Health Blog

Private hospitals in Ghana

43 Comments
Posted: Dr. Joseph Boateng

This week let’s talk specifically about private hospitals and other private medical institutions.

In previous topics, we have mentioned private hospitals in our discussions as part of other issues. Ceedoo, Fambondi, Jay, Chief and others have emphasized that an increased role and prominence of private hospitals should be a major component of the health delivery system in Ghana.

I personally agree, strongly, with these ideas.

The question is: what kind or kinds of private hospitals or medical institutions are we talking about?

For private medical institutions to be of benefit to the health delivery system in Ghana, and meet the needs of the system in the way that we have been discussing, they must have certain characteristics. I believe that private hospitals and medical institutions, be they laboratories or radiology facilities in Ghana, must be of the highest quality. By highest quality, I am not saying they should have the same sophisticated equipment as we have in developed economies. What I am saying is that, if they say they have a CT scan, then, the reports of the CT scanning should be accurate and of the highest standard so that patients are not given wrong diagnoses based on poor results.

The same should go for laboratory and ultrasound results. There seems to be a proliferation of stand-alone laboratories and ultrasound facilities in Ghana. How reliable are the results coming out of these stand-alone institutions? How qualified are the technicians? Are patients paying for quality? Are patients being harmed by poor results? Why are technicians directly telling patients what they think is wrong before their reports get to the doctor? Who is checking the quality of these facilities? Who has oversight responsibilities? And how are these responsibilities discharged? Where does an aggrieved patient go to seek redress?

We must prevent the proliferation of shoddy, poor quality facilities; something that is bound to happen if there is government encouragement of increased private participation in health care delivery.

Private hospitals must have the highest quality of medical care delivery, within their four walls. Their quality oversight must be robust. For example, private hospitals who admit patients who they obviously do not have the facilities to care for but keep these patients anyway (for whatever unacceptable reason) until when the patient’s condition deteriorates then quickly refer them to public hospitals, especially Korle Bu, the Ridge Hospital and 37, should be identified, the “referrals” investigated and the appropriate sanctions, including closure of the hospital applied. A lot these patients who are so referred die in the big hospitals because the referral was done too late.

Private hospitals must have a good and proactive referral system to help save these patients. Money should never be a reason to keep patients you cannot take care of. The patient’s well-being should be supreme. Private hospitals that will not do this voluntarily and professionally must be sanctioned, firmly. Patients’ family members should know which institution to send such complaints to for investigation. Which number to call. Which email to write to. Which address to mail a letter to.

So this week, the primary discussion question is: what are our experiences with the private hospitals and medical institutions that exist in Ghana today? Again, the good, the bad and the ugly. What needs to be improved and how?

The secondary question is: what kinds of private hospitals and medical institutions do we want to see in the future?

"43" Comments
  1. My experience with a private hospital

    I live in the UK and about 3 years ago my mother was diagnosed with breast cx. The diagnosis was made at a private clinic in Kumasi. Apparently the owners of this private clinic had been promoting themselves heavily on the airwaves that they are number one in the country when it comes to breast cx.

    After the diagnosis I was told treatment had begun and as usual lot money was demanded. About a year or so into the treatment there had been no improvement in my mother’ situation and she was having swollen glands all over her body so I advised that she should be withdrawn from the clinic and taken to a government hospital. At the hospital the Doctor who happened to attend to her on the first appointment said she recognises her name and that she had seen her mammography before at a locum site. The site happened to be the private clinic that gave the initial diagnosis and in fact it was this same Doctor working in the government hospital and also doing locum at the clinic who gave the diagnosis. This doctor was furious about why it has taken so long for my mother to be referred.

    Well, they quickly organised a surgery to remove the cx and treated her with, I believe, both radio and chemo therapies. My mum however, never fully recovered and passed away last year. I guess treatment was left for too late.

    I was speaking to a friend recently and the issue about the private clinic that treated my mother came up, my friend was livid with anger. Apparently, she has seen so many women being referred too late from this very clinic and wonders why the health authorities have not taken action. She even doubted the authenticity of the qualifications of the owners of the clinic.

    My question is what is the government guidelines for private health facility operations in Ghana? Who monitors these facilities and are there precedence of any being closed down due to dangerous practices etc. But, I think I know the answers to these questions already anyway. No one monitors any private clinic in Ghana. Even if there is a body set up to do that they are probably sitting in an office somewhere taking bribes and hand-out from offending practitioners. For, if that’s not the case how come we often hear of the cases such as the sex abortion doctor and the recent one about the plastic surgery clinic all the time? But, I believe, this is just the tip of a very huge iceberg.

