Repositioning Tamale Teaching Hospital: Health Sector Responsibilities and Financing Realities

Introduction
In recent weeks, the Tamale Teaching Hospital (TTH) and Ridge Hospital have dominated headlines for the wrong reasons during a surprise visit of Hon. Kwabena Mintah Akandoh, Minister of Health. At TTH, an unfortunate confrontation between the Minister and some health professionals triggered a strike action by the Hospital's Doctors’ Association. Their demands included an official apology and the provision of essential medical equipment to facilitate effective care delivery.

Following this, the Minister donated equipment to the Hospital, and the King of Dagbong, Yaa-Naa Abukari II, sent a delegation to persuade the Doctors’ Association to return to work.

The Role of Stakeholders in Health Policy and Management

From my perspective as a Health Policy, Planning and Financing Analyst, both the Minister and the staff of TTH acted with good intentions. While the Minister was advocating for improved service delivery, the Doctors’ Association rightfully demanded tools and equipment necessary to provide optimum care.

Different actors have distinct roles in the health policy ecosystem. The Minister of Health is responsible for policy formulation and mobilizing sectoral resources. In contrast, hospital management is tasked with policy implementation and efficient resource utilization.

Management issues such as unclean washrooms, poor customer care and staff attitudes, water shortages, as well as the lack of consumables and medications should ideally fall within the purview of hospital management. I, therefore, urge all public hospital administrators to proactively address these concerns.

Underinvestment in Health Infrastructure and Equipment

That said, challenges relating to poor infrastructure and outdated equipment point to a broader issue of chronic underinvestment in the health sector. Over two decades since the Abuja Declaration, which mandates African Union member states to allocate at least 15% of their national budgets to health, only Rwanda, Botswana, and Cabo Verde have consistently met or exceeded this benchmark (Africa CDC, 2025; WHO, 2023).

This is where the Minister’s role becomes crucial—advocating for increased health sector funding in national budgets.

Understanding Internally Generated Funds (IGF)

A recurring question relates to the use of Internally Generated Funds (IGF) by public health facilities. IGF primarily comes from two sources:

1. Out-of-Pocket Payments (OOPP) – also known as "cash and carry."
2. Reimbursements from the National Health Insurance Scheme (NHIS) – which covers around 90% of clients at government health facilities.

Even in cases where insured clients pay additional fees ("top-ups"), these are technically prohibited under NHIS regulations. Tariffs under the NHIS are fixed and often below market rates. For OOPP, charges are regulated under the Fees and Charges Act, 2022 (Act 1080), considering the social service role of public health institutions.

Government facilities cannot charge market rates because:

• Salaries are paid by the state.
• Capital expenditures are also government-funded.

As such, IGFs can only reasonably cover recurrent expenditures such as:

• Consumables and medications
• Minor equipment
• Routine maintenance

The Case of Tamale Teaching Hospital
TTH last experienced major retooling between 2011 and 2015, when it received advanced diagnostic equipment like CT and MRI scanners. These are expensive to maintain and likely require replacement after nearly a decade of use. The responsibility for capital-intensive retooling rests with the government and not with hospital management.

This situation is not unique to TTH—it reflects a systemic issue across many government hospitals in Ghana.

The Challenge of Health Sector Financing

More recently, funding cuts from Western donors have intensified the need for domestic financing. The Government must respond with improved budgetary allocations and explore innovative financing strategies.

Proposed Solutions:

• Earmarked taxes (e.g., on airline tickets, alcohol, tobacco, imports, mobile services)
• Leveraging diaspora remittances (Africa receives an estimated $95 billion annually)
• Public-private partnerships to fill funding gaps

Meeting the Abuja Declaration target remains essential to addressing systemic deficiencies in the sector.

Systemic Health Service Delivery Issues in the Northern Region

One key observation about TTH and healthcare in the Northern Region is the weak Gatekeeper System. District hospitals are unable to manage many health conditions, resulting in the overburdening of TTH. This is compounded by:

• Health workforce shortages
• Migration of skilled professionals to developed countries

Currently, African countries and for that matter Ghana has only 2.3 health professionals per 1,000 people, well below the WHO’s recommended 4.45 (Africa CDC, 2025).

Conclusion
To strengthen Ghana's healthcare system, hospital management must rise to the task of operational excellence, while the Ministry of Health must intensify policy formulation and resource mobilization efforts. Only through joint responsibility and improved financing mechanisms can we deliver better healthcare outcomes to the population.

References

• Africa CDC (2025). Africa’s Health Financing in a New Era: Concept Paper.
• WHO (2023). Global Health Expenditure Database. Geneva: World Health Organization.
• WHO Africa (2023). Health Workforce Status Report for Africa.

Author:
Alhaji Farouk Adam Iddrisu
Health Policy, Planning, Management and Financing Expert

Member, Association of Health Service Administrators – Ghana