Survey Says...

In recent years, Ghana has improved its national infrastructure to achieve some of the Millennium Development Goals set forth by the United Nations. Inside Accra, Ghana is just like any other country, particularly regarding the healthcare. Korle-Bu, the teaching hospital inside Accra, has sophisticated machinery that one would expect inside a 21^st century hospital. There are also private practices that cater towards the upper class. Outside of Accra, the healthcare system is very different than the healthcare system within Accra. Inside Buduburam, a Liberian Refugee Camp, there is a hospital called St. Gregory’s Catholic Clinic. The hospital has two doctors, two medical assistants, numerous nurses, and numerous pharmacists. The education requirements for each of these positions differ greatly compared to the education requirements in the United States. Doctors in Ghana must attend school for six years and after those six years, they are allowed to perform surgery. Medical assistants were created for the sub-district level to fill the position of doctors. They go to school for four years and perform the same duties as the doctor except surgery. Nurses and pharmacists both go to school for two years.

In addition to the education requirements of each of these positions, the general function of each of these positions differs greatly compared to the United States. The doctors would come to work for about four hours a day. He would go on rounds through the different wards and perform any procedures that needed to be performed. Afterwards, he would go to his office and occasionally take a few patients. Majority of the patients saw the medical assistant. The medical assistant usually saw around 45 patients a day, but on a single day, he saw as many as 110 patients. Each visit is rather short, lasting around 4-5 minutes. The medical examination is merely a medical history, checking the eye for anemia, checking the skin for fever, and occasionally feeling the abdomen or listening to the lungs depending on the symptoms. The nurses, like nurses in the US, are the ones who interact with the patients the most. Some of the procedures that they perform in Ghana, however, are traditionally performed by doctors in the US.

I found that at times, the doctor was rude to his patients. In the US, most patients choose a doctor and establish a trusting relationship with their doctor. The doctor is rarely rude to the patients because if the doctor is rude, the patients will transfer to a different doctor. I concluded that since the patients do not have a choice regarding their doctor, the doctor does not have repercussions for his poor attitude around patients.

Compared to the US, the facilities at St. Gregory are from the 20^th century. Records are kept in composition books. The IV is not attached to a sophisticated machine that monitors every bodily function of the patient. The patients have bed pens rather than catheters. Majority of the conditions in the hospital are unlike conditions that would be found anywhere in the US. The wards hold about six beds for patients and the ward generally smells like urine. Compared to the technology and availability of space at hospitals in the US, the hospitals here are lacking. The conditions only get worse as you go further from the city. In more rural areas, the facilities are less accommodating than St. Gregory and the patients have to travel greater distances.

When thinking about the healthcare system, it is easy to assume that NGOs are improving the situation in Ghana. In Ghana, there are 500 NGOs in the Ghana Health Coalition, which operate under the Ministry of Health. Majority of these NGOs focus on education rather than the improvement of the healthcare system. Because the NGOs are not run by healthcare professionals, the NGOs do what they can to improve their communities through education, such as malaria education, nutrition education, and sanitation education. Y Grow, an NGO in Kasoa, has worked with USAID on the BCS project, the behavior change support project. According to the founder of Y Grow, the Western world helps the job because of the reception that a foreigner will immediately receive. The most effective role that the Western world can play in Ghanaian medical NGOs is by sending health teams to feel the “plight of the people.”

The Ministry of Health estimates the number of doctors in 2007 at 2,026. A recent census found that about 24 million people live in Ghana. According to some predictions, by 2025 the population will reach 32 million. If Ghana wants to achieve a doctor to patient ratio of one to one thousand, it would require 32,000 doctors. Many believe that the government cannot fund such an endeavor due to funding the education and employing all these doctors. Due to the lack of funding from the government, many have called for the privatization of healthcare. The Aureos Capital Group recently created the African Health Fund to invest in commercial healthcare in small and medium enterprises. They plan on investing in markets that provide care to the disadvantaged, hoping that these areas have a greater potential for growth from which Aureos will regain their investment. The World Bank Group has also pledged to engage in the private health sector.

Compared to education in the US, tuition at university or medical school in Ghana is not expensive. Although allowing the private sector to invest in Ghanaian healthcare might be beneficial, it does not address the real problem. Even with that investment, there will still be a shortage of doctors in the near future. The hospital I worked at only had two doctors. In the US, there are more than two doctors in any given practice. Without an investment in the education of these doctors, the population will continue to grow without a steady growth in the number of physicians. In my eyes, this is the most staggering aspect of healthcare in Ghana. Yes, their facilities are different than facilities in the US and so are their education requirements, but they both get the job done. Without an investment in the future, an investment in future doctors who seek to help their nation through healthcare, Ghana will fall behind. I think that this is where the Western world can do more, in partnership with NGOs in Ghana. The NGOs here focus on education and, with healthcare professionals from the Western world, they can help educate more doctors so that Ghana does have to rely on the generosity of doctors from more developed countries. This is what I believe has to happen in the future. Our current model of NGOs falls short on creating a sustainable solution to the problem.