power. Ghanaian doctors and nurses thrive in advance countries because their forefathers worked to build the country and not build for their families.
          2. There is a fine line between the nurse and the doctor but the nurse spends 90% of the time with the patient and is required to know early symptoms and early intervention of disease process. This is vital for recovery, prevention of death and life of the doctor is made easier.
          I do not know much about the procedure with the Ghanaian healthcare system, but i can emphatically tell you that the nurse can never prescribe nor administer any drug, be it early intervention or not, without the instruction of the doctor or the PA. Remember, everything has to be documented in the patient chart and it has to be the doctor’s/PA signature.

          • Thanks much for your reply. in regards to the nurse cant administer any medication be it early intervention or not my friend you are wrong. There are standing orders in Emergency,ICU ,Telemetry you name it. A nurse does not need to call a doctor before administering medication when the monitor is reading a ventricular tachycardia. The nurse is expected to use an independent judgement,critical thinking and administer medication. In the ambulance the nurse still calls those shots till arrival at emergency room and this are knowledge based practices. It has nothing to do with how high your basic educational standard is rather based on the post training and on the job training. This things do not exist in Ghana so we accept the status quo. The question here again is not about how good the education is but how effective. US is given you the chance to educate because every human is capable of unless you choose to defeat your own purpose. My friend i see you are very patriotic to your country and for a change i say amen but the problem still exist. Regardless of political situation do you think we should pay for healthcare to ensure autonomy? Can you give me an example of a workable strategy to help solve Ghanas healthcare problem.Malasia being a teocratic country had an understanding that science and technology develops a country not prayer camps.Thats a whole different argument but what could be done at this time. sorry for all spelling mistakes. Thanks again for your points.

    • No words minced, the truth hurts but should wake us up to take action.

  6. please can some one tell me if, when people in Ghana go to a public hospital do they have to pay ho is it free. Thank you in advance, regards .

    • Sam, what I know is this: patients who have insurance such as the NHIS have a predetermined set of services that the insurance pays for which the patient does not pay anything for. There are no co-payments or prepayments. Any services outside this list, however, has to be paid for by the patient out of pocket.

      The NHIS also covers a list of approved drugs that it will pay for. Anything outside that list will be paid for by the patient. In some situations the patient may be required to go outside the hospital for laboratory or radiologic services or buy drugs from private pharmacies. In those situations the NHIS will pay if the services or drugs are covered and the private facility is accredited with the NHIS.

      Some patients, even with NHIS, still pay money out of pocket during in-patient stay for one reason or the other. For example diabetics are allowed a certain number of accu-checks (say 3 or 4) during their hospital stay, anythingg over that the patient has to buy the strips.

      In short hospital care mostly is not completely free. However it is much better than the previous “cash and carry” system where the patient paid for everything out of pocket and there was no insurance safety-net.

  7. Dr. Boateng, I really agree with you that grading hospitals improve services and helps in patient in making a choice, depending on the sickness. Unfortunately, It will be very impossible in a third country like ours with limited resources. With Korle Bu being the only hospital where the entire population of Accra are referred to in case of an accident. If we grade Korle Bu as LEVEL 1 TRAUMA CENTER, which other hospitals are we going to label LEVEL 2 TRAUMA CENTER? Especially when most of the clinics do not have 1 xray equipment.
    I would rather suggest cooperate bodies(Daily Graphic, Times cooperation, GBC, TV3,ect) should initiate awards for hospitals and clinics in the following:
    1. BEST HOSPITAL AWARD
    2. BEST ICU AWARD
    3. BEST CARDIOTHORACIC DEPT
    4. BEST NURSE
    5. BEST NEUROLOGY DEPT
    6. CLEANEST HOSPITAL
    7. BEST PATIENT/HOSPITAL RELATION
    These are a few example. Hospitals can also initiate EMPLOYEE OF THE MONTH award starting with the department. This should depend on punctuality(if time keeping is efficient), attendance, appearance of employees, approach to work and feedback from patient and patient relatives.
    The government should also initiate a task force with legislative powers to inspect all clinic unannounced. Unannounced State inspection throughout the world has improve efficiency in health facilities. My only worry is that in a third world country like our, the inspectors might end up being the same ones tipping the clinics about their coming. Corruption, corruption, corruption.
    I think privitisation is the best option for state hospitals. But that will depend on an improvement in our NHIS, because majority of the population depend on it. One of the reasons why i fully support privitization is to keep the hands of politicians away from our health system. Politics has been used so wrongly, so that some of the best medical professionals have been chased away. Where are the likes of Dr frimpong Boateng??? Secondly, medical equipments can not be purchased for Korle Bu as long as the minister of health, finance and other directors would not get their percentage.
    Whilst on vacation in Ghana before President Mills administration, a friend of mine stopped at Korle Bu to say hi to some old folks. The employee he stopped to see was lamenting about the malfunctioned MRI equipment purchased. He decided to take a look, since he has vast experience in MRI. Upon enquiry about the amount purchased, he found out the price has been bloated buy about $2,000,000. Is this what we call patroitism by our politicians? At a time when most of the best hospitals in the world do not purchase such equipments but rather lease then. With an agreement that it will be fixed at no cost to the hospitals for a number of years.
    During my son’s brief stay at korle Bu sometime last year, a doctor requested xray a day after his surgery. The portable xray machine had been out of service for two years. There was no transporter, no stretcher for some one who had an abdominal surgery. We had to find our way to the xray dept in the accident block all the way from the surgical block without a nurse or NA. What if there was a complication on our way, especially using a wheel chair less than 24hrs after an abdominal surgery. I kept wondering how those on tubes in the ICUs could get their routine xrays done. God bless Ghana.
    A fews years ago, a co-worker came down with a state of the art diagnostic equipment to set up a radiology center. They include MRI, CT, xray, Ultra-sound EKG, etc. Before coming with the equipment, he was told upon enquiries that there was no custom duties on the above medical equipments. Upon the arrival of equipments he was hit with $20,000.00 customs duty. He had to borrow money to clear the equipments. He was hit with so much bureaucracy from Kuffour’s to Mills administrations that he had to abandon the equipments to return to USA. The PRO of Korle Bu can not deny this story, because he did his very best to help this young man. When some official of 37 Militry Hospital got information about these equipments, they promised to help. They decided to go into joint partnership with my friend. Shamefully those leading the partnership came with a proposal demanding 45% of the proceed as bribe. My friend refused, because he was only willing to part away with 15%. 7yrs later, the equipments are gradually rusting in his house somewhere close to Korle Bu, while Ghanaians are dying. Today he working tirelessly to pay back the $20,000. What next for a Physician Assistant(PA) with certification in MRI, CT and xray dying to serve mother Ghana????????