    Mungo Paks

    • Mungo, as I have advocated in the previous blog topic, what we need, to be able to deal with perceived poor and substandard medical care in Ghana, is for there to be an easily identifiable institution which patients or family members can quickly contact when they believe medical negligence has occured. If this institution is vigorous and firm in its investigations and follow through, a lot of the poor quality healthcare facilities will be identified and either sanctioned or closed.

      I do not know from your piece whether the aggrieved patients or family members tried to find which institution to make a report to. As I have mentioned previously most people do not know who to report negligence and substandard medical care to.

      I would not necessarily assume that all the regulatory institutions are ineffective or that their officers are corrupt (“taking bribes”), even though I acknowledge that corruption is quite pervasive in Ghana. There are some honest and effective officers. What we need to make sure is that we are able to contact them and put our complaints accross and evaluate what happens.

  2. Kwaku Ananse PhDc (Bioethics), MA (Bioethics), MA (Psychotherapy), M.Div

    Hospital systems in Ghana are in crisis. The crisis does not only stem from the lack of adequate infrastructure and equipment, but importantly qualified personnel. For instance, considering that hospitals or treatment facilities are incubators for all kinds of germs, bacteria and viruses, it is unconscionable for a hospital not to have good running water. There is agreement in the medical research literature that something as simple as handwashing can cut down the rate of infections by more than half. In order words, to have a hospital with no running water for hand-washing or for flushing contaminated faecal matter is a no brainer. Such a facility, rather being a treatment center, becomes a death trap. This simple illustratration takes us straight to the core issue, the qualification and competence of medical personnel. Do the administrators of treatment facilities care about hygiene needs of their facilities? Are they aware of the threats and dangers unsanitized environments pose to patients and workers? Does anybody care or are those in authority so unqualified they are not aware of such dangers? Qualification of medical staff and their competence and skill levels is a major issue in Ghanaian health facilities.

    On that note it appears properly constructed medical facilities score higher marks than the public ones. That is to endorse the notion that private hospitals constructed and managed by qualified personnel do a better job than all the mushroom clinics springing up. In this regard, government oversight of who could open and run medical clinics is the biggest obstacle to medical innovation in the Ghanaian health care system. Presently, it appears the most popular and decent clinics are privately run. And then you have all the people running around calling themselves doctors who have no training or efficacy of work. I am particularly scared of all the locally, traditionally produced medications and concoctions being distributed to patients without oversight and testing. It makes Ghanaian patients guinea pigs. Anybody can sell anything as medicine to Ghanaians. read from this website how some unscrupulous Chinese in collaboration with Ghanaians were selling baby diapers as a drinkable potion being sold to desperately sick Ghanaians. Now, that is scary! Anybody can do what they please with patients without any sort of accountability. That is rather irresponsible of our leadership and a mockery of our medical system. So, whether private or public, our medical system needs more attention to streamline how medicine is practiced and importantly, who should have access to patients. It is an important topic that scares people who have used efficiently run hospitals in other places.

  3. 1.teaching hospital
    2.hospital
    3.clinic
    4.health centre
    5.medical centre
    6.health post
    7.treatment centre
    8.polyclinic
    9.pharmacy
    10.Diagnostic labs
    11.Ultrasound facility.
    12.Prayer camp.
    13.Shrine.

    The list can go on and on and on. All these FACILITIES deal with the sick in Ghana. It actually depend on what one can afford.
    Treatments also depend on what the patient can afford.
    How do we standardize such a mixture of facilities??

    • Dr Berko, we can standardize them by creating or identifying institutions that should have oversight responsibilities over these varied entities and give these regulatory institutions the clear legal mandate and clear description of their responsibilities to protect the patient.

      The overriding expectation is that the patient’s welfare, rights and well-being are protected and respected.

      There are existing institutions in Ghana currently which are mandated to regulate most of the entities you have enumerated.

      • Are there any laws in Ghana protecting a patient?
        Are there any laws in Ghana defining who is allowed by law to treat a patient?
        There is a need to define by law who a patient is and who is mandated by law to give treatment( a doctor). Anybody else whether a religious priest, pharmacists , laboratory technician or other charlatans who take a sick person for cure can be prosecuted.

  4. Benedict Baidoo

    I am not privy to any laws governing the public and private hospital practice and management but can these institution be sued for negligence? If someone holds him or herself as specialist capable of curing a disease at a cost and negligently fails to render the services advertised, I think they should be held liable.

  5. This platform is very enlightening.
    Please I am passionate about contributing to healthcare in Ghana. I am not a medical doctor and would like to set up a private hospital. Given my non-medical background, what steps must I take to run an efficient and effective hospital in the country.
    Thank you.

    • Azaato Asignaba

      Mbl, All you need to do is hire good medical doctors, get a good expert in hospital administration, have a good collection of well educated professional nurses and make sure your building is actually designed to take care of the requirements of a hospital. Your business acumen would take care of the rest.

