We are now a week into our second course of out study abroad program, studying the disparities of the Ghanaian healthcare system. These disparitites range from Ghana to the US, urban to rural, and ever North to South. We have seen and learned about a number of different healthcare situations in Ghana. Since my interest is in access to basic healthcare I have been watching health clinics as we traveled around for the first 4 weeks and I have been trying to understand how the healthcare system worked, now all that I have observed is making more sense.
The Statistics
– one third of the 138 districts have no hospital
– high maternal mortality rate (hemorrage & infection)
– beyond the capital the road system is poor
– 40% of population is covered by the national insurance
– life expectancy is 57 (this has fallen with the emergence of HIV/AIDS)
– healthcare is geographically, financially, and culturally inaccessable
The key problem in Ghana is figuring out where the divide should be joined between traditional and western medicine. What is more interesting is the integration of traditional medicine into the very western Ghanaian health system. I noticed from my pre-healthcare course observations that there is a large number of missionary clinics, government hospitals, pharmacies, and other private health service centers in the Accra area. As we traveled from Cape Coast, Volta Region, and Kumasi I noticed that there was a lesser degree of healthcare services advertised or offered. Why was there such a change from the urban to rural was my first question. Even more so why was there such a disparity between the other regions and the Volta Region of Ewe people?
7 June 2007
Our first visit of the health systems in Ghana was to a health clinic and research center that was solely focused on using traditional medicines and herbs for cures of ailments. It was very interesting to observe the research being conducted and see that they were also running a full health clinic with their findings. The center claimed to have WHO (World Health Organization) funding, but I am not sure if that is true anymore. While there we met some students from the US who were interning at the center for the summer. This is a direct linkage between the traditional and western methods of medicine. This also brings up the issue of intellectual property rights – do the communities that the center learns from benefit from its revenue? Sure the health clinic, but otherwise? This is a reason that the center’s director gave for not partnering with large pharmaceutical companies – to not lose IP rights.
From there we went to the Mampong district outside of Accra to view the structure of the health systems and network of regional health services. We first visited the regional administration offices and talked with the head nurses. They gave us a very well run and organizaed outlook on healthcare in Ghana. At the offices there was also a counseling and testing clinic for HIV/AIDS and a peer educator class taking place. Here we learned that USAID (United States Agency for International Development) provided food rations for new mothers and mothers with malnourished children. I asked if this was true at all regional districts. The answer was yes, but I wonder if all the regions are as well established as Mampong. We then went to visit the regional hospital. It was a large, modern building, not very dissimilar from what you would find in America or Europe. But, there were obvious differences in the developed nature of the hospital. It was a nice hospital, but not one that I would want to stay in. 
We were given a tour of the entire premises and had a near-death experience in the elevator. Twenty plus people in an old hospital elevator in Ghana makes for exciting times. The elevator descended with the help of our weight and gravity – there was a loud bang as we hit the safety catch – there were still three floors to fall. The head nurse was not very keen on what to do next, but eventually we all climbed out from the gap left between the two floors to the wondering faces of what seemed like the entire hospital staff. Its the stairs from now on. 
There seems to be a very good system of healthcare in the relatively developed areas of Ghana, but as for the villages I cannot say. It seems that we have visited mostly well put together centers and clinics. This made me think of the situation in Uganda, where it is the private and mission clinics that have all the supplies and the government run centers have absolutely nothing – very different.
At the Mampong regional administrative offices we learned that in many villages where there is no clinic or government hospital there is a nurse that lives in the community and is charged with the health of that community. However, I cannot speak to the degree of training or equipment that these community nurses have. This speaks to the obvious disparity between the urban and rural environments. There is not as much access to healthcare in the rural areas and so I wonder how much access there is in much of the rural North of Ghana? How many people do not have access?