    • I agree with Ruth. The awards idea is fantastic. We should find a way to actualize it. A well publicized annual award ceremony as is being done for Banks and Marketing intitutions.

  8. I am curious why some of the hospitals do not have simple gloves to provide care for patients, patients should not be bringing their own gloves! Hand washing and wearing gloves should be basic education in the healthcare system for infection control.

    • Anita: it is part of the, very serious, problem of lack of basic supplies that public hospitals face. It may be due to poor management or inadequate operational income (which may be due to poor management!) or inadequate government subvention. It is a rather sad and absolutely ridiculous situation where patients are sometimes given prescriptions to go and buy gloves, syringes, basic drugs, IV fluids , surgical sutures, POP etc. from private pharmacies.

      I must admit that the situation is better than when I was a junior doctor in Effia-Nkwanta Hospital when we wrote prescriptions for almost everything: like IV fluids for a cholera patient BEFORE we could start treatment! And paraldehyde to stop convulsions in a child. We just waited, watching the child convulsing while we waited for the frantic parent to get back with the drug. Absolutely barbaric and inhuman! One of the most heart-wrenching things I have ever seen as a doctor. Can’t get it out of my mind after 33 years!!!

  9. I have always said Ghana has a lot of intelligent book long people with very little practical use of that knowledge. Everyone has a PHd but can’t come together to apply all our different ideas. Too many are selfish and don’t look beyond today to improve our system for our children or even great grandchildren.
    We certainly have issues with our hospitals and many will point them out. How do we improve it or fix it? What practical processes or policies can we put in place to improve our hospitals. What can we do to motivate hospitals to strike to provide better care than the next hospital on its level. Competition in most places improves quality of service. As mentioned early, awards and recognition needs to be given to individuals and institutions that perform excellently.
    Having autonomy over your hospital, having a personal stake in your hospital should be motivation enough. How engaged are you as an employee of your hospital to individual take steps to improve it. Will an employee walking down the hall pickup an empty can of coke to keep the image of the hospital?
    Our hospitals need to be run like a private hospital, with the intention to give the best care and be profitable in the process. Why are patients coming in from other West African countries to the cardio dept at Korle Bu? It is clean, service is great, they have great doctors and is unlike most depts in KBu. Why can’t KBu use that approach for all of KBu? The great results and service from Cardio has indirectly created medical tourism.
    The government should have very little influence once hospitals get to the highest level assigned to hospitals. Most hospitals will then strive to get to that level. Administratotors will be held accountable for not meeting goals they set. Once completely autonomous, that institutions will be accountable for mismanagement. Paying your employees will come out of your budget. You find creative wys to attract clients (patients) capable and willing to pay for your services. Why buy an MRI machine for 2 million when you can get one for 500K. The inflated prices only benefits a greedy few. If procuring it will directly affect your finances I bet you’d think twice about duping the unknown (government ) owner. Again, you know what business such an expensive machine will generate nd how it will boost your image, perform a cost analysis and purchase the most ost efficient product for your hospital. The notion that its not “‘my father’s” hospital leads to neglect and disengagement.
    I believe most employees will now have a personal stake in their hospital. The hard work will yield better bonuses. The allied health professionals will not just show up, only to sneak out for locum. Even the employees will hold other employees responsible for their lack of performance.
    One step at a time.
    Not all government hospital can be completely autonomous, but should be given a time table to reach that level. The govt should form partnerships with the private sector to improve care. Eg. If the psychiatric hospital in Pantang is falling apart, the govt should hire consultants to find a private group with the capital and resources to take over the hospital, improve the care, manage efficiently and the govt in turn just has a financial stake in it. The private group overnight has access to an already established hospital and patients and only has to mprove care and attract other patients.
    Why can’t we build a new state of the art hospital? We need one. Well, the govt doesn’t have money, right? Why should the govt build it? Again, we can build a new Medical village in 3 years if we want to. All the government has to do is to secure the site, build the main hospital, then solicit partners sitting on the side with a ton of cash to Bid for the various parts that’ will make up this new hospital. You’d need a couple of cardiology groups, oncology, endocrinology, psychiatry, O/B etc to build in this new medical village. The community will instantly grow, as housing, schools, hotels, restaurants etc will be needed. The govt owns the land, will benefit through taxes and most importantly have a new hospital for Ghanaians and its neighbors.
    Sorry for the rant.

  10. Thanks. it is time for the health administration of Ghana be modified or change for better. It is opinion that Health Administration be discentralised. All large hospitals or Teaching hospitals be made autonmous. Other hospitals are centralised and be brought under various district assemblies.
    Structure and job availabilities must be determined by the district assembly and must be professionally managed.
    The role of Central government in all these hospitals should be determined. Details for application of this proposal need be worked on with objectives of (1) making health administration to all,(2) each health administration is equipt with appropriate health administrators with the needs of each institution, and (3) effective responsibility and respect for rule of law for protection of rights of both employer and employees.