      • Mbl, Azaato has mentioned some of the essentials you need.

        I have had some recent experience in trying to help a non-medical person set up a hospital in Ghana. My impression is that the non-medical person sometimes sees a hospital purely as an investment to make good returns from. That is an acceptable aim so far as the investor will recognize that a hospital is not a hotel which houses patients. Hospitals, both developmentally and operationally, are complex and unique entities. They need the right kind of expertise to be successful.

        What I will say is that it is important to involve an excellent hospital development consultant right at the outset. He or she should have an intimate knowledge of the Ghanaian healthcare market and also know how hospitals work and make income.

        The overriding principles in your development planning should be that the hospital should:
        1. provide the highest quality of medical care at affordable prices (by affordable I do not mean “cheap”).
        2. provide a positive patient experience in terms of the physical structure of the hospital, the services that you offer and the quality of your staff (doctors, nurses etc).
        3. try to minimize the cost of building the hospital so that you are not forced to overcharge in order to try to recoup your development expenditure or pay high debt charges if you took bank loans.

        What I can say is that there are some challenges in trying to develop a world class medical facility in Ghana but they are surmountable and the rewards are excellent if your facility is well planned and well operated.

  6. Azaato Asignaba

    Private clinics should definitely be part of the health delivery system but they shouldn’t completely replace a well-functioning system public system. However, the government should not absolve itself of the responsibility to maintain a well-functioning public service to care for the less well off in the society by for instance, selling off state hospitals instead of funding them.

    There was once vibrant public education system which took care of most of us. Now the picture is different. State schools, i.e, elementary schools, have been ran down due to under funding so many parents, especially in the urban centres turn their children to private schools because of the perception that they are better, meanwhile they are so expensive that the urban poor cannot afford them. This is producing a class-based educational system-run,which in the long-run isn’t beneficial to social and economic progress.

    Private clinics should therefore not be seen as a panacea to our health problems. They should be well regulated. The government should not succumb to international donors’ pressures to completely abandon public hospitals or sell them off to international health delivery chains.

  7. Dr. Boateng, you raise very important questions. I will attempt to answer your secondary question: “what kinds of private hospitals and medical institutions do we want to see in the future?” and hopefully one can extrapolate the flaws of the current healthcare system. I think generally speaking Ghana needs a functional primary health care system; not large, overcrowded tertiary facilities like KBTH, KATH, 37, Cape Coast etc. I say this because what kills most people in Ghana is lack of early detection (and treatment) of diseases. For those who have read posts from people’s experiences at the hands of the Ghana health system, diseases are usually diagnosed late becasue of the three Ds:
    #1 Delay in recognizing the need to seek care,
    #2 Delays in accessing the right kind of care at the right time and
    #3 Delays in Providing care by healthcare personnel

    The kind of private hospital I will want in Ghana, should be one where I will love to be treated. I have very high expectations for my health and that should be the standard for all Ghanaians. I will like to seek medical care in a facility with the following features:

    1. It must be staffed by competent and friendly personnel. I want to see polite and smiling faces. I want to be spoken to with respect and treated with dignity.
    2. My care MUST be multidisciplinary: A team of nurses, doctors, lab techs, and health aides, nutritionists, physical therapists working together with my sole interest at heart. No solo dodgy one doctor/one nurse practice. The name, credentials and expertise of my providers must be available to me at request.
    3. Care must be efficient: I must be able to receive good care within a reasonable time-frame; no long waiting hours, no delays, lateness or no-shows on the part of providers.
    4. There must be continuity of care: If I start seeing one doctor, and I want that doctor to be my primary provider, I should be able to schedule follow-up appointments with that doctor unless I decide to switch doctors at which time I can have my medical records forwarded to my chosen provider.
    5. Confidentiality: my medical information must be kept confidential and only disclosed to providers directly involved in my care or to people I designate. Failure to do so should warrant a penalty against the institution.
    6. The facility MUST be clean; with good toilet facilities and water supplies. No over crowding. All providers must adhere to the highest standards of hygiene. I should be allowed to ASK my provider to wash or sanitize their hands before examining me without fear of retribution.
    7. I want my doctor to spend time with me to carefully explain (in language I understand), my medical conditions and what treatment options are available and help me come up with a treatment plan.
    8. Care I receive must be of the highest standards and guided by the best available evidence.
    9. I must have an avenue to voice my concerns or displeasure about the quality of care that I receive to a third party who will arbitrate any wrong doing.
    10. Last but not the least- my health care MUST be affordable.

    Now, as you can see this is a very demanding list, but you know what, our patients deserve nothing less. In government institutions, this may be challenging because they are stretched thin (financially and from an HR perspective). This is where private healthcare can contribute immensely.

