- “A complete stranger has the capacity to alter the life of another irrevocably. This domino effect has the capacity to change the course of an entire world. That is what life is; a chain reaction of individuals colliding with others and influencing their lives without realizing it. A decision that seems minuscule to you, may be monumental to the fate of the world.”
Ghana currently has approximately 3,200 doctors and a doctor to patient ratio of 1: 9043. For us to half our current doctor to patient ratio and bring the figure to 1 doctor to 5000 patients in five years will require a lot of policy planning and strategic thinking. Using the current population of 29 million, this will mean we will need a doctor population of 5,800 in 5 years assuming none of the current stock is lost through, migration, ill health, death or career change. If attrition is factored in at 10% it implies our current stock of doctors will shrink to 2,880 leaving a training requirement 2,920 over five years or 584 doctors yearly assuming none of the newly trained doctors is lost to attrition yearly.
With Ghana training approximately 300 doctors a year, it implies there will have to be a clear plan to train 284 extra doctors a year over five years as a minimum to ensure we make inroads at achieving this. If we factor in population growth projections which indicate that the country will have a population of about 32 million in 2023, it implies we will need 120 extra doctors trained yearly to be on track, bringing the total required to 404 extra doctors yearly. These number means a lot of resources will have to be focused on the training of other health professionals too to complement these extra doctors. Considering that since 2016 the component of our healthcare budget covering staff remuneration has gone up by approximately GH400 million annually, meaning about 59.1% of our healthcare expenditure is spent on staff and obtaining financial clearance to employ new doctors has become a nightmare in recent years, what are the chances of achieving this?
It must be stated that in September 2015, Ghana held its first National Quality Forum under the auspices of the Ministry of Health resulting in the publication of the Ghana National Quality Healthcare Strategy (2017-2021) which was published in December 2016. A critical look at the document indicates that though it aimed to improve quality of healthcare, it failed to give a clear direction as to how the critical quality driver (availability of healthcare human resources) will be improved. Suffice to say, following a change in government, the document has been gathering dust.
Truth is, we have no plan to make inroads on our poor doctor to patient ratio or any other healthcare professional to patient ratio for that matter. Data on a roadmap to improve these statistics are not available from any arm of the Ministry of Health, neither are they available from the respective healthcare professional bodies. Without the required human resource capital, it is interesting that we still believe in constructing more CHIPS compounds and other brick and mortar facilities we will struggle to resource is the route to improving healthcare access. In a country where a poor maintenance culture is known to persist, we run the risk of having more dilapidated healthcare facilities commissioned with fanfare and no benefit to the rural dweller. Even more poignant is the littering of newly constructed healthcare facilities that government is struggling to operationalize.
This is why some of us advocate for the use of innovation as the fulcrum for improving healthcare access. In a country where the mobile phone is probably the only object that penetrates every nook and cranny, one wonders why phone connectivity is so poor among our health facilities and why the mobile phone hasn’t become the object around which primary healthcare systems especially revolve?
Recently, when a citizen, unfortunately, lost his life after going to a number of healthcare facilities and being confronted with an absence of ”medical beds, ” most of the narrative focused on the lack of beds, the inhumane attitudes of healthcare professionals etc. and not on unpacking the real reasons why we got here. For me, investigating the issue from the premise of “no beds” rather than unpacking the tragedy was a missed opportunity. This tragedy happened as a process and not an event. As is said in health, death chilling as it may sound is often a process and in our parts often one froth with many missed opportunities.
A few questions come to mind; when did the patient’s health begin to deteriorate? What were the barriers to him seeking early intervention? Why did the family not call the respective health facilities in an attempt to identify which had capacity rather than drive there? Assuming calls were made, would the facilities have answered? If these calls were answered, will the family not have found a facility that they could have driven straight to and gotten emergency care much quicker? In a more organised healthcare system, will that call not have allowed the health team in the said hospital prepare for the arrival of the patient? These questions are not exhaustive but in my view are critical to preventing similar occurrences in the future.
We seem to prefer to be reactionary and only firefight when the unfortunate happens without engaging in the critical analysis that will prevent future occurrences. Though the report for the no-bed investigation hasn’t been released, I dare say I will not be surprised if none of the questions above fails to be answered. Call me a pessimist and you will be wrong. In all honesty, I am optimistic we can learn from this sad occurrence and build a serious system that relies on the mobile phone.
This is why I believe we need to start chipping at the advocates of brick and mortar and subject their view to critical scrutiny. We need to analyse how health care access has improved with this strategy and whether a change in focus wouldn’t yield better results? Those of us who advocate a different way of thinking that focuses on more innovative approaches like telehealth should know that new views will never be accepted willingly and must be prepared to educate, obtain a critical mass and start a domino effect. It is only when we do this in a dogged collaborative manner with a tenacity many will find uncomfortable will the penny drop and the real conversation start. Our lack of numbers and poor healthcare professional ratios may be a barrier but it is also a huge opportunity. I see the glass as half full, others may see it half empty; it’s a matter of perception. Welcome to the health numbers game.