  11. So long as the primary providers of health services at the hospital (doctors) remain their own bosses in health facilities, we should all forget about improving the quality of service.Management ,in all spheres of life, is what determines the growth, stagnation or retrogression of any human endeavour.To put people with no managerial know-how in charge of such essential service as health care, is to bastardize the health of your own people.What we need to do as a nation is to change the structure of management at the facility level to give trained managers control over all categories of staff,including doctors in the hospitals.That way, all workers in a hospital, including doctors, will work under managers who have the power to hire and fire. In our current situation where doctors hold sway over everybody else in the hospitals and virtually do as they please,malpractice, extortion,poor services will linger, as doctors are so reluctant to reprimand their own subordinates.Of course, they are not trained to manage people.

    This, I’m afraid, will never materialize as doctors have constituted themselves into a cabal, snatching all decision-making positions and Directorates in the GHS and the Ministry.I’m reliably informed that almost all directorates of both the GHS and the Ministry of Health, including Human Resource, is controlled by them. There was even an attempt to snatch the Finance Directorate by a doctor.They are also scheming to smuggle an amendment to the current ACT governing the Health Service and Teaching Hospitals to Parliament to give themselves more powers over all others.

    If we dont wise up as a people and restructure the Health System and give control to trained managers to control the marauding doctors, we’re doomed,people. You can’t make a person whose actions or inactions can cost your life his own boss. They must be controlled by managers.Period!

  12. As a nurseI read with disgust the condition of our hospitals. most hospital
    buildings are collapsing for lack of repairs. brokendown medical equipments
    and above all doctors and nurses other staff who will not attend to apatient
    without taking bribes. This is not how its supposed to be. All staff are paid
    monthly and I they have no reason to demand bribes.Govt should fix all hospitals,
    supply the neccesary equipments adjust the salaries of doctors/nurses and auxially staff
    to keep them away from accepting bribes. we also need good managers to run the
    hospitals

  13. I think most of the Government hospitals in Ghana are sickening and lack of control, bad infrastructured management, even come to talk of our nurses? lack of practical and theoretical training and that is why the health care sector in ghana is not and will never funtioning.
    I believed the Government should introduced a new health care bill ( a parkage to the ministry of health) to deal with the situation or just invite us to come down and deal with situation by privatisation through a lease just like the one in the Netherlands.

    Murtala Imam UK

  14. This is an interesting topic with aspects that reach well outside of healthcare. The word autonomy caught my attention and it seems the attention of others. It is a little easier to use other institutions as examples…for this discussion, let us use VRA. In order for autonomy to work, the individual hospitals (or conveniently grouped hospitals) would be structured similar to VRA. There are several elements to this. These entities would no longer be part of the Civil Service structure and therefore allow the operation as profit oriented (or loss reduction oriented facilities). This then allows for a grading system which fosters competition.
    As a quasi-government institution, a hospital’s fees and charges would be presented to government once every so often (say 3 years) for approval for increases. It is a good thing that some form of health insurance is operating…because this provides a structure for universal care and reimbursements of costs to providers. For all of these to work, the health insurance sector must be shored-up and made to operate efficiently. The government may, additionally provide funding for the capital budget of these facilities.
    As one of the contributors pointed out, Hospital management or administration should not be the forte of the healthcare professionals. Legon used to have a program in hospital administration at the diploma level (I do not know if it still exists). Certainly, this approach requires trained personal at the Masters level or better. By the way this gives the Universities new opportunities to add to the course offerings.
    When you have healthcare professionals doing what they were trained to do and administrators doing what they were trained to do, the facilities stand a better chance of being run properly.
    The 10% skimming off the top of contracts will be lessened and more money will go into care.
    In a structure like this, job retention becomes important to the professionals in the system. This means that any standards developed (for example, patient confidentiality) become easy to implement.
    I must say that the issue of bad attitude in the workplace is not only an issue in the health delivery system. It cuts across in industries and is especially prevalent in institutions controlled by governmental entities (central, regional, district). In order for these proposals to work,there must be government’s willingness to let go, professionals desire to stay within their spheres of training and expertise, the patient’s ability to ask for his entitlements, etc. We must keep in mind that it is still a risky endeavor as the healthcare system is still not going to be working in isolation. If access roads/streets need to be fixed, if garbage need to be removed, if the police have to help keep order in the hospitals, if the judicial system will allow cases to go thru expeditiously, if…if…if…,then maybe there is a chance that things will work out.

    • Its sad to be reading such things about our beloved country especially the health system. The problem we are facing is mostly caused by politicians managing sectors they have no clue about.
      If they have the knowledge about the use of diagnostic equipments and its benefit to our nation, they will not demand bribes and unnecessary duties to be paid. This have led to many benevolent individuals and organisations to defer from coming to our aid. We also need lots of health education as we are fond of waiting for long periods with illnesses at home before seeking medical attention.
      I can assure you that our health professionals have attained good knowledge to render better services but frustrations of working with little or no resources have turned some against their ethics.
      We need to improve upon the quality of care given to our patients and that will increase their confidence in the health service and alley all fears.
      (Do unto others what you want others to do unto you) so goes the saying. We should therefore do our best to render the care as we would like to be cared for.
      To our politicians, it is the people that makes a good nation not you the leaders and so their welfare should be your priority. We know the doctors and nurses cannot be paid for services rendered but something can be done to make life much better for them.
      To my fellow ghanaians, the nation belongs to us so let us stop our selfishness and rather help to build our nation. Let all unite in our small ways to uphold, build and defend the good name of Ghana.
      Thank you.

  15. First, we have to change the culture of our people. We hail the dead, spend our future to bury the dead. It has become a tradition and a competition. I wanted to start emergency medicine in Ghana. After consulting with the expects, the question was, who was going to pay for the service?.most cardiac arrest could be reversed if CPR is initiated immediatly . That means, I need to train people, pay them good, buy the buses to transport these patients to hospitals with the appropriate level of care, and get paid to continue the programme for every one who might need it in the future. Well, I had to pack and come to the States. The truth, barriers, and the attitudes of the people I intend to help was so evident.the consultant took me around a particular hospital and I saw ambulances packed there. What?, so they have ambulances, so what am I doing here with all these ideals?. Well, these ones pick the dead and the families will actually pay the driver, and give a bottle of liquor to the driver. All I was being told was that my customer want another product from what I intend to give them. What a shock!.i want to reverse some of these untimely deaths in Africa, give my people another chance in life, but the very people you intend to help don’t even see the need. I have seen various governmental officials travel abroad for care. These same people could have donated their money to help improve on the healthcare for all so that by the time that they need help, the trained guys would have been expects to render care to them.everyone needs a care system at the backyard not distant places.i hope that some body wishes same for my people. I wish that every locality would have an emergency system to prevent some of these untimely deaths.

