GHANA HAS since time immemorial been saddled with various pertinent health challenges. One of such is having a doctor-to-patient and population deficit gap. A report by the World Bank indicates that the doctor-patient ratio of the country is 1:1000; a situation the Ghana Medical and Dental Association has described as dire. This alarming doctor-patient ratio has several ramifications for the country's already ailing health care. Successive governments have enacted several policies to improve the doctor-patient ratio by building more health facilities and also to enroll more health workers. Data available shows that the doctor-nurse ratio was trending downwards till the surge of COVID-19 and its associated migration of health professions to countries such as UK, Canada and the USA.
Before we move to COVID-19 and the exodus of nurses to Europe and America, it is essential to evaluate the strategies of successive governments in further reducing the doctor-patient ratio. These strides that have been chalked so far through various governmental interventions typically involve the training of health professionals and also encouraging some of them to accept postings to rural areas.
The training of more doctors has historically been of grave concern due to the inadequacies of teaching hospitals across the country. Successive governments have tried to build faculties in new universities such as University of Development Studies, Tamale and University of Health and Allied Sciences at Ho to augment existing medical schools at University of Ghana, KNUST and UCC. These measures have increased the number of doctors in the country but as the population of the country is increasing, these measures have not been so effective in bringing down the doctor- patient ratio substantially. Doctors who are trained in Ghana know their worth and some have bluntly refused postings to rural areas. A study of the doctor-patient ratio shows that some regions like Upper West Region have a very appalling doctor-patient health ratio. A large proportion of doctors are in Accra and Kumasi. This means that the life expectancy of those in the rural areas lag behind their counterparts in urban areas such as Accra and Kumasi by a wide margin.
The figure is not rosy either among nurses. The nurse-patient ratio currently in Ghana is 1:18, which means that at any point in time, one nurse is attending to approximately 18 patients. Clearly, this picture implies that there are more nurses attending to patients than doctors, a situation which poses an essential question of the extent nurses should be empowered to serve in the country's rural, urban and peri-urban communities, in the light of major deficits evident in the small population of doctors in Ghana. Due to how doctors are “scarce commodities” in Ghana, some health facilities have only one to three doctors manning them.
Imagine a hypothetical situation where a patient has been rushed to a medical facility in a critical condition, and is told to “wait for a doctor to arrive.” If you live in a community where there are only two doctors, it means that the probabilities of your ailment worsening is higher. Death at that point becomes nearly inevitable. Currently, Ghana's life expectancy is 64 years and these are the little things that make us have such a lower life expectancy. As we see, many nurses looking on helplessly beyond the initial care they give, are unable to do much in instances beyond their given mandates. Some of the deaths which occur in our various health facilities are preventable. A solution to this can be an examination of what is a common practice in the United States of America.
Let's examine the case for the United States of America (USA), which is currently one of the highly ranked countries in health care delivery. As part of a nationally accepted healthcare policy in the USA, there has been an emergence of a considerable number of nurse practitioners across the country, who have formally received Nurse Practitioner Training (NPT) to diagnose, write prescriptions and perform certain medical procedures in addition to their core function. The training usually spans an average of two and half years – approximately one third of the total training period of a medical doctor! This can be implemented in Ghana together with the training of more Physician Assistants.
Thankfully, there have been recent partnerships between some universities in Ghana and the USA to facilitate this training programme in Ghana, eliminating the high cost associated with having nurses travel abroad to pursue this training. For instance, Aspire Business Network led negotiations between Valley View University and Andrews University to introduce a Doctorate in Nursing Practice programme, which can be particularly targeted at highly motivated and committed nurses who are already in rural and deprived communities across Ghana. These nurses who may have had a considerable number of years' experience at their current facilities, most likely have already built deeper relationships with the communities in which they live.
Due to this enhanced community trust and high community involvement, these nurses can for instance, be government-sponsored to undertake the Nurse Practitioner Training (NPT) programme. Subsequently, their allowances can be slightly adjusted upon programme completion and assumption of this new role.
I believe that this initiative is one of the most effective ways which present an impetus for directly addressing and bridging the healthcare quality gap between rural and urban communities and also reducing death rates that may be arising due to doctor unavailability in some situations.
More so, COVID-19 taught us many lessons. And one of those lessons was how vulnerable our healthcare system has been over the years. Nature spared us this time. Africa/Ghana didn't suffer a lot of the craziness the virus delivered to the Western world. But just imagine if what they had predicted about Africa had happened. We can't continue to leave life to chance.
Introducing this programme will also help to correct the nurse distribution anomaly in Ghana by influencing more nurses who are mostly in the urban communities to migrate to some of these rural communities. This could be a follow-up solution to earlier concerns raised by the Health Minister in June 2019 during a three-day tour in the Volta Region, that “although it appears we (Ghana) have enough nurses, they are all centered in the urban areas.”
Beyond the borders of Ghana, implementing innovative solutions such as these, will aid in putting Ghana on a higher pedestal when it comes to the mention of significant strides that have been chalked in line with helping the United Nation attain Sustainable Development Goal No 3 of “Good Health and Well Being.”
The potential and opportunity in using nurses as active drivers in the improvement of Ghana's healthcare delivery system is simply limitless, and I remain optimistic about the positive benefits this proposed initiative will bring to bear on the quality of healthcare every Ghanaian can receive no matter where they find themselves across the country.
BY Kwame Antwi-Frempong
The writer is the CEO of Aspire Business Network and its subsidiaries