IS THERE A DOCTOR IN THE HOUSE?

Ghana 2018 | HEALTH & EDUCATION | FOCUS: HEALTHCARE ACCESS

In Ghana, e-services and technology in healthcare are filling in the gaps left by a lack of human resources.

the Aesop fable “The Town Mouse and the Country Mouse" nurtures an idyllic, yet not completely utopian, conception of a rural life, one which has been deeply entrenched in many societies. In emerging markets like Ghana, the risk of running into diametrically opposite connotations of the term “luxury" is extremely high. Access to medical services offers compelling evidence of this double standard. Regrettably, this is more visible when comparing urban centers with rural areas.

Indeed, highly skilled professionals, for the most part, are based in cities like Accra, Kumasi, Takoradi, Tamale, and Koforidua, which have all seen their population triple over the past 30 years. If major cities keep getting bigger, as witnessed by the 3.15% urbanization rate, it comes as no surprise that medical facilities, too, are present almost exclusively in high-density locations. Even more troubling, in terms of access to healthcare, in Ghana, there is one doctor for every 10,450 patients—roughly one-eighth of the WHO's recommended doctor-to-population ratio of 1:1,320.

Health access should not be an urban luxury, and the government is targeting initiatives to address this issue. The National Health Insurance Scheme, established in 2004, sought to improve access to healthcare and offer financial risk protection to the average Ghanaian citizen. Essentially, it put financial access as the health sector priority. However, 13 years later, the fact that only 40% of the population is under national coverage implies there is still much to be done.

Health service access, not affordability, is the reason behind the depressing numbers. Indeed, a recent survey shows that among households, 66% of the uninsured ones and 70% of partially insured ones could afford full insurance. Yet, they do not buy it. After all, why should Ghanaians pay for the eventuality of a service they would hardly receive? Tackling the issue of healthcare under a financial point of view was considered a priority. Now, however, the issue of human resources deserves equal attention with the same degree of urgency.
Ghana Health Service's (GHS) 2016 Annual Report recognized the “disparities in distribution of health workforce between urban and rural settlements." In response, the Ministry of Health (MoH) developed “Staffing Norms" for healthcare facilities in line with WHO's method for determining the appropriate number of staff based on facility needs.

E-services and the integration of technology in the health sector is another way of building the capacity of healthcare facilities. At this stage, the Ghanaian health sector is enhancing its digital health information systems. According to the 2016 GHS Annual Report, the Centre for Health Information Management developed the MoH's new reporting portal. At the time of the report, 86 facilities, including community-based health planning and services, health centers, hospitals, and tuberculosis hospitals, were equipped for electronic data entry and reporting. Furthermore, “The District Health Information Management System 2 (DHIMS2) e-tracker modules have been developed," specifically for tuberculosis, HIV/AIDS, and maternal and child health services.
Efforts to increase healthcare access and staffing ride on the coattails of the system of decentralized health coverage. The One Million Community Health Workers Campaign is active in Ghana to train and deploy community health workers and e-health technical assistants, completely integrated into Ghana's health system but in a decentralized system, with a focus on community-based solutions. Through the financial support of GlaxoSmithKline, community health workers in the Ashanti region—the pilot region—were equipped with the devices and software, including DHIMS2, to deliver technology-enhanced, data-based healthcare. The initiative will be scaled up in other regions, addressing issues such as healthcare quality and employment needs in the sector.
Technology in Ghana has leapfrogged Western standards in almost every field, from finance to education and power transmission. And more remote areas of the country are working to tap into the same potential in healthcare.