    • Yaw, we both know how easy it is to have basic life saving skills ie CPR. If this is even taught to all JHS,SHS students, can you imagine the impact it would make? In this county , people die needlessly because politicians make plans about our education and health without contacting professionals.I dont even know the phone number for the national ambulance service because it is simply too long to retain in my memory, moreover they would probably demamnd money me if they show up at my house so why bother. We all want the best for Ghana, but if our people are not educated how will hey even know they are being short changed to even demand for more. I been practising for a short time, but i had already lost hope and i grew weary everyday. I actually had to give myself a pep talk to psych myself before going to work everyday-so many needless deaths!i have now found my place in the private sector which is why i am a strong proponent of the need for ultra modern private hospitals to give afforadable, accessible and quality health care.

  16. The nurses and the dorctors at ER they are the one is killing people in ghana , they don’t no what is ER mean, I think we have to bring the nurses and the from USA to show them how to work at ER.

    • Hope you will not be surprise when you find out that nurses and doctors who will come down from USA to help you will be led by your fellow ghanaians working abroad. Will you reject them because they are ghanaians or you will accept them?

  17. You the doctors yourselves are half educated.You know nothing.All you know is strike,strike and strike.Our women are dying in your hands for simple fabroid surgeries.The usual prescriptions for malaria,finish!.Ghanaian doctors are a disgrace to the medical profession.Shame!.

    • Edward, while I will admit that there are some unprofessional, arrogant and negligent doctors in Ghana, I would not say that that applies to all the doctors in Ghana. Some are very good. Some are indeed brilliant physicians. Indeed most Ghanaian doctors are very well educated. The best testimony of that is how well they do when they emigrate to the developed economies after their basic medical training in Ghana. They do very well out there. So the problem is the poor system that they work in in Ghana. So as much as we may criticise some we must commend the majority who are doing their best under rather difficult conditions.

      Let us identify and find solutions to the systemic problems that make our healthcare delivery so distressing to patients. Of course that includes identifying the bad doctors and sanctioning them or even stopping them from doing harm.

  18. Are our hospitals clean or are they dirty? I will like to make my suggestions by answering these questions.
    What are our attitudes as a people to hospitals?
    What are the attitudes of donor organizations/business(local and internationals towards hospitals?
    What do we know, hear,expect from the NHIS scheme.?
    I happened to be at the scanning center of the La General Hospital and guess what I noticed.It was a newly built block because someone from somewhere was visiting the country for the first time and that hospital happened to be one of the places of interest.Now, before the start of the scanning and when everyone was sitted, a nurse in pink gave a 15mins talk on the need to keep the hospital clean.What did l see the the end of the the scanning section, from 9am-12noon.The good people of our beloved country who patronized the block flooded it with black plastic bags,take-away containers,ice cream and ”pure” water sachet just because we were advice to increase our water intake.There were trash cans just infront and at the back.It was not hidden.Writtings on the hospital restroom walls.l remember vividly as a child,an INFORMATION VANS had occasionally preach all kind of sermons about healthcare in our communities.This happens in the early and and the late hours of the day.What do we do with all those informations? Resources were wasted.It is true that hosiptals are in bad shape but what do we do to the few existing ones we visit? It is a government structure,l paid for my services ATTITUDE.Well government come and go but hospitals remains forever.l blame part of the problems on us and suggest we change our attitude.Again our mentalities about hospitals must change.Im saying this because people are found of rushing moderate cases to KORLE-BU when it can be taken care of by clinics 2miles away thereby creating unnecessary queues and pressure at the big hospitals.It took a whole breath out of me to convience an antie that her minor surgery can be taken care of at La General instead of rushing to 37,korle-bu or Ridge.To our surprise the surgeon has just been tranfered from Korle-Bu .I suggest hospitals nearby and their specializations should graded and published. Some of the issues can be related to POOR Doc-patient ratio currently.
    My second point is about how organizations/business(locals and international) have paid less attentions when it comes to healthcare.l read on this forum where someone make a point about inadequate GLOVES for patient care.The sponsorship is always about the sports or the music industries forgetting that when there is a disaster at the stadium, it is our hospitals what suffers.Even when it comes to healthcare, MOST of the time the psychiatric or the foster homes are being considered.Don’t get me wrong?That is what l have known as a child.Bussiness in Ghana sponser expirates musicians and lm sure they walk away with fat checks-tax free meanwhile,l heard NO MERCY for importations of medical equipment when it comes to taxes though the obvious might not always be true.Now, My suggestions,Whichever policy bounds organizations/business to sponser other fields should also bound them to sponser healthcare facilities.Secondly,individuals can also donate.In this sense l will like to use this blog to appeal to the healthcare systems to encourage the public by accepting small donations such as gloves among other.I believe no contributions are too small or too big.
    Again, for the benefits of some of the concern raised on this blog,l adding my voice by saying the NHIS does not cover everything everywhere around the world.The more you buy/pay the wider and better the coverage.There are limitations,sometimes an extra fees is paid for miscellaneous.Suggestion, Politicals should stop giving the public false hope about healthcare,at the end Docs and Nurses suffers.(at the mercies of the public)

    I visited a clinic on the La Beach road near Kofi Anang center where l was asked to fill the form if l can and call for help should l need one.The officials then concerntrated on those who can’t fill it due to one reason or another.Photocopies of NHIS card was taken care of by the clinic.When it was my turn,the NA’s handled my file/folder beautifully and accompanied me to the Doctors room.ooo that was awesome!.In that same hospital/clinic,( l do not even know which of grades it falls under)immediately l dropped my presciptions at the pharmacy, an official took a quick look at it and alerted me that it was not covered.At least that saved me time and the tragedy of waiting in a long queue with great expectations only to be disaapointed.

