SYSTEM OF PUBLIC HEALTH IN GHANA


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Ghana is a developing country in West Africa with a population of about 25 million. Although economically poor by Western standards, it has a proud history, including as the first sub-Saharan state to regain independence from European colonial powers (in 1957), universal education through primary school, and a relatively high literacy rate for developing countries. Well-endowed with natural resources (including gold, timber, and cocoa), Ghana has a much higher per capita economic output than most West African countries but remains partially dependent on international financial and technical assistance. A physician, medical practitioner, medical doctor, or simply doctor is a professional who practices medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease, injury, and other physical and mental impairments. Both the role of the physician and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such as medical ethics requiring that physicians show consideration, compassion, and benevolence for their patients. In the 16th century, traditionally, village healers were the primary caregivers, offering herbal remedies through pre-modern traditional beliefs stressed the combination of spiritual and physical healing. Western medicine was introduced by Christian missionaries to the Gold Coast (Ghana) in the 19th century. There are seven medical schools in Ghana: The University of Ghana Medical School in Accra, the KNUST School of Medical Sciences in Kumasi, University for Development Studies School of Medicine in Tamale etc. Basic Medical education lasts 6 years in all the medical schools. Entry into these medical schools are highly competitive and it is usually based on successful completion of the Senior High School Examinations. The University of Ghana Medical School has however introduced a graduate entry medical program to admit students with mainly science-related degrees into a 4-year medical school program. The University of Ghana Medical School and KNUST School of Medical Sciences in Kumasi use the Tradition medical education model whiles University for Development Studies School of Medicine uses the Problem-based learning model. Medical graduates are then registered provisionally with the Medical and Dental Council (MDC) of Ghana as House Officers (Interns). Upon completion of the mandatory 2-year housemanship, these medical doctors are permanently registered with the MDC and can practice as medical officers (General Practitioners) anywhere in the country. The housemanship training is done only in hospitals accredited for such purposes by the Medical and Dental Council of Ghana [1]. While the practice of General Medicine is similar in principle to that in wealthier countries and the total range of illnesses is similar, some illnesses are seen in far greater measure than in developed countries. They include infections, particularly those common to tropical countries, trauma, and women’s health problems such as complications of pregnancy (specific examples of all these problems are detailed in the following article on the development of a particular General Medicine residency program in rural Ghana). Infections Infections are a primary reason for hospital visits and admissions. Malaria is rampant, and its burden is tremendous. Most malaria is treated easily with 3 days of pills distributed by the government, but many people acquire malaria repeatedly, and if untreated, it can be fatal. HIV infection are common (the latter infecting 1.8 percent of the population - much less than in Southern Africa), and about half of the patients in Ghana who die with HIV do so from consequences of tuberculosis. Trauma comes from the same sources as in other countries, including home and work-related accidents, and violence, domestic and other. Much more trauma, however, comes from motor vehicle accidents, which are far more common in most developing countries than in the developed world. Ghana is no exception. The cause is a combination of poor road conditions, vehicle malfunction, and, mostly, less well-trained drivers with dangerous habits. Rules of the road are not well adhered to or enforced. Motor vehicle accidents generate the large majority of severe trauma cases in Ghana. Women’s Health A disturbingly large percentage of emergency and critically ill patients are young women who are pregnant - and many from complications of botched abortions. Safe abortions cost approximately $25 in some private clinics, but this is prohibitive for many young women and their families. Various herbal concoctions may or may not produce miscarriages, but they also cause fulminant infections or even sepsis and subsequent scarring, obstructions, and child-bearing trauma. Maternal mortality is high in West Africa, approximately 560/100,000 births in Ghana, but Ghana’s is one of the best rates in West Africa. Infant mortality is 61/1000 live births, but reliable statistics are difficult to determine and just beginning to be gathered, in part because most births occur at home. Other Illnesses Diabetes, heart disease, cancer, asthma, sickle cell disease etc [2, p. 23]. Medical Technology While equipment and other facilities are generally modern in the university hospitals, this is not the case in most small towns. Nationwide, there are relatively few ventilators, except in operating rooms and in the thoracic surgery ICU at the university in Accra, with smaller units at large teaching and military hospitals. Cardiopulmonary resuscitation is seldom attempted outside major urban centers. Neither patients with coma from severe head injury nor those with severe respiratory diseases are intubated. There are hemodialysis units at only the two primary teaching hospitals in the large cities. It can be difficult to get a cardiogram done, sometimes even in the teaching hospital in Kumasi. With the development of a small but growing middle class, especially in the cities, some private clinics are springing up, and some have sophisticated equipment. Specialization Specialist physicians are relatively few in Ghana as most acquire their formal specialty training abroad, and most stay there. A few years ago, three of Ghana’s five urologists were killed in a single car crash after a medical meeting. Neurology, the field of one of the authors (AA), for example, does not have its own section in the universities. There are only a couple of neurologists in the country. There is one clinically active neurologist in Ghana, at the Korle Bu Teaching Hospital in Accra, who runs the only EEG and EMG laboratory. The two main teaching hospitals have CT scanners, as do a few medium-sized cities and private clinics. The Ghana Health Service consists of government (including university) hospitals and clinics, hospitals and clinics within the Christian Health Association of Ghana (CHAG), and private facilities. The Ghana government pays most of the salaries of the staff physicians, house officers, nurses, and some others in the government and CHAG hospitals. For other funding, the CHAG hospitals must be self-sufficient, and much of the operating expenses depend on income from patient charges. The Ghana Ministry of Health has introduced a national universal medical insurance system, the National Health Insurance Scheme (NHIS), which pays for hospitalizations and outpatient doctor visits, as well as basic laboratory testing and certain medications. Ghana's universal health care system has been described as the most successful healthcare system on the Africa continent by the renowned business magnate and tycoon Bill Gates. For many years because most physicians emigrate. Ghana is working hard to educate and retain locally trained physicians, but it is difficult to get them to work in rural settings, where the need is greatest. Despite facing many limitations, Ghana has made tremendous strides in promoting medical care in a moderately large and very complicated country. It is a leader in West Africa and beyond.
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About the authors

- Abdoulaye Sumaila

References

  1. Ghana Statistical Service [Electronic resource]. - Access mode: http://www.statsghana.gov.gh/pop_stats.html.
  2. Ghana. Demographic and health survey, 2014/ Ghana Statistical service (GSS), Ghana Health Service (GHS), and ICF International. October 2015. Rock- ville, Maryland, USA: GSS, GHS and ICF International.

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