Beyond New Machines: Ghana Doesn't Need More Equipment Agencies—It Needs a Maintenance Revolution

President John Dramani Mahama's statement at the commissioning of the Ghana Medical Trust Fund Cardiac Catheterisation Laboratory at the National Cardiothoracic Centre deserves national attention not merely because of the inauguration of a state of the art facility, but because of one critical admission that every healthcare worker in Ghana understands all too well.

"We must maintain these facilities to the highest standards. Ghana has on too many occasions invested substantial public resources in valuable infrastructure, only to see those investments deteriorate due to neglected maintenance."

This is perhaps one of the most honest assessments ever made by a Ghanaian President regarding the country's healthcare infrastructure. It is a painful reality witnessed in almost every public health facility across Ghana. Expensive diagnostic machines remain idle for months, theatres become partially functional because of faulty equipment, ambulances are grounded due to minor mechanical defects, and patients are forced to travel long distancesm or even outside the country for services that could have been available locally.

The President further announced the establishment of the Ghana Medical Equipment Services Limited to oversee the maintenance of medical equipment nationwide.

The intention is commendable. However, an important question must be asked:

Do we really need another centralized institution, or should we strengthen and empower the maintenance structures that already exist within our health facilities?

The Problem Is Not the Absence of Institutions

Almost every government hospital in Ghana already has technical personnel responsible for maintaining medical equipment. Biomedical engineers, biomedical technicians, electricians, artisans, maintenance officers and estate departments exist within our facilities. Many regional and teaching hospitals have qualified biomedical engineering units with professionals trained to install, service and repair sophisticated medical equipment.

The problem has never been the absence of technical expertise.

The real challenge lies in how our healthcare institutions are managed.

In many facilities, technical departments have little authority over equipment management. Decisions regarding maintenance budgets, procurement of spare parts, servicing schedules and equipment replacement are often delayed by layers of administrative bureaucracy.

Ironically, those with the least technical knowledge frequently control decisions concerning highly specialized equipment.

Excessive Centralisation Is Costing Lives

One of the greatest weaknesses within Ghana's public healthcare administration is excessive centralisation.

A simple repair requiring a few thousand Ghana cedis may have to pass through several administrative approvals before funds are released. Sometimes requests move from the facility to the district, then the regional level, and in some cases even to the national level.

By the time approval arrives, the equipment may have remained non-functional for several months.

Patients suffer.
Healthcare workers become frustrated.
Hospitals lose internally generated funds because services cannot be provided.

This cycle repeats itself year after year.

Maintenance cannot succeed under such a system.

Hospitals Must Take Responsibility for Their Own Equipment

Every public health facility generates Internally Generated Funds (IGF) through the National Health Insurance Scheme (NHIS), private services and other legitimate sources.

Rather than waiting for central government intervention whenever equipment breaks down, hospitals should dedicate a defined percentage of their IGF to equipment maintenance and replacement.

Maintenance should become a planned annual investment rather than an emergency expenditure.

Every hospital should establish a protected Medical Equipment Maintenance Fund, managed transparently and used exclusively for preventive maintenance, spare parts and emergency repairs.

This approach would significantly reduce downtime and improve service delivery.

Empower the Technical Experts

Hospital managers and governing boards must trust the professionals they employ.

Biomedical engineers and technicians should not merely repair broken machines.

They should be involved in:

• equipment procurement;
• acceptance testing;
• preventive maintenance planning;
• budgeting for repairs;
• training users;
• monitoring equipment lifespan; and
• advising management on replacement schedules.

Technical decisions should be led by technical experts.

Managers should provide oversight—not substitute professional expertise.

Maintenance Begins Before Equipment Breaks Down

One persistent misconception within our public institutions is that maintenance starts only after equipment develops faults.

Modern healthcare systems operate differently.

Preventive maintenance is cheaper than corrective maintenance.

Routine servicing, calibration, software updates and periodic inspections prolong equipment lifespan and reduce costly breakdowns.

Hospitals should adopt mandatory maintenance schedules for all critical equipment with strict compliance monitoring.

Healthcare Must Be Protected from Politics

Healthcare is too important to be subjected to excessive political interference.

The management of hospitals should be driven by professionalism, accountability and evidence-based decision-making—not political considerations.

Frequent administrative changes, unnecessary bureaucratic controls and politically influenced decisions often disrupt continuity in equipment management.

Whether governments change or hospital leadership changes, maintenance systems should remain stable.

Patients should never become casualties of administrative transitions.

Do We Need Ghana Medical Equipment Services Limited?

The proposed Ghana Medical Equipment Services Limited could become an important coordinating body if its role is clearly defined.

However, it should avoid becoming another centralized bureaucracy that duplicates existing structures.

Instead, it should focus on:

• setting national maintenance standards;
• developing preventive maintenance guidelines;
• certifying biomedical engineers and technicians;
• coordinating specialized repairs beyond hospital capacity;
• supporting training and capacity building;
• ensuring quality assurance; and
• monitoring compliance across health facilities.

Routine maintenance should remain the responsibility of individual hospitals.

Only highly specialized repairs requiring national expertise should be escalated.

A National Culture of Maintenance

The President's warning should not become another ceremonial statement that fades with time.

Ghana's healthcare system has invested billions of cedis in medical infrastructure over the years.

What has often been lacking is a maintenance culture.

Buildings deteriorate.
Equipment breaks down.
Projects are commissioned with excitement but gradually become unusable because maintenance was never adequately planned or funded.

This culture must change.
Maintenance is not an expense.
It is an investment.

The Way Forward

If Ghana is serious about improving specialist healthcare, then the following reforms deserve urgent consideration:

1. Allocate a mandatory percentage of every public hospital's IGF specifically for equipment maintenance.
2. Establish dedicated Medical Equipment Maintenance Funds in all public health facilities.
3. Empower biomedical engineers and technical departments to lead equipment management decisions.
4. Reduce bureaucratic delays in approving maintenance expenditure.
5. Institutionalize preventive maintenance programmes nationwide.
6. Strengthen existing hospital maintenance units before creating additional centralized agencies.
7. Insulate healthcare administration from unnecessary political interference.
8. Introduce annual maintenance performance audits for all public health facilities.

Conclusion

President Mahama has correctly identified one of Ghana's greatest healthcare challenges: neglected maintenance.

The solution, however, may not lie solely in creating new national institutions. It lies in empowering existing technical professionals, decentralizing maintenance decisions, ensuring hospitals retain adequate resources to maintain their own equipment, and building a culture where preserving public investment becomes everyone's responsibility.

Modern hospitals are not defined merely by the sophistication of their equipment.

They are defined by how well that equipment is maintained.

Ghana has built enough infrastructure.
The next chapter should be about protecting it.

Author:
Emmanuel Twum Barimah
Senior Administrative Manager, Ghana Health Service
Law Student, Faculty of Law, Pentecost University, Ghana

Disclaimer: The views expressed in this article are solely those of the author and do not necessarily reflect the official position or policy of the Ghana Health Service, the Ministry of Health, or any other government institution.

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