  19. The above suugestions were made by the NA rossie, who will like to be known as Naana on this blog.

  20. I hear a lot of complains about the so called “BIG” hospitals such as Korle-Bu, KATH and 37 and I wonder why for so long nothing seem to improve, even with all the supports and efforts from the government. This clearly shows that a developing country like ours can’t depend on the government alone to run a successful healthcare system.

    As Dr. Boateng stated there are some good, bad and ugly ones and I think the government should set up some standard within which the facilities are to operate. Any facility operating below standard should be close down, Period! But unfortunately the system is so inefficient that no matter what you do the bad and ugly will still find means to operate. In my opinion, I think we should rather look for ways to eliminate the bad and the ugly from the system and the only thing I can think of is by introducing competition.

    All I pray for is that some day there would be more private “state of the art” Hospitals”, Clinics, Urgent Care Centers, Ambulatory Surgical Centers, Skilled Nursing Facilities, Home Health, Chiropractors, Hospice, Dialysis Centers, Physician Offices, you name them… and I believe this would ease most of the unnecessary pressure on the existing “BIG” hospitals I mentioned above. These in addition to the already existing facilities in the country will generate greater competitions and patients will then have the option to choose a more convenient and appropriate facility for the services needed. For example, why would you go to the ER at Korle-Bu for a simple procedure whiles there is say an “Urgent Care Center” nearby that you can go to and get the same procedure for a shorter period of time?

    The next thing I would hope for, when all these facilities are in place would be more private insurance companies in the country because I believe these facilities would rather like to be paid by health plan payers for their services rendered to patients instead of through a government program such as NHIS which at the moment is having trouble paying hospitals on time for claims submitted. This doesn’t help the hospitals because they need money to pay their doctors, nurses, bills etc.

    With the private companies, I believe they will ensure that they go into agreement or sign contracts with only the good or high ranking facilities which will intend generate competitions among the facilities because if you have low or bad ranking, you will not have customers or patients through the health plan.

    With regard to the doctors, perhaps the bad doctors get paid the same as the good ones especially those in the government sector. Similarly the bad doctors in the private sector still have some patients to render services to so what is the punishment for the bad doctors? First of all how do you identify a bad doctor? Is it by his or her attitude, arrogance or services rendered to patients? Some can be arrogant and have bad attitude but can render good services. Or is it simply some one who render a few services for bad results or the one with more services but bad end results. (Remember, the more the services the more the cost). In short I think there should be a proper criteria to identify the bad from the good.

    • I’d like to add that businesses can partner health workers to set uo ultra modern private hospitals which would offer higher standards of care because health workers simply aren’t paid enough to fund such huge projects. i am sure most Doctors and nurses would give anything to work for a better employer than government and to provide affordable quality health care

      • I think both Caeedoo, and Jay have raised some very important points:

        The public sector (Government) cannot provide for all the services that are needed in Ghana. Dr. Boateng had outlined in prior posts that Ghanaian doctors, nurses and allied health workers need to think like entrepreneurs by creating private health facilities/medical centers that compliment government’s efforts. I think the term he used was the “business of medicine”. I think the Ghanaian health sector is ripe for business and people (including the government) should strongly consider divesting some of the services to private groups.

        Government should also act to provide a conducive environment (tax breaks for import of medical equipment and medicines, low interest investment loans with flexible re-payment plans) for local entrepreneurs to start up practices.

        There are a few examples in Ghana such as Ortho-Focos, Nyaho, Lister; to name a few, and there is room for many more physicians with skills to fill the void so that patients don’t have to queue in hospitals to receive care from overworked, under-equipped health workers in public institutions.

        • I want to add my voice to Fambondi, Ceedoo, Jay and all contributors who have supported, either under this topic or under previous topics, a vibrant, more robust private medical practice as a serious component of our healthcare delivery system.

          I, very passionately, believe that the Government of Ghana, as a matter of urgency, should encourage and support the development of large, well-equiped, well-planned private hospitals, clinics, urgent care centers, etc. etc. as Ceedoo has enumerated.

          There should be a clear-cut national policy that not only encourages private involvement in healthcare delivery but also sets out clear guidelines of what will be permitted and what will not.

          I believe that these private hospitals, clinics etc. should be able to fill a niche or several niches.

          1. They should provide improved access to healthcare. Thus their location may be scrutinized and encouraged in places where they would improve access to medical care. Hospitals, clinics etc. which elect to be sited in suburban and rural areas or even in poorly served urban areas should be given priority and support (we can define the appropriate but attractive support).

          2. Those located in urban centers such as Accra, Kumasi, Takoradi etc. must have services that are not available in their competitive areas to receive support.

          3. All these hospitals, clinics etc. must provide the highest standard of care comparable to international standards. I do not believe that mediocrity is the preserve of developing countries. We can and should provide international standard services in Ghana, especially in healthcare. We should insist on it as a country! I am absolutely convinced that it can be achieved.

          4. Private Tertiary Hospitals and Centers of Excellence should be particularly encouraged to ease the burden on Government to provide them. Tertiary hospitals are expensive to build, expensive to run and the Government cannot fund these hospitals, if it is to provide enough of them, without compromising on the more important basic primary healthcare, maternal and child care, and preventative health services (including immunization) which will always end up being the Government’s responsibility. Private tertiary hospitals can set the competetive tone for other government or quasi-government institutions, and reduce the Government’s wage bill when it comes to doctors, nurses and allied healthcare workers. I personally believe that Government should only be directly responsible for building and running Teaching Hospitals and the Military and Police Hospitals. All other hospitals should be in private or semi-private hands with the appropriate caveats and strong regulatory oversight. Even the administrators of the Government hospitals should have enough autonomy to run these institutions efficiently as viable business concerns and compete vigorously with any competitors. This can be done without reducing access to healthcare to anybody whether rich or poor. Access to appropriate medical care, especially for emergency care, should be a fundamental right of every citizen or resident of this country. Again, I sincerely believe that that should be our natioanl target. Easy to achieve? No! Necessary to work hard to achieve it? Yes!

