One of the concerns that successive Governments of Ghana have tried to address in healthcare delivery in the public sector is shortening the distance one travels from his or her home to access healthcare. In healthcare delivery, the distance one travels to access the required health services is referred to as geographical accessibility. The ability of the citizenry to afford the services provided is also termed as financial accessibility or simply termed as affordability. It is thus not surprising that the Ghana Health Service is legally mandated among other things to“increase access to good quality health services.”
Over the past two decades, successive governments have improved largely on geographical access to healthcare in Ghana and this is commendable. One must equally not be oblivious of the fact that the introduction of the National Health Insurance Policy and the Free Maternal Health Policy have also improved significantly, financial access to healthcare in Ghana.
In terms of geographical access however, a mere siting of a hospital or polyclinic close to the people does not necessary make the health services geographically accessible to them. There are other germane factors within the geographical access permutation that enable the community members to truly and comprehensively have the health services at their doorsteps.
Notable among the other germane factors are the nature of the road networks within the catchment area of the new health facility and more importantly, availability of the required medical and non-medical consumables to enable the health workers posted there to hit the ground running and have the confidence of the community members reposed in them.
Most often than not, government (be it NDC government or NPP government) swiftly inaugurates the new health facility (the building and medical equipment) and forgets about the fact that a new hospital or polyclinic needs more than that to begin operations. The medications and non- medical consumables such as cannulas, examination gloves, detergents, stationery (clinical and non-clinical), facemasks, syringes & needles, catheters, spatulas, pulse oximeters and many more are not made available by the government before the new health facility is inaugurated. This often makes it very difficult for the health facilities to take off properly.
In their attempt to start operations, the unfortunate managers of these new health facilities move from one existing hospital to another, lobbying for such commodities from their colleagues.
How can a new health facility be built to improve on geographical access to healthcare but the healthcare is still geographically far away due to lack of the required healthcare commodities? The people still need to bypass the new health facility and seek for healthcare from the existing one far away even though the new one could have provided the needed care if the required commodities are provided. This makes the work of the Regional Health Directorates very difficult because they do not generate revenue let alone support the new facilities for which they have oversight responsibility.
Ideally, initial provision of the required medications and non-medical consumables should have been considered before inauguration of a newly built health facility. This way, those items would constitute the seed capital for the new health facility to start operations since the public health facilities do not benefit from national budget allocations in terms of GOG Funds (GOG – Service and GOG-Administration). Each public hospital relies solely on Internally Generated Funds (IGF) for its overhead expenses. It means that a newly inaugurated health facility has to start providing services before it generates enough revenue internally to fund the procurement of logistics. Despite the fact that this is the arrangement, no initial logistical provisions are made for a newly inaugurated health facility to start healthcare delivery immediately after the inaugural ceremony. Also, no funds are made available for the managers of new health facility to be able to fund the overhead expenditure budget in the interim until the financial situation stabilizes.
Surprisingly, the political leaders who build and inaugurate the new health facilities often create the impression at the inaugural ceremonies that all is well for the workers at the new health facilities to hit the ground running. In most cases, such an impression does not depict the reality. The reality is that due to lack of the required medical and non-medical consumables, most of the newly established polyclinics and hospitals are unable to provide comprehensive healthcare to the communities they are meant to serve. Situations like this do not provide a true panacea to the problem of geographical inaccessibility in healthcare delivery in the country.
One would recommend that whenever such healthcare infrastructural projects are being planned, adequate provision should be made for the healthcare commodities that the health workers will need to start providing care to the people.
Another issue is that most of these healthcare facilities are built without residential bungalows for the health workers. Even in times that those residential accommodations are provided, they are woefully inadequate hence most of the critical workforce live far away from the health facility with its attendant detrimental effects on emergency care. We are of the considered opinion that the bed capacity of a new health facility should inform the size of the residential accommodation provided for the health workers as part of the project.
Another challenge has to do with inappropriate siting of the new health facilities. Frankly speaking, the beneficiary communities are also to blame sometimes for the inappropriate locations of the new health facilities. The land tenure system is such that the community members are those who allocate land for such projects. Sometimes, the land for the project is allocated a bit far from the community itself due to petty land disputes and similar other communal factors. For example, one would have thought that the new Sege Polyclinic in the Ada West District of the Greater Accra Region would have been located a bit closer to the Sege community.
For the people of Sege who live on the Sege-Accra road and the Sege-Battor-Mepe road, the newly built Sege Polyclinic is still not geographically accessible with ease due to its distant location from the Sege town. The Sege-Battor-Mepe road for instance is currently in a very deplorable state. Aside that, the access road to the Sege Polyclinic on the Sege- Kasseh road is also in a deplorable state. The government should have made the contractor construct that short access road to the new Polyclinic, which is well designed to provide care to the community. The access road is very muddy with a little rainfall. This should not have been made a problem for the managers of the Polyclinic to solve. Residential accommodation provided for workers is equally not adequate thereby compelling some of the workers going to work from Accra and Tema.
Community members should therefore be mindful where they allocate land for such important healthcare projects which are meant to serve the community and not the central government. Land allocation for projects of this nature should not be seen as the community’s favour to government.
In conclusion, all stakeholders should be well informed and each stakeholder should be allowed to play its roles effectively. This way, a newly built health facility that is meant to increase geographical access to healthcare will be able to provide the care as expected. There is the need for a new paradigm shift in the architectural designs of our health facilities in terms of residential accommodation design for workers, where the project is sited and provision of the needed logistics for the health facility to start operating. Successive governments must however be commended for such lifesaving infrastructures that have been put up to bring basic healthcare to the doorsteps of the people.
- Philip Afeti Korto ([email protected]’yahoo.com )
- Ms. Adelaide Setordji ([email protected])