Rot in Governance: Why Ghana’s Health Facilities Still Reek of Ethical Decay

“When the system fails to punish wrongdoing, it trains the next generation to normalize it.”

In what should have been an ordinary audit review session, the Public Accounts Committee (PAC) of Parliament dropped a bombshell that once again exposed the festering rot within Ghana’s governance and public administration. The revelation that Tamale Teaching Hospital (TTH) had continued to pay a deceased staff member for 26 months after their death is more than a clerical error, it is a moral indictment of a system that has lost its capacity for shame.

According to the Auditor-General’s Report cited by the PAC, the hospital disbursed over GH¢1.4 million in unearned salaries, of which only GH¢303,558.68, barely 21 percent has been recovered. The rest remains hanging in bureaucratic limbo, a ghostly reminder of how public institutions can literally pay the dead while the living struggle to get their due.

TTH’s management has since referred the matter to the Economic and Organized Crime Office (EOCO), but that is often where such cases go to die --- buried under case files, procedural delays, and political fatigue. The hospital, like many other public institutions, may escape the public fury soon, only for the next audit cycle to reveal yet another absurdity elsewhere.

A System That Rewards Negligence

This is not an isolated incident. In 2023, Korle Bu Teaching Hospital was directed to refund GH¢36,000 paid as salaries to deceased and ghost employees. The Lands Commission was also cited after a “deceased employee” somehow withdrew GH¢20,000 in salaries over two years. These are not small oversights, they are evidence of structural rot that cuts across ministries, agencies, and departments.

It is not as if Ghana lacks laws to prevent this kind of malpractice. The Public Financial Management Act (Act 921) and the Public Financial Management Regulations (L.I. 2378) explicitly demand that all heads of spending units maintain accurate records and be held personally liable for financial losses resulting from negligence or mismanagement. The Audit Service Act (Act 584) even empowers the Auditor-General to disallow unlawful expenditures and surcharge those responsible.

Yet year after year, the Auditor-General’s reports read like a horror novel: unearned salaries, unaccounted imprests, uncollected revenue, expired drugs, and procurement violations. In some institutions, “ghost names” have become so entrenched that removing them feels like exorcising spirits from a haunted payroll.

How Do We Keep Paying the Dead?

The problem is not mystery, it is indifference! Health facilities like TTH, and indeed many government establishments, suffer from weak human resource systems. When a staff member dies, retires, or resigns, it can take months, sometimes years, for payroll databases to be updated. The linkage between a hospital’s HR office and the Controller and Accountant-General’s Department is often tenuous or outdated. Death certificates may not be promptly submitted; the deceased’s files may remain on desks; and sometimes unscrupulous payroll officers simply look away, especially when a few extra months of unearned salary can be “shared” quietly.

The Auditor-General’s findings have repeatedly cited poor internal controls and failure of supervisors to verify payrolls. In the TTH case, management admitted the lapse, citing “communication delays.” But the real issue is cultural --- a pervasive moral fatigue within the public service that treats accountability as optional.

The Cost of Moral Fatigue
Every cedi paid to a dead worker is stolen from the living patient who needs a blood transfusion, from the nurse who works double shifts without gloves, from the broken oxygen cylinder that goes unrepaired. Ghana’s health system is perpetually underfunded. Teaching hospitals complain about shortages of equipment and drugs. Rural health centers have no vehicles or fuel for outreach. Yet, millions of cedis vanish annually through unearned salaries, expired contracts, and procurement bloating.

In a country where the Ghana Health Service has publicly lamented declining public trust in healthcare delivery, such revelations deepen cynicism. Citizens begin to ask: if hospitals cannot keep track of their own staff, how can they keep patients safe? The moral decay goes beyond finances. It manifests in absenteeism, nepotistic postings, and the sale of hospital consumables meant for patients. In some facilities, cleaners have turned into de facto “medical suppliers,” selling gloves and syringes pilfered from stores. This is not merely corruption, it is betrayal!

Why “Sanitization” Fails

Governments have promised to sanitize the public sector countless times. New directives, committees, and monitoring teams are announced with pomp, only to fade into bureaucratic oblivion. Why does the rot persist?

• Weak Internal Controls: Most institutions lack real-time HR databases or biometric attendance systems. Payroll validation is often manual and delayed. A hospital may have a dozen staff on paper who have long left for private clinics or even migrated abroad.
• Lack of Accountability: The PAC hearings expose the rot, but follow-up action is rare. Managers implicated in negligence are transferred or quietly retired, not prosecuted. The cycle continues because no one truly pays a price.
• Political Interference: Appointments in state institutions are often politicized. Managers who owe allegiance to political patrons are reluctant to sanction wrongdoing, fearing backlash from their benefactors. When politics infiltrates administration, ethics suffocate. In the case of TTH, some staff have powerful chiefs as their godfathers.
• Inadequate Oversight Capacity: Internal audit units are grossly underfunded. Many hospitals lack independent auditors, and those that exist are overburdened. The Audit Service Act (Act 584) mandates them to prevent and detect irregularities, but they can only bark --- they rarely bite.
• Resource Constraints: Ironically, the same financial leakages that drain hospitals also undermine their ability to enforce accountability. Without funds to digitize records or train staff, the same paper-based systems that enable corruption remain in place.