          A major component of this private practice encouragement policy will be a strong regulatory framework and national institution to prevent mediocre private institutions and poor services. Sanctions for poor and negligent services must be severe. Aggrieved patients and family members must have a credible and easy way to report sub-standard care and negligence. And the regulatory body must have the legal teeth to be effective in a fair but firm, deterrent manner.

          The third component of this private push is the optimization of the quality and breadth of health insurance in the country. More private health insurance companies should be encouraged alright but I believe that the NHIS should, particularly, be strengthened, made very efficient and managed well enough to become the preeminent healthcare insurance system for the country. It should be affordable, well resourced and cover services in a tierred fashion that will be attractive to all Ghanaians and residents whether rich or poor. I think this current situation where NHIS seems to have become the insurance for the poor, not popular because of poor and unreliable reimbursement etc. is not a good thing. The NHIS should develop a tierred service coverage and efficiency that will be attractive to fee/premium paying rich and middle income clients. The NHIS has to become the most sought after and most universal insurance product in Ghana.

          Ghana can become the health tourism center for the West African subregion with excellent potential to make very good income.

          Health tourism pays! Ask India, ask South Africa, ask Cambodia!

          As Fambondi said, “the Ghanaian health sector is ripe for business”. I agree with him completely. Let’s find a way to pluck the fruits.

          • Dr. Boateng, I believe that your above comment is an awesome proposal- have you contemplated organising a symposium drawing stakeholders (MoH, GMA, GMDC, Private physicians, Medical school Professors, and Medical students, District heatlh directors, and members of the general public) to discuss this?

            If not, I will urge you to please do so…the idea being that a working group/committe can convene to produce a policy document that could be submitted to parliment for consideration.

            I share your passion that the future of heatlhcare in Ghana lies in the private sector. Government cannot do it all.

  21. The problem is the priority given to hospital care despite all the problems we know about them. Our development partners have convinced our top policy makers that prevention is better than cure and frown on investment in hospital modernisation because it is clinical. Throughout my association with the policy making process, it was only in 2003 I believe that that a Hospital Strategy was developed to guide hospital improvement in a holistic way but never impleneted. And top level clinicians are often left out. Recently I must add the GHS Council has top level clinician but their influence has been minimal.Even when we had another clinician/pathologist in charge of GHS, hospital care did not get the face lift it needed. I can however point to Dr Daniel Asare who managed the ultra modern Sunyani hospital with excellenc. He did the same for the Koforidua Government Hospital and is doing well for the Cape Coast Hospital. I understand Dr Ken Sagoe is doing well with Tamale Teaching Hospital.
    I wish we can get the Hospital Strategy document back on the table and the government will commit the necessary funds to implement it rather than building new ones which politically may be attractive.

    • Dr. Asare is, indeed, committed to excellence and should be supported.

      • Dr. Adjei, this is where a robust private hospital system can take the pressure off Government in the need to provide curative medical care. The Government can then concentrate its limited resources on the more important preventative care.

  22. Dr. Boateng, I would like to thank you for your concern about healthcare access and delivery in Ghana. I have a lot to say about our healthcare system but I will restrict myself to just one question under this topic- Why do ALMOST ALL doctors in Ghana see the need to ask relatives or care takers of patients to leave the ward or their rooms when the doctors go on their rounds? Thank you.

    • Hi, visitors are asked to leave during rounds because 1. visitors do not have the right to know the patients medical history(this is only meant for the patient;even spouses can be told only if the patient consents or patient is unconscious or a child) 2. most wards are large open spaces and people may overhear other people’s medical histories 3. Ward rouds can lan last up to 5 hours sometimes and are also used for teaching sessions in teaching hospitals, a team of about 30 medics may be rounding, causing overcrowding. 4. rounds is meant for the health staff to reassess the patient,and to allow he patient to ask questions. this cannot be done freely if visitors are around. Dont believe what you see on tv, this is the practice everywhere. only authorised family or friends may stay in during rounds. these are a few reasons why visitors are asked to leave during rounds, there is no malicious intent

      • Jay, I think Nyansasem has asked a very legitimate question that highlights a key flaw in the set up of our health system- Lack of confidentiality.

        While visitors may be excluded from hearing a patient’s medical history, family members should be given an opportunity to be present and ask questions during rounds; especially if the patient is not very educated or is too ill to understand medical lingo. The way wards are setup with open beds in most facilities in Ghana allows the next patient hear it all does not ensure confidentiality.

        Furthermore, and more importantly, if we as providers exclude family members during ward rounds, do we ROUTINELY (emphasis on routinely) communicate health issues to a health care proxy/next of kin? From my experience the answer is no! And I think that is Nyansasem’s issue. Many patients (even those with university degrees) may be too ill to comprehend their illness, and I think family members are a vital component of medical care that should be included in the medical decision process. The concept of family rounds is commonplace in parts of the world with the time and resources. In these instances- members of the health care team (nurse, MO or health aide) meets with the patient and their family (with the permission of the patient of course), to explain their illness, the management plan and how they can help the patient get better. This is patient centered care.

        Until we have the resources to provide private rooms for each patient, a way to provide better patient care should involve:

        1. Routine designation of a health care proxy/next of kin for each patient admitted to our facilities. (Ask the patient: who would you like to be notified about the reason for your admission and the management plan?)

        2. The appointed person should be informed about any progress, or change in the management plan of the patient.

        I think by communicating better with our patient and their families we can win the support of the general public and will goa long way in boosting the already battered image of doctors in Ghana.

