How Ghana’s health system is making and breaking hearts
According to Saidi Mdala, “bad luck is what results when bad things happen to you unprepared, or when you neglect to do what you have to do when you are supposed to do it.”
This week I read of claims that medical personnel had neglected a patient leading to a loss of life. Whilst reading that, I was also aware of a doctor who improvised to get an infant to a hospital where appropriate levels of urgent care could be provided. On his way back to his station, he also had to assist a mother in labour to deliver with the aided by a midwife.
The fact is, our health system always makes and breaks our hearts. It does because whilst a lot of good goes on, often too much goes wrong for the knights in shining amour to be seen in a positive light. There is a lot to be said about how we got here but I would rather on this occasion deal with what needs to change. For far too long, we as citizens have failed to accept that the healthcare, we receive is a direct consequence of our actions and inactions.
We have treated healthcare as though it is for the politicians and bureaucrats to decide what our needs are and how they are met. In doing so, we have allowed them to have a debate about health improvement using parameters that often have little bearing on our healthcare outcomes or quality of care. For as long as I have followed healthcare in Ghana, I have come to hear our debates focused mainly on inputs. For example, by how much infrastructure was enhanced under a particular government whether it is the building of new hospitals or the purchase of ambulances. In debating on inputs, we have failed to consider simple things like the prudence of spending decisions or whether value for money is a major consideration. On a few occasions, these debates shift to outputs in the sense of whether the infrastructure was delivered. Here too we never discuss the correlation between expenditure and results.
Few of us have sat to think and discuss how these inputs have helped to improve our healthcare by way of decreasing maternal mortality, infant mortality and ultimately improve life expectancy. We seem to forget that all the inputs and outputs are of no relevance if they cannot translate in real terms to tangible outcomes. We fail to ask whether at the end of it all we are living healthier and longer. Based often on our political lineage we wrongly assume that just by having infrastructure that we can visualize, we are better off from a quality of health viewpoint.
Unfortunately, this is extremely erroneous. Infrastructure can at best be described as tools and enablers that enhance the capability of a health system to deliver healthcare to society. Without the human resources in these facilities, the right attitudes and skills set, the infrastructure by themselves cannot change our health outcomes.
Clearly, from the positives and negatives I read about this week, there seems to be a range of attitudes in our health system. From the very motivated and determined who want to deliver quality care irrespective of obvious constraints and remain true to their professional oaths to those who at the least instance give up. To have the former is commendable but can we blame the latter? Can it be asserted that their behaviour is deliberate?
Several factors go into the motivation of health personnel. Important amongst them is a clearly defined role with a clear understanding of how the individual’s role fits into the wider goals of the health facility. Speaking to health professionals, I am aware that many have little idea of what the mission statement of their specific institution is, let alone know what the vision and goal are. How then can patients and or leaders in our health institutions expect the provision of optimal healthcare?
Another serious motivator is the provision of training and upskilling. This must not be limited to the leadership of these institutions but must be targeted at the frontline staff who are the face of care delivery. There are many aspects of health that rub shoulders with customer care and service yet it is rear to see such training provided to health professions before graduation or whilst on the job. It is strangely assumed that these soft skills come naturally. Should it then come to us as a surprise when it is claimed nurses on occasion can be rude and vile?
Another area that needs urgent addressing is empathy and understanding. This is because health facilities unlike recreational spaces are not visited by citizens because they want to but rather because they have to. In our country, many are known to avoid these places until they have virtually no choice. Thus, most patients arrive frustrated and anxious. In such a situation the caregiver must be adequately equipped to manage the patient in a manner that irrespective of potential health outcomes allay their fears. The skills required to achieve these professional qualities must be nurtured continually, a situation that does not pertain to many of our health facilities.
I have always insisted that no rational health professional will set out on a path to deliver poor healthcare. As was demonstrated by Dr Emmanuel Adipa-Adapoe last week the reverse is the case. On the contrary, many are to make ill health bearable. However, if they are left in a situation where the system is skewed in a way that they feel done to, the result is the negligence we sometimes hear of. That bad luck happens to us repeatedly indicates that our society has failed to plan and is often unprepared.
As citizens, we need to accept that just shouting about no bed syndrome, medical negligence or the absence of an ambulance to transport the sick child will not lead to changes that will prevent a recurrence. Changes will only happen when we begin to challenge public office holders on why all their claims on investment in health have not resulted in significant changes in health outcomes. Allowing them to have the usual banter around who has invested more is an exercise in futility. Ours is not bad luck but a situation in which citizens have neglected their responsibility to hold public office holders accountable for their failure to plan. By so doing we are bearing the brunt but sadly cheering our political stables on.
By Kwame Sarpong Asiedu