Ghana: Avoiding the politics of emergency medical care

Anytime I see political players discuss healthcare policy, I have the distinct feeling that they see Ghanaians as consumers of whatever healthcare they are provided with. I hold this view because often discussions around healthcare, be it by way of quality or deliverables, are held with the views of the end-user relegated to irrelevance. Last week I elaborated on what constitutes an Emergency Service System (ESS) and explained why in my view Ghana lacked one.

Important feedback I received on that piece asked if I could anchor the analysis contained in that article to the procurement craze that has become characteristic of many aspects of our health planning. To achieve this, I have decided to look at the frenzy that follows the purchase or non-purchase of ambulances. ESS, like all aspects of healthcare, can be described as a nonexcludable public service; meaning every one of our population of 30.2 million should ideally have access. That access, however, must be aimed at improving survival chances in an emergency.

Ambulances are not just emergency transport vehicles. They are an integral part of an ESS that must ensure that patients are transported quickly whilst being stabilized to a facility that can get them out of a medical emergency on the road to recovery.

In the lead-up to the 2016 general elections and following the swearing-in of the current President, there was considerable press coverage around the fitness for purpose of some ambulances that had been ordered by the previous government for the Ghana Ambulance Service (GAS). These discussions culminated in an assurance from the government that 275 new ambulances were being ordered to ensure each constituency in the country had an ambulance at its disposal. As I write, I am reliably informed that these would soon be in the country. I cannot help but prompt readers that this would be greeted with considerable political fanfare and reminders that another campaign promise has been fulfilled.

As I opined last week, ambulances must work as part of a seamless system. They must be managed, maintained and operated through a central command that ensures longevity. Most importantly, these provisions should be available long before the ambulances are made operational. A simple look at the website (click here) of the National Ambulance Service (NAS), the institution statutorily empowered to hold these vehicles in trust and operate them, greatly gives me concern. The website looks neglected and provides little previous or current information on the workings of the National Ambulance Service. In the spirit of transparency, I was expecting to find information about ambulance response times and fleet size as a minimum. My question is if the central portal from which citizens are supposed to obtain information on the NAS is this poorly maintained, what does it say about the potential maintenance culture these ambulances are going to be operated under?

As I came face to face with reality, the ghost of the previous fleet which at the last count had dwindled to 55 began to flash in my memory, leading me to wonder if adequate maintenance provisions had been made for this new fleet and what if any were the learnings from how the previous fleet was left to perish. Then I remembered that a similar fate had befallen the Ministry of Health’s mobile outreach clinic vans that have been left to the elements within the precincts of the Korle.bu Teaching Hospital; getting occasional use when political expediency requires that some brownie points are scored.

The point is if we as citizens do not know what to measure these public services we receive against, how do we know if the system is failing?

At this point, I was oscillating between delusion and reality and began to wonder if any deliverable key performance indicators (KPI) were in existence for the NAS and if there were, how knowledgeable the public was about these? The point is if we as citizens do not know what to measure these public services we receive against, how do we know if the system is failing? I ask because I am aware of a hospital where an emergency transfer was aborted because the ambulance driver had left his duty post to go have a meal. Unfortunately, the delay led to the expiration of the patient in distress, such a needless loss of life.

This brings me to the issues surrounding the work ethic of the paramedics that will be expected to operate these ambulances. If they are not cultured to understand that their job is not like any other public service job where lackadaisical attitudes have no repercussions, they would fail to improve the survival chances of Ghanaians irrespective of the quality of their vehicular equipment and gear. Thus, I expect that they will have Standard Operating Procedure (SOP) that spell out clearly what their response rates should be, what should happen during patient transfer and the repercussions if these are flouted. It will be important also if the public is well educated around these expectations to ensure the system has adequate external checks.

For those of you who are busily awaiting the arrival of these ambulances to engage in the usual propaganda, hear me out. Ambulances are not just emergency transport vehicles. They are an integral part of an ESS that must ensure that patients are transported quickly whilst being stabilized to a facility that can get them out of a medical emergency on the road to recovery. Having one in each constituency is a good start; but without all the other underpinnings, it is an exercise in futility.

You should be demanding from those we have put in charge of our destiny, how these ambulances will be made operational, how they will be maintained and how you will be able to measure their service delivery levels and quality. So, you should be interested in the level of resourcing these ambulances will receive by way of human resources, replenishment of emergency medical stock and the services and standardisation of emergency medical equipment onboard. For even with the best will, an ambulance arriving at an emergency with inadequate gear is of little use to the patient in distress.

The political procurers may have gotten their cut, but as citizens we need to demand our fair due. If we fail to ask for these basic accountabilities and rejoice at the simple landing of ambulances in our constituencies, we would have done ourselves a serious disservice and would have justified why our democracy has become procurement driven. In doing so we would also have increased our level of complacency and decreased the chances of these ambulances enhancing our chances of survival during an emergency. We need to ensure that we are no longer treated as rectifiers and consumers of whatever decisions our politicians with little bureaucratic input come up with but as partners who have an interest in healthcare outcomes.

By Kwame Sarpong Asiedu