        • Fambondi, you might have a legitimate point, but what Jay explained is the practice everywhere. Rounds are done to access patients and it’s also a teaching period for medical students(doctors, physician assistants-PA, nursing practitioners). Visitors are excused from wards and ICU principally for the privacy of the patient. Don’t forget patient info is discussed among the Attending doctor and the medical students. The patient is also accessed at the same time, sometimes with the patient’s gown and cover sheet taken off. How would you feel if family members are loitering around and ease-dropping, and then you hear a visitor gossiping that, ÿou see that patient in bed 4, the doctors said he has HIV. Or he will not make it past next week. How would you feel if that was your family they were talking about? However, my only problem with Ghanaian system is the refusal of most doctors to disclose the patient’s situation, next line of action and the prognosis to the immediate family.

        • Thank you very much, Dr. Fambondi. There is no doubt in mind you could bring the much needed change we desire in our health care system. With such understanding, your patients would have no problem whatsoever in communication.

          I chose my words carefully and that is why I did not use “visitors” but rather family members or care takers. I could have used “power of attorney” but I know that not every sick person has power of attorney when they arrived at hospital. But there is always a son, mother, father, spouse or a family member.

          Communication is very important aspect of health care delivery and this is something that our healthcare professionals fall short and that is the reason why I brought up this discussion. Most times, from admission to discharge, a doctor could care less whether a family member was there with his patient. Sometimes, I wonder whether some doctors think about the well being of their patients’ holistically. Your (2) solutions to my question could go a long way to bring drastic change in our delivery. One point I would like to add is, always if possible doctors will ask the nurses to ask the patient, one person or two who they want to stay behind when the time comes for round. Thank you.

          For Docs Jawando & Jay – I would like to respond to some of your concerns and answers. I must admit that the only thing that makes sense to me is about our wards being an open spaces. But even then, I think a quiet “place” could be created or assigned in the ward for the purpose of informing the family member or care taker about the progress and management plan for the patient. It shouldn’t be that difficult, or?

          Now, about “family members” not having the right to know patient’s medical history, I think Doc Fambordi has answered that eloquently. And I believe knowing that a person is there to care for your patient at all times should be your primary concern too. In the United States or Canada, I believe there is a place on the H&P form for the triage nurse or doctors to write the name of the accompanied person and whether or not the History was given by the patient himself or the accompanied person. And as doctor Fambordi said, you can ask for a “proxy” if the patient is willing, because to maximize your patient centered-care, it is ALWAYS proper and fitting to include family members in your management plan.

          Secondly, it is not true that the practice of asking patients to leave the ward while the Attending, Interns & Residents, medical students are on the ward or rooms is done everywhere. Totally false. Again, in the USA or Canada, as far as I know from the Emergency room to C/ICU to Wards, no doctor would ask a spouse, son, daughter, or family member to leave just because he is there to check on the patients. They are actually happy to see someone there. I don’t know where you got that from. And remember, here we are not talking about 5 to 20 people, we are talking about immediate family members. If you believe they are too many, you could probably ask some to leave, but not everyone just because the Attending is there.

          Thirdly, how do you reassess patients who can’t talk well or having difficulty in breathing in your care? Are you going to do that just looking into the chart and rely on vitals, labs or imagings only? Don’t you think a family member who had been at the bed side could also assist you even better than our overworked and underpaid hard working nurses?

          Lastly, the degree of a medical doctor who can’t counsel and console a family member because of bad prognosis is not worth the paper is written on. Any doctor should be able to diagnose most diseases or illnesses but it takes a great doctor to convey, counsel and console a patient or family member about bad prognosis. This is where I know whether or not if the doctor has a communication skills.

          Thank you, doctors! It is about time to think outside of the box if we really meant to change health care delivery in Ghana.

          • All of you have some valid points. To add to your points A patient is suppose to be the focal point of the healthcare system. When a doctor tells family members to step out because of rounding is harsh and detrimental to healthcare. The patient is to make the decision about who has access to their health information and sometimes wants family members to stay for support. The family is also important to the doctor because sometimes family genetic history and lifestyle provides doctors with clues to arrive at or confirm a diagnosis. Our medical system has a paternalistic approach and so whatever the doctor says holds. In an ideal situation when a loved one is sick ,you don’t feel good and filled with the fear of the unknown. To be sent out can break a much needed support system for the patient.

          • Thanks for your submissions, they are highly appreciated and duly noted.Most Doctors are more han happy to talk to patients and their designated family members about what ails them. During ward rounds, Doctors even make phone calls for patients to their designated family members. Health workers also may leave signs on the bed posts asking family members to stay behind or come in at specific times to have discussions with Doctors. I don”t like to compare us with other vcountries because the demographs of our patients are completly different. A lot of the people who visit in hospitals aren’t even family members, u may find friends, church groups and other people on the wards during rounds. Also, believe it or not, most patients only want you to talk to the family member who is providing financial support and this may be an uncle or a distant person and not a spouse. i assume that bloggers are educated and so your experiences in hospitals may be different, but for the masses, we do these things just to protect their dignity. Health workers do know what best practices are, we do talk to the right family members at the right time but unless the patient is a minor or unconscious, his/her medical history belongs to him/her and only the patient can make a decision as to who else can be told. but this does not necessarily have to happen during ward rounds. Family can be informed even during visiting hours.At the end of the day, the most important person in the hospital is the patient and his/her feelings must be considered first

          • Nyansasem, I think its very unfortunate when we start using words like “TOTALLY FALSE” on this educative blog. We may have different experience depending on the country of practice. If you do not know about other parts of the world fine. We are here to share our ideas and experience for a better Ghana. In my almost a decade of experience working in more than five known hospitals in USA, I have never come across a hospital without a well furnished family/visitors waiting area with TV and other entertaining equipments. The attending has also a place on the floor be it ICU, in-patient floor or recovery room. They are always available 24/7 to interact with the family about the progress and prognosis of the patient. They interact with the family at every level.
            As a first hand experience, patient family are always asked to excuse the team during rounds or trauma until they are done. This is not false, but hands-on experience, but i must enphasis i do not know how it works in Ghana. During trauma in a ER what will the family provide in a triage? The trauma team’s first priority is to stabilize the patient and not to socialize with the family. It is after stabilizing the patient that the family will be called in and talked to. I must say that there is no specific visiting time as is practice in Ghana. By the way, what vital information will the family give for a patient in ICU on tube, if not the accessment by doctors, information on patient chart and PC. Let stay on the topic and not digress. I have lived it and practiced it, so where lies the totality of falsehood.

