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The Thoughts Of A Lay Man On Improving Health Delivery In Ghana

Feature Article The Thoughts Of A Lay Man On Improving Health Delivery In Ghana
DEC 12, 2013 LISTEN

When one does the math, dividing 24 million people by 2700 doctors, it is quite a sad situation that has been and will continue to stare us square in the face for years to come. The quality of health care depends on a team of health professionals, which is headed by a medical practitioner. I do not mean to infer that we have adequate numbers of the other health professionals, but it is imperative we stock up the number of doctors we have.

As Prof. Frimpong Boateng righty said [1], in order to have an adequate doctor-to-patient ratio of 1:500, we will need to have nearly 50, 000 medical doctors. Assuming that with our current infrastructure churns out an average of 500 doctors annually, and in the absence of factors that reduce the doctor population, we will achieve this aim in 100 years! We do not have 100 years to do this, so we need to accelerate action on the training of doctors. Initially we need to “mass produce” a good number of them, and then we can continue gradually until we reach our target.

To tackle this problem, I would like to offer some suggestions, some of which may seem radical, but it depends on all of us to ponder over these problems and the possible solutions to improve our lot, and that of generations to come. It is my suggestion that:

1. We decentralize medical education and training. We have 10 regions, and we must set up medical schools in each of those regions to cater for the health needs of that area. An advantage of this policy is that residents of the region will be trained in their region, and will more readily serve there than in another region. Looking at the current situation where the three Northern regions especially are underserved, as compared to the rest of the country (which in practice is underserved too!) UDS is the only university in the northern part of the country that trains doctors, and it does not admit a many students, like most of our other universities. Therefore, it is relatively less likely a student from the three Northern regions will be trained as a doctor in the north. After graduation, this new graduate will most likely want to remain in the south, if he trains there.

2. We “reduce” the qualification criteria of high school graduates. This is implicit in the above point. If we have more medical schools, it means more people will be accepted into them, people who under the current situation are considered not “qualified” according to the criteria set up by our current Universities. I am not saying we should compromise quality for quantity. Nevertheless, who says a good doctor is the one who obtained aggregate 6 in W.A.S.S.C.E? This aggregate 6 student is an excellent student, such people are not common so even if we make doctors out of all our excellent students, the might not be enough to solve our health problems. The most common kind of person is the average person. [2] The average person has an average problem that does not require a very intelligent person to solve. Malaria, for example, is an important infectious disease in our country, and continent. How much intelligence does a doctor need to diagnose and treat this and other disease?

3. We change the objective of training a Swiss army knife kind of doctor, and focus on the training of general practitioner (GP) with more emphasis on the health problems facing our country. It is a fact a GP must know a bit of everything. It is also known the issue of insufficient number of doctors includes both GP's and specialist registrars (SR). Therefore, we must train both in very significant numbers. Training programs in medical school should be more biased towards OUR problems, the most frequent ones. A GP should be able to solve basic health problems, and refer complicated ones to a readily available SR. Like it or not, there will be complicated pregnancies and deliveries. What do we expect a midwife, or GP (for those who are lucky to have one nearby) to do? In the real world, real people die because of issues like this. A jack-of-all-trades is a master of none.

4. We take another look at our health problems, and make serious plans to prevent disease and its complications, rather than treating them. Prevention is expensive, but is much cheaper than treatment. Prevention, they say, is better than cure. If we base the solution to our health problems on prevention, then it is even more likely that a person with average IQ can play the role of a doctor, and we can all be happy  [3]

5. We move to a more community-based and preventive medicine. Medical practice revolving around the individual and his family, inside the community where he lives. This way, the GP is more familiarised with the people and therefore, there can be a better comprehension of the communities health needs by the doctor, and there will be a better doctor-patient relationship, and hence a better probability of getting the patient's health needs met. The processes that lead to disease will be very visible to the doctor and hence he can act to prevent it. We need restructure our health care system, especially primary health care. Prevention is better than cure. For both the individual and for the Society. The purpose of primary health care is to prevent disease and to manage the fundamental health needs of the community (this forms the larger part of all health needs). We do not need hospitals for this. We need Health centres or Polyclinics for this purpose. They are cheaper, and more efficient to run, than hospitals. [5] [6] We already have district hospitals. They can act as primary referral centres for those who need care that is a bit more specialized. Most patients who are attended to at our outpatient department of district hospitals need not go there in the first place. They can easily and efficiently be attended to in Health Centres/Polyclinics. The hospital can this way, be a more efficient referral centre.

These ideas are not new. They have been tried and tested in various parts of the world. Whatever our goals are as a nation, we need healthy citizens to achieve them. In order to remain healthy, we need to actively prevent disease. What are your thoughts?

Reference
[1] http://www.ghanaweb.com/GhanaHomePage/health/artikel.php?ID=293443

[2] http://en.wikipedia.org/wiki/Normal_distribution

[3] http://www.cdc.gov/features/preventionstrategy/

[4] http://communications.med.nyu.edu/media-relations/news/nyu-school-medicine-debuts-three-year-md-program

[5] http://en.wikipedia.org/wiki/Primary_health_care

[6] http://en.wikipedia.org/wiki/Primary_care

Andrew S. DZEBU
Fifth year Medical Student
donkhermikal at gmail dot com

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