    Starting with my last point- in order to drive down cost, Ghana must incentivise qualified providers to set up multidisciplinary primary care facilities/clinics with the aforementioned qualities. If a few young doctors and nurses have some money to invest to set up such a group practice, Government can help by:

    - issuing tax breaks for the importation of hospital hardware (computers, hospital furniture, medical equipment, ambulance, defibrillators, cardiac monitors)
    - Providing free land for the construction of such facilities
    - Private financial institutions can also help by providing low cost loans to medical providers who have this team based approach to health.
    - The NHIS should also be brought on board to pay for medical services provided to members seen at such facilities; and they should do so on time and without delay.
    - There must be strict regulation of facilities- by regular inspections with accreditation contingent on meeting the 10 criteria outlined above.

    We can learn from other countries such as the UK and the USA where the NHS and Joint commission respectively inspect all facilities and flag down those that are found to be wanting. Institutions found wanting should be published in the media- that is a very strong deterrent in those countries.

    I know of many bright young Doctors and nurses in Ghana, who if steered in the right direction will be able to provide world-class healthcare that people in advanced countries get.

    • Fambondi, PIPEDREAM, CASTLES IN THE AIR.
      It is good to aim at something, but a little bit of realism won`t be bad. Where in the world will you get that??

      • Fambondi on July 10, 2013 at 4:00 pm said:
        Criteria #1: It must be staffed by competent and friendly personnel. I want to see polite and smiling faces. I want to be spoken to with respect and treated with dignity.
        Question: How much does it cost to smile and be polite?
        Answer: GHC0.00

        Criteria #2: My care MUST be multidisciplinary: A team of nurses, doctors, lab techs, and health aides, nutritionists, physical therapists working together with my sole interest at heart. No solo dodgy one doctor/one nurse practice. The name, credentials and expertise of my providers must be available to me at request.
        Question do we lack the medical personell to do this?
        Answer: NO! What we need is organization and leadership; re-training of health workers to learn to work side by side with other professionals.

        Criteria #3: Care must be efficient: I must be able to receive good care within a reasonable time-frame; no long waiting hours, no delays, lateness or no-shows on the part of providers.
        Question: Is this realistic?
        Answer: Yes, while it may be challenging to do this in KBTH or KATH, a well set up, well run private health facility can do this and do it well; hence my argument for an increasing role of private health providers.

        Criteria #4: There must be continuity of care: If I start seeing one doctor, and I want that doctor to be my primary provider, I should be able to schedule follow-up appointments with that doctor unless I decide to switch doctors at which time I can have my medical records forwarded to my chosen provider.
        Question: is this Realistic?
        Answer: Yes, not all visits have to be with MDs, for follow up for blood pressure monitoring; elevated cholesterol or glucose can be with a Medical assistant or a Nurse. (They have skills too you know); and we need to start integrating them in the health system as partners not just subordinates to physicians; Doctors should take the lead in this initiative.

        5. Confidentiality: my medical information must be kept confidential and only disclosed to providers directly involved in my care or to people I designate. Failure to do so should warrant a penalty against the institution.
        Question: Is this realistic?
        Answer: This does not need to be justified. Any doctor who cannot provide this to his or her patient is not worthy of the name “doctor”

        6. The facility MUST be clean; with good toilet facilities and water supplies. No over crowding. All providers must adhere to the highest standards of hygiene. I should be allowed to ASK my provider to wash or sanitize their hands before examining me without fear of retribution.
        Question: Pipe-dream you say?
        Answer: In a well set-up private facility, one can maintain the aforementioned standards. If Ghanaians have a taste of good medical care, they will start demanding it from doctors who work at the large academic medical center. Someone has to pioneer the concept of quality health care and the private health system is the best place to set the pace for public institutions to follow.

        7. I want my doctor to spend time with me to carefully explain (in language I understand), my medical conditions and what treatment options are available and help me come up with a treatment plan.
        Question: Is this possible?
        Answer: Yes! This is where organization comes in. When patients come for follow up, people with pre-existing conditions should be spoken to by nursing staff or Medical assistants, first assessing their understanding of their health (or disease) and fill in gap of knowledge. The patient should be empowered with information about their health rather than reprimand them for not taking the initiative. In many instances it is lack of understanding; remember the term “doctore” in Latin means “teacher” so we must teach our patients about health.

        8. Care I receive must be of the highest standards and guided by the best available evidence.
        This is self explanatory.