What the Laws Say

• Under Section 96 of the Public Financial Management Act (Act 921), any public officer who “misuses public funds” or “causes financial loss to the state through negligence” commits an offence punishable by fine or imprisonment. The law further empowers the Minister for Finance and the Auditor-General to demand refunds or surcharge individuals found culpable.
• Similarly, Regulation 78 of the PFM Regulations (L.I. 2378) mandates that all payroll validators ensure “timely removal of separated, deceased, or inactive employees” from payment systems.
• The Audit Service Act (Act 584), Section 18, authorizes the Auditor-General to disallow expenditure “contrary to law” and to surcharge “any person responsible for, or who benefits from, the loss.”

On paper, Ghana’s laws are airtight. In practice, they are toothless. The same institutions empowered to enforce them are themselves trapped in the web of patronage and inertia.

From Ghosts to Guardians: What Must Change

The rot in health governance cannot be fixed by rhetoric; it demands systemic surgery. Below are some urgent reforms government must implement --- not as token gestures, but as a national survival strategy.

1. Biometric Payroll Integration: The payroll of all public health institutions must be fully integrated with the National Identification and Births and Deaths registries. The moment a staff member dies, their biometric ID should automatically deactivate from payroll. This is technologically feasible, if only there is political will.
2. Quarterly Payroll Audits: Every teaching hospital should undergo quarterly internal payroll audits, supervised by the Internal Audit Agency. These should be published publicly --- online and on notice boards --- showing the number of staff added or removed. Transparency itself deters wrongdoing.
3. Personal Liability for Managers: When unearned salaries occur, the Chief Executive and HR Director should be personally surcharged under the PFM Act. If negligence results in loss, recovery should be from their own remuneration, not the institution’s coffers.
4. Whistleblower Protection: Staff who expose unethical practices must be protected and rewarded, not victimized. Ghana’s Whistleblower Act (Act 720) exists but is barely enforced. Hospitals should designate anonymous reporting channels for internal corruption. As a Columnist of ModernGhana, if I have verifiable facts about wrongdoing, mine will be to crosscheck and do a write-up.
5. Digitized Human Resource Systems: Manual record-keeping must end. The Ministry of Health should roll out a unified Human Resource Management Information System (HRMIS) across all regional and teaching hospitals. Every employment action --- appointment, promotion, separation, should be logged electronically.
6. Ethics and Leadership Training: Public service ethics should not be treated as ceremonial lectures. Training in moral accountability must become part of continuous professional development for all public health administrators.

The Role of Oversight Bodies
The Public Accounts Committee, Auditor-General, and EOCO each play crucial roles. But coordination among them remains weak. PAC recommends recovery, EOCO investigates, and the Auditor-General surcharges, often working in isolation. Ghana needs a joint enforcement mechanism where PAC findings automatically trigger EOCO and Attorney-General prosecution timelines. Moreover, Parliament itself must begin enforcing its own recommendations. Too many PAC resolutions gather dust in archives. The credibility of parliamentary oversight depends on whether citizens see actual consequences.

Beyond Laws: Restoring a Culture of Shame

Ghana’s crisis is not only legal, it is moral. We have normalized misconduct to the point that it no longer provokes outrage. When a public servant collects unearned salary, he rationalizes it as “the system’s fault.” When a manager covers it up, he calls it “protecting the institution’s image.” Until the culture of impunity is replaced with a culture of accountability, reforms will remain decorative. Leadership at all levels must lead by example. The President, Ministers, and heads of agencies must speak and act decisively when such cases emerge.

Civic society, the media, and professional bodies also bear responsibility. Investigative journalism must continue to expose such rot, but equally important is sustained public pressure after the headlines fade. Ethical reform is not an event, it is a movement.

The Human Cost
Behind every statistic lies a tragedy. The money wasted on paying the dead could have supplied a neonatal unit, repaired dialysis machines, or restocked essential drugs. Meanwhile, Ghana’s hospitals continue to rely on donor aid and emergency appeals to function. When a health institution loses its moral compass, it endangers lives. The TTH case is not merely about payroll, it is about trust, competence, and the value of life in public service.

Time for Moral Reconstruction
The Tamale Teaching Hospital scandal should be the last straw. It should awaken us to the painful truth that Ghana’s governance problem is not lack of knowledge, but lack of integrity. Our laws are robust, our policies clear, but our enforcement weak and our conscience numb. I visit TTH often, and as Bob Marley said, “he who feels it, knows it.” The rot at TTH is unparalleled; it stinks! Sanitizing TTH and other health facilities requires more than directives; it demands leadership that values honesty over loyalty, and results over rhetoric. Until that happens, we shall continue to pay the dead while the living die in neglected wards.

If Ghana cannot fix its public health governance, then our development agenda will forever remain a mirage --- beautiful on paper, rotten in practice.

FUSEINI ABDULAI BRAIMAH
+233208282575 / +233550558008
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