Dr Elikem Tamaklo, Managing Director, Nyaho Medical Centre, on the health care needs of Ghana

How have the rise of chronic and non-communicable diseases (NCDs) impacted Ghana?

DR ELIKEM TAMAKLO: Globally, the rising burden of chronic and NCDs has had a significant impact on increasing health care costs, with greater emphasis on early detection and better health management as a means of improving quality and reducing costs.

In Ghana the inability to achieve universal health coverage, due to financial constraints in the public and private sector and a fragmented health infrastructure, presents a unique challenge for enabling the health care system to adequately detect and monitor patients at risk, resulting in comparatively greater and increasing rates of complications, further increasing costs of care and mortality associated with NCDs.

Projections from the World Health Organisation suggest that while infectious diseases like HIV, tuberculosis, diarrhoeal diseases and malaria will see a decline, other NCDs like diabetes, cancer and chronic obstructive pulmonary disease will increase in the region. As of yet, Ghana does not have a robust screening culture and this double burden of infectious diseases and NCDs threatens to cripple the Ghanaian health care system if greater investment in relevant infrastructure and workforce capacity is not achieved.

However, both the public and private sectors are responding to this risk with noticeable emphasis on increasing health care infrastructure, capacity building and supportive health platforms, such as mobile health and telemedicine, as a means to better detect and manage populations at risk within the country.

What are the biggest challenges to ensuring universal health care in Ghana?

TAMAKLO: The biggest challenge is ensuring access to affordable and quality health care. Currently, there are two main types of health care insurance in Ghana, the National Health Insurance Scheme (NHIS) and private health insurance schemes. Though the NHIS caters to around 60% of Ghana’s population, many drugs and tests cannot be accessed through this scheme. In addition, the narrow spectrum of benefits from private health insurance schemes means patients are compelled to pay out-of-pocket for significant health care services, further limiting access to adequate treatment and influencing decision-making. Moreover, these schemes have been fraught with delays in payments to health facilities; hence, many facilities are beginning to shy away from their use.

Priorities for reforming the current insurance system include better regulation of insurance schemes, alignment of policies for insurance providers and health service providers, and increased collaboration to create innovative ways of reducing costs and widening the spectrum of diseases covered.

Where do you see the most pressing staffing needs in Ghana’s health care sector?

TAMAKLO: According to the annual report on the Ghana Shared Growth and Development Agenda 2010-13, the population ratio of clinical staff, doctors and nurses was one doctor per 10,452 people and one nurse per 1251 people in 2012. These figures were in sharp contrast to that of South Africa’s, where there is one doctor per 1250 people and one nurse per 212 people.

The number of doctors and nurses trained yearly in Ghana compared to population statistics is shockingly inadequate. This is compounded by the continuing migration of doctors and nurses to developed countries, looking for better pay packages and professional development opportunities.

Compounding the low figures is a disproportionate distribution of doctors in the Greater Accra region, which accounts for 48.5% of the total number of doctors in the country. The Ashanti region is responsible for 20.9% of doctors and the remaining 30.6% are shared unevenly in the remaining eight regions of the country

This trend has not gone unnoticed by the private sector, and the first private medical school was commissioned in Accra in 2015. There are an increasing number of private nursing schools that have sprung up, some in collaboration with local and international health care institutions. While this is encouraging, it will take some time to see these staffing needs are met in the Ghanaian health care sector, and the quality of graduates from these private institutions is still yet to be determined.