        9. I must have an avenue to voice my concerns or displeasure about the quality of care that I receive to a third party who will arbitrate any wrong doing.
        Many people have expressed dissatisfaction on this forum, perhaps a formal entity can take up the role of looking into these things with the aim of improving quality of care. Failure to do so results in missed opportunities to improve quality and safety of care

        10. Last but not the least- my health care MUST be affordable.
        Public health 101

        • Fambondi, brilliant contribution. I sincerely believe that this should be the operational business model for private hospitals that are serious about being successful in Ghana; indeed in any healthcare market.

        • “shoot for the moon and if you miss,you’ll land among stars”. Well put brother, This could be achieved especially with a little education of the masses. Your standards as mentioned above will do well in private sectors and then eventually trickle down to the public sector if we vote for our politicians based on substance. I sit back sometimes and cant understand our system but my conclusion always takes me to the same place i.e the mentality of my people. Nelson Mandela is near death but he is being treated in his country. The health system is comporable so it attracts other foreign doctors. Aaron Sharon is sick but still in Isreal. Capt Kwashiegah health minister of Ghana for many years died seeking for alternate medicine in Israel. Our past president was a patient in S.A yet our health system was never a priority. There was no where it was mentioned thatCPR was performed rather he was rushed to 37 and died on arrival. With most of your expertise and i mean every body on this forum something could be done. Y BERKO i always enjoyed your perspective but i will have to jump ship.Am waiting for your informative comeback. Thanks to everybody for the education.

    • Azaato Asignaba

      Fambondi,your contribution so far stands out clearly in the way it has set out to describe the essential things which allow for best practice in health service delivery in Ghana. Someone has dismissed your contribution has a pipe-dream, implying that it is not achievable. I disagree. None of the things outlined above is beyond our means just because it sounds too good in the eyes of Ghanaians. It is the typical mindset which we Ghanaians approach policy issues. We don’t begin by rigorousy outlining the issues as you have done and then afterwards addressing the resources which needs to marshaled. It seems to me that we usually begin by putting the cart before the horse. That is why we don’t even have a functioning public health system which would solve nearly half our health problems if we could ask the right questions first.

      To compound it all, we also have very little confidence in our capacity to solve our own problems or provide what we need. Instead we are consumed with the thought of some foreign investor coming to our rescue. Unless we overcome this high psychological barrier, we shall keep on marking time.

      Your contribution should form the basis of discussion for medical practitioners and policy-makers. It is must-reading

    • where in this world do you get all that at an affordable price?Wake up dreamer.

      • poks, I do not think Fambondi is dreaming at all. As strange and unbelieveable as is may sound it is not only feasible but it has been done before. Google the Narayana Hrudayalaya Hospitals in India (www.narayanahospitals.com).

        It takes vision, organization and a commitment to help those who are less well to do. And remember “affordable” does not mean “cheap”. It means operational ingenuity to make the hospital servises affordable to the many.

        In fact I personally believe that developing, and operating a private hospital to be affordable to the largest number of ordinary folk is the most viable business model for success in a developing country such as ours!

        Again, if you analyse what Fambondi has enumerated and his subsequent explanation you will find that most of his requirements do NOT cost money at all. They only require a change in mind-set and dedication to doing things right.

    • Fambondi, great piece. Apart from the issue of “providing free land” I believe your ideas are spot on.

      The land tenure system and the problems associated with land acquisition in Ghana will make it rare for most healthcare entrepreneurs to obtain free land, especially in the urban centers.

      I think one will be more likely to get free land from chiefs in more rural communities who will see a hospital in their communities as a social good.

  8. Hello Dr. Boateng,
    Do you know where one can find Ghana morbidity and mortality statistics ?

    I’m in the US and not sure where in Ghana/or website such info can be found.
    thanks.

    G Adofo MD

    • Dr. Adofo, I will suggest that you try the Monitoring and Evaluation (M&E) division of the Ministry of Health and the Births and Death registry (mortality). These are the two places I can think of at the top of my head.

      Unfortunately, I cannot say how current or reliable whatever information you may get will be.

  9. Azaato Asignaba and Fambondi,
    Many thanks for your contributions – they are well noted.

  10. Criteria #1: It must be staffed by competent and friendly personnel. I want to see polite and smiling faces. I want to be spoken to with respect and treated with dignity.
    Question: How much does it cost to smile and be polite?
    Answer: GHC0.00

    Criteria #2: My care MUST be multidisciplinary: A team of nurses, doctors, lab techs, and health aides, nutritionists, physical therapists working together with my sole interest at heart. No solo dodgy one doctor/one nurse practice. The name, credentials and expertise of my providers must be available to me at request.
    Question do we lack the medical personell to do this?
    Answer: NO! What we need is organization and leadership; re-training of health workers to learn to work side by side with other professionals.