11-13 June 2007
Some of the issues brought up in our classroom lectures about the health systems in Ghana relate to money. Not everything is covered and so some people cannot pay for access to services. There is bribery in medicine, we have not experienced this, but I do not doubt it. The basic insurance policy in Ghana costs about 72,000 cedis a year, this may not seem like a lot to ‘developed’ countries, but to a Ghanaian this could mean a great deal. In its health development, Ghana is still working on eradicating polio and guinea worm – even in metropolitian areas. Sanitation is a big problem. “The world is my toilet,” has become a joking phrase among the males in our group. If you are a male you can urinate just about anywhere, except where it says, “do not urinate here!” However, you still see people urinate by those signs. Sewage drains have stangant water and often do not drain anywhere. Trash is not collected and is often burned by the roadside. This reminded of Uganda where trash is just thrown out the window. In Kampala you cannot get away from the smell of burning trash, and there are not even drainage ditches.
Another issue brought up was that of ‘assembly line medicine.’ In Ghana there is such a high number of out patients (40% due to malaria) that the health workers often diagnos based on perception, not based on evidence. The issue of traditional and modern medicine is also a hotly contested topic. The health worker crisis in Africa seems to have been circumvented slightly in Ghana. Ghana has included traditional birth attendants in their health system and has just set up a new council for traditonal medical healers to have their say. The most fatal health issue in Ghana now is maternal motrality. Why? Good question, Ghana is ery developed in its understanding of health practices and so it makes no sense whatsoever that a mother should die due to complications of childbirth.
We next traveled to Ashesi University, a private, liberal arts university in Ghana (the most liberal in all of Africa, supposedly). Here we met a Fulbright fellow and a former fellow who is a profesor at Eastern Michigan University. Here we talked about the ‘brain drain’ and new ideas for Ghana’s health system. Currently a physician is in charge of managing the health center, but this means that often the physician has no idea how to manage and makes the staff unhappy and then does not practice medicine because he or she is too busy managing the center. The professor from EMU was working on publishing a study to help change this and introduce education for health managers. The incentives for staying in the country to work are minimal, but inticing. If you work in the Ministry of Health (MOH), then you can be sponsored to increase education and degree. The professor also talked of how Africa, “gets under your skin, you keep coming back.” It really made sense to me and I really don’t want to leave.
13 June 2007
Today we visited the Korle Bu hospital, the best government hospital in all of Ghana. We were not able to tour the main clinic becuase we arrived late, but we did get a quick tour of the Department of Child Health. It was a very nice center, as you can tell from the pictures. This was again an amazing compund that constituted a village in itself. It was obvious that this center must receive a large amount of the government funding for health. There were a number of different center, housing for doctors and nurses, a bank, pharmacy, and a teaching hospital for the University of Ghana. Hopefully we can return later and get a tour of the main clinic to see how things are run there.
The recommended health center for the MSU program students, if they are to fall ill on the trip is Nyaho Clinic. It is a private center tucked away in a random area of Accra. We have had a few students go there, but I have not seen for myself the interior. I have heard it is very nice and Ghanaians in the health profession know it as a nice and expensive clinic.
So far most of the health systems we have seen are very well established and well run and seem to be in great condition. We have not seen the failings of the Ghanaian health systems and the picture for now seems very rosy. I have seen the many mission, private, and government hospitals and clinics in the fairly ‘developed’ regions of Ghana. What I have not seen is the lack of healthcare like I saw so vividly in Uganda. The EMU professor at Ashesi University told us stories of his experiences with health in Ghana. He told stories of overrun rural clinics, a family’s inability to pay for lifesaving medication, the long distances traveled wo receive attention when it is too late, the sheer numbers of people who just do not have access to basic healthcare. This is where I feel we should be, this is where it would make sense to me, this is where we can make a difference. We will now be leaving for the village of Otibini near Danfa to do a community health assessment. I think here is where we will get to feel the village life and true health crisis.
Index of blog post series on Ghana.
Alex B. Hill 