          • Bro Alh. Mohammed Your points are valid there is nothing like Totally wrong unless proven to be so. All the points you made were valid but your statement about what information will a family give when a patient is on a tube should be revisited. My brother all patients in ICU are not there because of trauma. Some patients may be there because of cardiac, neuro, sepsis or whatever. you made mention of doctors making rounds which is a teaching process as well so vital information is needed and that will come from family. Genogram gives a picture of family lifestyle ,medical history etc. for example a family history of diabetes, hypertension and ethnicity and culture doesn’t necessarily means that the patient will develop these diseases but remains a strong influence in the diagnosis. It will also help when doing patient and family teaching to promote healthy life. I know for a fact that in the US where you reside ,Healthcare is evidence based and families play an essential role.

          • Nyasasem anyway Eye Asem ! You’ve made some valid points but the doctor who cant console family members after the delivery of a bad prognosis their degree is not worth the paper is written on. My friend may I borrow your phrase of TOTALLY WRONG ? This is actually MORAL VERSUS ETHICS. The doctor is ethically right but morally wrong. On the other hand some medical schools do not incorporate counseling into their program so patients are referred to chaplain or the nurse who happen to be the patients advocate may fill that void. Remember it is a teamwork.Thanks for your comments.

          • “Fambondi, you might have a legitimate point, but what Jay explained is the practice everywhere”—Alh. Muhammed S. S. Jawando

            Hola, Dr. Jawando, my response was to this comment you made. I am sorry if you found my use of “totally false” offensive. On a second thought, I could have said, your statement was inaccurate, wrong or whatever, and I would still be right because you have not been to EVERYWHERE. May be, what you need to do then is not to “generalize” everything you have seen or done, don’t you think so?

            Anyway, I just passed through and won’t be back to make that mistake… I have read enough from here and it’s hot in here, jeez, I feel like I am in Ghana being “dressed” up and down by the almighty “gods” at the hospitals.

            Wish you all the best. Maximum love and God blessings as you seek ways to bring changes in our health care delivery.

  23. The solutions to our health care problems lie mainly in the hands of government. Government is required to make sure our public is educated to be able to take decisions on when to access healthcare and how to prevent diseases especially related to hygiene. Government needs to improve facilities at medical schools and pay the consultants and specialists who teach the medical students well.
    Every Doctor leaves medical school with high hopes, love for his/her patients and aspirations of how he/she is going to change our failing system for the better but after a year of being frustrated by salary shenanigans(no pay), no conditions of service, lack of essential medications to save lives resulting in needless loss of lives and day after day of spending your life in the hospital to the neglect of your family(high divorce rate for doctors), they simply become jaded and start to rebel against the system. Imagine being sent a hospital bill after delivering a baby in a hospital where you work day and night to save lives, or somebody suddenly reducing your pension and telling you to be ok with it. Being posted to a different region without being notified in time to make preparations for your family. ALL THESE ARE PROBLEMS HEALTH WORKERS FACE BUT TRY TO DO THEIR BEST. IT IS UNFORTUNATE THAT THEY MAY SOMETIMES TAKE OUT THEIR FRUSTRATIONS ON PATIENTS BUT REMEMBER THAT HEALTH WORKERS ARE HUMAN BEINGS WHO LIVE AND DIE JUST LIKE EVERYBODY ELSE.
    In terms of supervision, hospitals have management made up of administrators and medical directors. This is the practise all over the world, and these days a lot of Doctors have MBA’S and other qualifications to take mangerial roles. There is also the need for setting up quality assurance departments in our hospitals.The government needs to sit up and provide the right working environmet for health workers and stop lying to the public to score cheap poliical points. Not all strikes are for increase in salary, in the last two years, health workers have gone on strike over condions at the emergency wards(KATH IN 2012, LACK OF ESSENTIAL DRUGS(JUNIOR DOCTORS kath, 2012) and reduction in pensions but the public is not informed about all of these. There is no point vilifying health workers-everyday they go to work with the intention of saving lives:some may have bad personalities-just as in every field, but they only want to save lives with the little resources at their disposal. Our health system will remain as it is until we get a government that actually cares enough about our health to make the necessary changes.

    • Well said jay.”Our health system will remain as it is until we get a government that actually cares enough about our health to make the necessary changes.”

      Sometimes one gets the feeling as if health care is not a national priority for our government.We must know that if the nation as a whole is not healthy with life expectancies in the mid 50yrs then our economy can never be strong because we will not have the workforce when the people are expected to be in their most productive years.I’m sure all the problems and the solutions listed above by concerned Ghanaians on this blog have been discussed somewhere before in the highest levels of government or at least at the leadership levels of our tertiary health institutions.The problem is is that,there is no political will and Vision to change so things remains the same.Some one mentioned in one of the posts above that if Cardiothoracic center at Korle is possible then it is possible to change the system in the whole country.I think that is 100% true.I do not care if people like or hate Dr Frmepong Boateng but if he has been able to lead and set up such a center it will not be a mistake to learn from his example to help set up other centers like that or at least improve the existing ones.
      No matter how many problems or solutions we list and discuss I will always blame the leadership in these instituations for the failures .I think it is time Ghanaians made their voices heard on radios ,TVs etc and demand change.
      We all love our dear country but things must improve.

  24. Fantastic Discussions so far….lets not forgot the Hospitals that breeds Mosquitos. Visit Nyaho and there you go!!

  25. Dzade, there goes the sacred cow :-) . I agree that there is a mosquito colonization in hospitals where transfering malaria from one patient to another could be quite efficient. Any ideas on how to solve this mosquito menace in hospitals? Anyone?

  26. please i want to know more about how hospitals are graded. What are the criteria? I want to grade my hospital badly. Thank you.