    Criteria #3: Care must be efficient: I must be able to receive good care within a reasonable time-frame; no long waiting hours, no delays, lateness or no-shows on the part of providers.
    Question: Is this realistic?
    Answer: Yes, while it may be challenging to do this in KBTH or KATH, a well set up, well run private health facility can do this and do it well; hence my argument for an increasing role of private health providers.

    Criteria #4: There must be continuity of care: If I start seeing one doctor, and I want that doctor to be my primary provider, I should be able to schedule follow-up appointments with that doctor unless I decide to switch doctors at which time I can have my medical records forwarded to my chosen provider.
    Question: is this Realistic?
    Answer: Yes, not all visits have to be with MDs, for follow up for blood pressure monitoring; elevated cholesterol or glucose can be with a Medical assistant or a Nurse. (They have skills too you know); and we need to start integrating them in the health system as partners not just subordinates to physicians; Doctors should take the lead in this initiative.

    5. Confidentiality: my medical information must be kept confidential and only disclosed to providers directly involved in my care or to people I designate. Failure to do so should warrant a penalty against the institution.
    Question: Is this realistic?
    Answer: This does not need to be justified. Any doctor who cannot provide this to his or her patient is not worthy of the name “doctor”

    6. The facility MUST be clean; with good toilet facilities and water supplies. No over crowding. All providers must adhere to the highest standards of hygiene. I should be allowed to ASK my provider to wash or sanitize their hands before examining me without fear of retribution.
    Question: Pipe-dream you say?
    Answer: In a well set-up private facility, one can maintain the aforementioned standards. If Ghanaians have a taste of good medical care, they will start demanding it from doctors who work at the large academic medical center. Someone has to pioneer the concept of quality health care and the private health system is the best place to set the pace for public institutions to follow.

    7. I want my doctor to spend time with me to carefully explain (in language I understand), my medical conditions and what treatment options are available and help me come up with a treatment plan.
    Question: Is this possible?
    Answer: Yes! This is where organization comes in. When patients come for follow up, people with pre-existing conditions should be spoken to by nursing staff or Medical assistants, first assessing their understanding of their health (or disease) and fill in gap of knowledge. The patient should be empowered with information about their health rather than reprimand them for not taking the initiative. In many instances it is lack of understanding; remember the term “doctore” in Latin means “teacher” so we must teach our patients about health.

    8. Care I receive must be of the highest standards and guided by the best available evidence.
    This is self explanatory.

    9. I must have an avenue to voice my concerns or displeasure about the quality of care that I receive to a third party who will arbitrate any wrong doing.
    Many people have expressed dissatisfaction on this forum, perhaps a formal entity can take up the role of looking into these things with the aim of improving quality of care. Failure to do so results in missed opportunities to improve quality and safety of care

    10. Last but not the least- my health care MUST be affordable.
    Public health 101

  11. Boatang!

    This blog is really good stuff.Very Kwabotwean. More grease to ‘the’ elbow!

    But I went to the Hill on Kwabotwe last two weeks and it is a disgrace to all of us.You must turn some of your genius on that situation.

    On the above specifically and the Ghanaian condition generally, what we have to do is to use guerrilla tactics to circumvent the crass inertia and lack not only of foresight but of the simple actions we must take to capitalise our well-intentioned thoughts.

    I will certainly contact you next time you are in Ghana to discuss and plan concrete action steps. Perhaps the old Boys meeting?

    At a more relevant level,we need to use medical teaching and research universities as the spearhead to the planned industrialisation of our districts and develop the Inspection Industry as our central national monitoring system and major employment generator.

    Systemic issues need holistic solutions. Nothing less will work. There is a lot of money for well-researched, risk-mitigated, financially sustainable and even profitable solutions to our developmental challenges.

    Ghanaians must learn to manage their leadership to get what we want and deserve! We can do it. It only needs a corps of resolute and insightful planners and doers! Not many.
    ‘kimpet’

    • Kimpet! Nice to know my classmates are following the blog!

      I am back in Ghana. We should meet at the next Old Boys’ meeting.

      I absolutely agree with you that this country has the resources both material and human to be a well-functioning, prosperous nation. What we need is innovative, committed, insightful, and effective leadership.

      I believe that we have great leaders in our midst. For a variety of reasons they are not in the positions where their assets can be utilised for the benefit of our nation. Rather unfortunate.

  12. I have always blamed our educational system for our predicament. I call it the ‘govt school mentality’.
    For those doubting that the Fambondi’s wishlist for an ideal healthcare delivery establishment is possible, have they heard of Private and Mutual Health Insurance?

    During a meeting at the Harley Street Clinic last week, their fire alarm went off and we had to evacuate. My host and other staff were profusely apologetic, I only smiled and explained to them that at least they had fire alarms!

