The Well-Organized, yet Somehow Inefficient Health System of Ghana (Part 1).
A true story of Ghana’s Health System.
From 1957 when Ghana finally had her independence from Britain till now, her health care system has gone through series of evolution with the aim of making it better and leading it towards universal coverage.
Health care system is very pivotal in any country. It heavily impacts on the development of a nation. That is, a poor health care system may be enough to judge a country as a poor one. Any state which does not take the health of her people seriously may never live to be called a developed country, because, her human resource would lack the ability to live long and healthy enough to contribute to the development of the country. Additionally, a poor health system is a very good reason for a country’s populace to seek greener pastures in other nations, thus, brain drain occurs.
Ghana started on a good note in the early years as an independent nation under the leadership of the widely celebrated Kwame Nkrumah. Health care was virtually free in this period. Next came some series of political tussles that affected the health care system greatly. The instability continued for a good number of years until the fourth republic which came with 1992 constitution that sought to put things in order for the smooth running of the country, including issues of health care. This opened the door for more policies that came in to strengthen and better the wobbly system.
Presently, the health care structure is in three main tiers, from highest to lowest: national, regional and district. At the district level, the primary health care model (from district to sub-district to the community level) is utilized to make health care more accessible to the populace. This structure also makes it easier for referrals to be made from the lower levels to the higher ones, and vice versa. Each level has its package of services offered to the patient, with the number of services increasing as one moves from the community level upwards.
The Ministry of Health (MoH) oversees all matters concerning health care in Ghana. Its work is mainly policy-making and governance, leaving the provision of health care to its agencies such as the Ghana Health Service (GHS), Christian Health Association of Ghana (CHAG), and other peripheral institutions like the Food and Drugs Authority (FDA) and National Health Insurance Authority (NHIA), whose roles are imperative in health care provision, though indirectly. The majority of health facilities are under the GHS, since they are in the public sector. Though the hospitals built by various Christian sects are under CHAG, they also work hand-in-hand with the GHS to make a more organized system, which makes sharing of health information for the purpose of preparing reports for national assessments and policy-making a seamless one.
This structure is one that is supposed to adequately provide Ghanaians with proper health care, but it is plagued with very avoidable challenges which stem from inadequate funds. Mind you, this issue of inadequate funds is of our own doing. If the executives in the MoH and its agencies, in conjunction with the Ministry of Finance, prioritize health care, we would not be facing this problem.
The NHIA is the chief financier of Ghana’s health system, pooling contributions from the people and standing on the premises of solidarity so that all, whether rich or poor, can access health care. The mismanagement of funds earmarked for the health sector has reduced the quality of services offered under the National Health Insurance Scheme (NHIS), which has caused people to lose trust in the scheme. It has compelled Ghanaians to patronize private health facilities, which prefer out-of-pocket payment for their services to using the NHIS card.
Many facilities complain of the late payment of claims by the NHIA and which has forced some of them to refuse treatment of patients that turn up with the NHIS card.
This has taken us many steps backward to the ‘Cash-and-Carry’ system (out-of-pocket payment for health care) which brought huge disparities in terms of healthcare access between the rich and poor. At that time, health care was a luxury, and it looks like we may end up that way today if measures are not put into place to deal with the corruption and mismanagement going on in the high offices of the public sector, including health care.
Part 2 of this issue would centre on how the NHIA finances Ghana’s health sector, so that we better understand whether the scheme is to blame for the inadequate funds or, this is indeed the result of having corrupt officials. Anyway, let’s talk more in the comments section.
Signed, Richeal.
