A Public Health Perspective On The Proposed Health Kiosk

I have listened to the President’s explanation of the proposed health kiosks under the Free Primary Healthcare programme. The idea is to establish health facilities described as 20-foot containers in places where large numbers of people gather, including markets and lorry stations. They are expected to provide basic outpatient services, screening and referral, with digital connectivity to district hospitals to support clinical decision-making.

The innovation is understandable. My concern, however, is not with the innovation itself. It is with whether the proposed innovation represents the most efficient, sustainable, and health-system strengthening use of our scarce public resources.

A kiosk may appear simple, but making it clinically functional requires much more than placing a container at a location. It requires competent personnel, equipment, medicines, and a functioning referral pathway. The proposed digital connection to district hospitals is useful, but technology cannot substitute for the capacity of the receiving district hospital. If a kiosk identifies a patient with a serious condition, there must be a district hospital capable of receiving and managing that patient. This is why the value of a new access point should be assessed not only how many people it can screen or see, but by what happen to those patients afterwards.

Within Ghana’s health system, public health and health promotion personnel already work at district and sub-district levels. Their responsibilities include disease prevention, health education, community mobilization, screening, surveillance, health promotion etc. If some of the activities proposed for the kiosks are already part of these personnel’s mandate, we should first examine whether they have adequate number, equipment, digital tools and operation resources to perform those functions effectively. Well-resourced public health personnel can take preventive services to markets, lorry stations, workplaces, schools and communities rather than waiting for people to come to a fixed facility.

Ghana’s Network of Practice framework provides a useful way of thinking about the kiosk proposal. At the community level, Community-Based Planning and Services (CHPS) and other existing service points function within a network, while health centers serve as important sub-district referral hubs. The district hospital is the apex service delivery point within the district and provides clinical and technical support to facilities in the network. Our health facilities are not isolated units; they function as interconnected parts of one system. The question, therefore, is whether we are strengthening the network as a whole at the same pace as we are adding new points of service.

I believe the addition of a new layer of structure is most useful when the wider system around it is capable of supporting it. Community-Based Health Planning and Services (CHPS) compounds and health centers remain central to primary healthcare, and the country has already invested considerably in them. The priority in many communities at the moment may be to ensure that existing CHPS compounds and health centers have the personnel, medicines, equipment and logistics required to perform their functions effectively. Primary healthcare is not simply about providing a point of service. It is about continuity, prevention, early intervention and robust referral system.

This consideration is particularly relevant in districts without functioning district hospitals. In the Sene East District for example, where a viable agenda 111 district hospital project is near completion, completing and operationalizing that facility may provide more health system benefit than adding another standalone access point.

There is also a risk of policy duplication. The government’s 24-hour economy model markets include clinics. The introduction of additional health kiosks in or around the same locations may amount to an overlap of interventions and structures. A historical lesson reinforces this caution. In 2015, President Mahama, in his first term launched the “Onuador” health initiative to deliver essential care to remote and deprived communities. Significant national resources were invested, including the procurement of mobile clinic vans. The initiative could not be sustained. Questions remain about whether it was adequately integrated into the existing healthcare system or sufficiently informed by evidence. In 2025 State of the Nation Address, the President, in his second term, promised to reintroduce the collapsed Onuador initiative. More than a year later, there is little to show for that promise, yet a similar model – the health kiosk, is now being introduced.

To avoid the nation’s resources being expended on fragmented and disjointed policies, government needs to pause and take a second look at these overlapping initiatives. The health kiosk, the proposed reintroduction of Onuador, and the clinics embedded in the 24-hour markets should be subjected to critical needs and health impact assessments before implementation or reintroduction. For purposes of efficiency and effectiveness, these related initiatives should not be implemented in a disjointed form. They should be streamlined into a single, coherent approach and properly integrated into the mainstream health system at the district level. Retooling district-level facilities, increasing personnel numbers, and building the capacity of staff at district and sub-district levels would better enable the system to deliver the intended outcomes.

The decision to establish a health kiosk or to reintroduce Onuador should take into account the specific gap the intervention is intended to fill. If the government still intends to implement the kiosk as a standalone point-of-access policy, it should first undergo a needs assessment, be carefully piloted, and be evaluated. Before any scale-up, we need to know what specific gap the kiosk is addressing and what health outcomes it will produce.

I support the objective of bringing healthcare closer to the people. I support prevention and the appropriate use of digital technology to improve access. But innovation should complement health system strengthening, not substitute for it. Where existing personnel can deliver an intervention effectively if properly resourced, let us strengthen them. Where CHPS is the appropriate platform, let us strengthen CHPS. Where a health center can serve as the appropriate hub, let us equip it to do so. Where a district lacks a functioning hospital and a viable project already exists, let us give serious consideration to completing and operationalizing it. Where genuine service gaps exist, let us design evidence-informed interventions and integrate them properly into the existing health system.

Author:
Samson Gbolu
(Public Health Advocate)