    Then I had to try to describe the process from a doctor in Ghana requesting an MRI or CT scan, through the patient queuing to get on a waiting list, to the doctor eventually seeing the diagnostic images. don’t we need the money patients and family members want to pay for their treatment?

    Watch this space! I aim to do my bit to change all that!

    Oh, as an aside: This week KATH virtually stopped all surgery because there was no running water!

  13. We definitely need different kinds of private hospitals and Medical institutions but I think we should also ask ourselves what type of services are done in Ghana and do we have qualified professionals to handle these type of services. This goes along with your question (Dr. Boateng) “How qualified are these technicians”. “Who is checking the quality of these facilities”? etc. Is the patient at the right place for the services needed? Who referred the patient and is the reason(s) for referring the patient based on sound clinical guidelines? These are questions we need to have answers to before patients are being referred to such places. I believe it should be the responsibility of the NHIS to make sure there is good credential and referral systems in place since they are the payor of the services rendered. Before they go into agreement with any of these facilities and doctors, they need to know the qualities of these facilities and professionals working there. Patients safety and quality of care should be a high priority of the NHIS. They should not just be paying for low or poor quality of care. They need to monitor and measure the trend of quality of services rendered and this will also reduce cost of care.

    Once we have the above questions resolved, then it would mean we are cutting the bad and ugly ones out and giving way to fill in with the good and appropriate private facilities and genuine professionals. There are several specialties areas that medical institutions can be set up for to train medical professionals to be able to handle treatments within the different type of services. I am not sure of the type of training the medical schools in Ghana have but an example will be having an institutions for Diagnostic Radiology, Radiation Oncology, Anesthesiology, Dermatology just to mention a few.

    With the trained professionals available and ready to work in the “booming” healthcare industry (Great opportunities for jobs creation. Wake up my people!!!), examples of the private facilities I will suggest having in place are as follows:

    (1) Physician office :- Location, other than a hospital, skilled nursing facility (SNF), community health center, where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.

    (2) Urgent care facility :- Location, distinct from a hospital emergency room, an office or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.

    (3) Inpatient hospital :- A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under the supervision of physicians to patients admitted for variety of medical conditions.

    (4) Outpatient hospital :- A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick and injured persons who do not require hospitalization or institutionalization.

    (5) Ambulatory surgical center :- A freestanding facility, other than a physician office, where surgical and diagnostic services are provided on an ambulatory basis.

    (6) Birthing center :- A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting for labor, delivering, and immediate post-partum care as well as immediate care of new born infants.

    (7) Skilled nursing facility :- A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, and rehabilitative services but does not provide the level of care or treatment available in the hospital.

    (8) Hospice :- A facility, other than a patient’s home, in which palliative and supportive care for terminally ill patients and their families are provided.

    (9) Inpatient psychiatric facility :- A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.

    (10) Independent laboratory :- A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician office.

    The list can go on and on. Having some of these facilities in place will at least reduce the congestion at the existing facilities plus it will create more jobs and introduce competition in the system that will help improve the quality of care we are all hoping for.

    • Ceedoo, great contribution.

      Yesterday, a faculty colleague of mine in Cape Coast strongly advocated the training of healthcare workers with specialized skill sets to fill gaps in the system. Something that fits into your advocacy for specialized institutions.

      I agree with you that there is great potential for a booming healthcare business in Ghana. I believe that these opportunties should be actively encouraged but they should be planned very well and regulated very strictly to prevent the mushrooming of poor quality, unethical institutions which take advantage of patients’ vulnerabilty or hurt them.

      The role of the NHIS, the MDC, and the hospital regulatory institution (which I understand is doing a strict, fantastic job) in insisting on and ensuring the quality of healthcare delivery cannot be over emphasized.

    • Good post Ceedo. At the moment I believe the University of Ghana offers radiography degrees and KNUST offers Sonography degrees as well.
      The new university for allied health at HO, i believe, is aimed at plugging this gap in the allied health professions. Fingers crossed.

  14. It is encouraging to notice the palpable passion people have to see a change in our health care sytem. My field of interest is diagnostics( especially radiology). The era of doctors manipulating patients fractures without a single X-ray should be relegated to the stone ages. As already aluded to by most in this forum, the inadequate supply of good quality dianostic facilities and credible reports has meant that a lot of people are not going to be diagnosed and treated quickly.

    A proper multi-disciplinary approach is needed in ensuring that first class services are provided to our population. I think this is possible and all it takes is a bit of will in instituting a good regulatory regime.

    The hierarchical nature of our health care system where a doctor “orders” a scan or an X-ray (instead of request one) has seen its day. The medical physicists at the Ghana Atomic energy commission need to take a lead to ensure that private and public radiological facilities( X-ray, CT, MRI, Ultrasound etc.) are set up and regulated strictly to protect the public.We may not need the latest kit but to still use wet films for x-rays is a bit backward.

