Meeting the rural healthcare challenge in Ghana
By Dr. Samuel Kwame Buabeng-Frimpong
The conundrum of how to provide healthcare that is accessible and affordable, but is also of a high quality, is one that many countries are grappling with at the moment. And Ghana is no different. Last year, after finishing an eye-opening 12-week International Program in Public Health Leadership (IPPHL), held by the Evans School of Public Policy & Governance in Seattle, I decided to take a year off to focus on my PhD.
At the same time, I took advantage of the time off to apply my acquired IPPHL skills to an area I have always been passionate about: setting up a private medical practice that can help cater for unmet health needs in rural Ghana.
That’s how I came to be the executive administrator of TopMED HealthCare. The primary aim of establishing TopMED was to extend affordable clinical and diagnostic healthcare services that are of a high quality to people in rural Ghana.
Through my research, I have been able to identify geographical access and financial access to diagnostic and pharmaceutical services as being the key problems in communities in the country’s eastern rural areas.
The experience of a person who falls ill in a rural area in Ghana is as follows:
Local healthcare facilities often offer very basic services. This means a patient is referred to an urban facility for fairly simple diagnostic procedures such as an ECG or an ultrasound. Similarly, most medicines they need to manage their medical conditions are only available in urban areas.
This means the already poor patient has an added medical cost: transport to get access to the life-saving care they need. The results are sad. More often than not, poor patients in rural areas never manage to raise the funds to get the required treatment. Some resort to cheaper alternatives, such as natural remedies, which may in the end cause further deterioration to their health or even cause their untimely deaths.
As much as I have enjoyed fulfilling work in my position as Ghana’s Head for Health Information Management, I have long wished to apply my skills as a clinician and a sonologist to directly impact the lives of those in great need, particularly the rural poor. I think TopMED HealthCare has helped me achieve part of that aspiration.
A reduction of the maternal mortality rate has been at the top of my agenda, and I have dedicated TopMED’s outreach services to maternal care. The main beneficiaries so far have been pregnant women in the rural communities.
To ensure that these women receive essential diagnostic services, we eliminated a major bottleneck that prevents them from seeking essential services early in their pregnancies. Now, instead of them travelling to our facility to be served, we have moved our services to their very doorstep using mobile units. With this arrangement in place, we have been able to reach thousands of pregnant women with ultrasound and diagnostic services.
Through these efforts, many potentially life-threatening conditions in pregnancies — such as high-grade placenta previa, ectopic gestations, severe anemia and significant proteinuria — have been diagnosed and patients have been directed to the care they need. Our activities have been lauded by stakeholders in the areas where we operate, and our contribution towards the reduction of maternal mortality cannot be overstated.
We hope to expand the coverage of our outreach services in the months ahead. To achieve this goal, I am gathering support from potential collaborators who share in our belief that the poor also deserve quality healthcare.
I should mention that the leadership skills acquired from the IPPHL fellowship have proved invaluable in my work as director and executive administrator of TopMED.
Yet, even with this program, the key question around how to ensure universal healthcare in Ghana remains. A solution at the moment has been plans around a health insurance scheme. A question I am tackling in my research is: How can Ghana achieve sustainable funding for its health insurance scheme?
A solution I am looking at is co-payment for healthcare. I know influencing a countrywide change with this policy solution will be a enormous task. Perhaps one answer lies in testing the co-payment solution at grassroots level.
This is where TopMED becomes relevant. If a rural patient is willing to pay out of pocket for quality clinical and diagnostic services that are affordable, then co-payment, which could guarantee the same quality of care at a lower cost, would probably be welcomed.
The bottom line for us at TopMED, though, is that access to quality healthcare is essential, and will lead to healthier, happier societies for generations to come.
Dr. Samuel Kwame Buabeng-Frimpong is a 2017 fellow of the International Program in Public Health Leadership.