    A recent report in a UK radiography magazine about Ghana’s radiotherapy set up is very heartbraking is unbecoming of an oil producing country. My friend’s father died needlessly of prostate Ca due to late diagnosis, poor radiotherapy and quack doctors.

    It will be nice for knowledgeable and experienced technocrats to actually lead health care policy in Ghana instead of the money grabbing and self-serving.

  15. my issue with the private hospitals is the use of poorly trained staff/half baked staff.instead of recruiting the right kind of professionals and paying them well, some do pickshs leavers,give them some on the job training and voila,they are in business.but this really impacts on the quality of service and soon these half baked staff create serios problems.a friends father was admitted at lapaz community hospital in ashongman.on 2 different occasions at the pharmacy ,the staff there dispensed the wrong medication which we later foun out.upon further investigation we realized that she was a an dispensary assistant on attachment.and she was working alone on a night shift.my God.Lord have mercy

    • Wki, I believe the solution will lie in:
      1. The existence of effective oversight institutions that take complaints of bad practices in health institutions very seriously.

      2. The ability of aggrieved patients or family members to easily identify these regulatory institutions and, again, easily contact them.

      3. The regulatory institutions making public the sanctions that are applied for infractions, to serve as a deterrent.

      If we do this well, the deterrent effect will prevent a lot of the bad practices, like the one you describe, and, in the long run, relieve the pressure on the regulatory bodies themselves, while improving quality.

  16. I believe private hospitals will play a vital role in improving health delivery in this country but one major obstacle in this country will be poor supervision of the private hospitals. If private hospitals will have the necessary supervision then i think its the way forward since the country is broke to provide all we need in the health sector. On the other hand, if there is no supervision, the private clinics will breed complications for the ill-equiped government hospitals to manage. The final common pathway will be death of patient because the government hospitals lack basic equipments to manage uncomplicated cases, how much the complicated ones. Thanks

    • Eugene, I absolutely agree with you that strong, effective and deterrent oversight (for both private and public hospitals) is central to any effort to improve the quality of health care delivery and patient safety in Ghana.

      The regulatory bodies should be well resourced and legally strengthened to do effective work. They must be proactive and their activities, where necessary, should be made public.

      I even would advocate the setting up of an umbrella institution which we can call the National Authority for Medical Excellence (N.A.M.E.) under which all the current regulatory institutions will be placed and which will coordinate all the activities of these agencies with the single overriding mandate: to improve and safeguard the quality of medical care in Ghana and protect the patient from harm and abuse.

      The singular role of the NHIS and other insurance companies in improving the quality of health care is also unique and should be understood and explored.

      At the end of the day we come back to the same mantra that we have been articulating over and over again (ad nauseum): we have to improve the quality of health care in Ghana. What we have is not good enough. In some instances it is very poor. It definitely is not commensurate with what we, as a nation, spend on it. We can do much better and indeed we should!

  17. DR Boateng
    Well done to all the contributors for contributions so far on the very important subject of Health care in our motherland Ghana.
    I am a non medical person who is considering going into partnership with 2 doctors to set up a hospital at ACCRA. I found your advice on the overriding principles in setting up a clinic/ hospital very informative. Thank you.
    On the specific question of contribution by the partners I understand that a non-medical person is required to pay twice the contribution of a medical person for similar share in the company we want to set up to operate the hospital? Is anybody able to advice if this is the norm please? -glems

    • Glems, I am not aware of any “norm” that says that a non-medical person has to contribute twice as much equity as a medical person in a hospital company. I would be surprised if there is a so-called norm or rule like that.

      How much equity that individual investors contribute to any hospital company, and indeed to any company at all, depends on what the investors all agree to.

      If an investor believes that he or she has a certain intangible asset (say, a medical degree) that will be beneficial to the company and which the other investor(s) do not have, that asset must be evaluated and quantified in monetary or share value terms with the agreement of the other investor(s).

      I will strongly advise that whatever is agreed upon between the parties in terms of their share capital, whether in monetary or material contribution or intellectual or effort (sweat equity) contributions MUST be legally and very clearly documented. That is imperative!

    • Typical!! Already someone is trying to rip a partner off!!

  18. I AM LOOKING FOR A FRIEND WO WAS TAKEN TTO. ROSE PRIVATE HOSPITAL IN ACCRA NORTHRIDGE. AFER AN AUTO ACCIDENR

  19. I AM LOOKING FOR A FRIEND WO WAS TAKEN TTO. ROSE PRIVATE HOSPITAL IN ACCRA NORTHRIDGE. AFER AN AUTO ACCIDENR

    Xher name is Sarah TAWIAH

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