Feature by Godfred A. Polkuu
Bolgatanga, Nov. 22, – A beautiful modern edifice for a hospital by
every standard. The Bolgatanga Regional Hospital also known as the Upper East
Regional Hospital is the major referral Centre and a first point of call for
emergencies of all kinds of health related incidents, yet has no Doctors to
manage specialist cases.
It is horrifying to know that the
206- facility designed to serve a population of about 1, 124, 193 has just
seven Doctors, whereas it needed 30 Doctors at least, to manage the health
needs of the people.
Clearly, there is a big challenge
at addressing the health needs of the people in the Upper East Region,
considering the threatening and volatility with which patrons of the hospital
are exposed to.
Glaringly, the hospital is
seriously battling its core mission statement to “offer quality health care to
all persons living in Ghana, and delivered by well-trained, highly motivated,
and client-focused health professionals”, because seven Doctors positioned
under this horrifying conditions cannot breakthrough to achieve this laudably
stated mission of the facility.
This feature therefore seeks to
examine the reasons why only seven Doctors live and work at the biggest
referral hospital in the Upper East Region, when that facility needs 30 Doctors
and more to contain the clientele population of about 1.5 million.
BACKGROUND
Established in 1902 to cater for
the health needs of the minority white population in the then Gold Coast, a
protectorate of the British, the Health Centre, as it was called, provided
mainly orthodox medicines.
The experience of colonial rule
in the southern part of Ghana guided the British to move with a small team of
medical personnel to provide health care services to only the white minority.
With time however, infrastructure
of the Brits expanded in the area and the black population that willingly
cooperated with the Brits started benefitting from orthodox medical care
together with their families.
The current site of the regional
hospital was started in 1946 as a health centre to continue service to the
whites and some few Gold Coasters working for the British and very few
indigenes.
From the 1946s the hospital was
expanded and given a bigger role to manage the health needs of the people with
a team of five Brits ( names not available), made up of a Physician's
Assistant, two nurses, and two health Assistants.
However, their numbers started
increasing as more expatriates came around and more blacks aided them in their
work.
Blacks started working in the
Centre from 1946. They were basically
Ghanaians who had their training in nursing and Physician Assistantship in the
UK as there were no adequate training facilities in Ghana for that. All these
while, the management of health care was entirely in the hands of the
expatriates.
The first Ghanaian doctor called
Dr Johnson, a Fante, was posted to the hospital in 1955 and assumed headship of
the health centre. The Senior Nurses
were still whites with blacks serving as Nurse Assistants. Dr Johnson died in
1961 and was succeeded by one Dr Gandaa.
The construction of the bigger
facility upgraded to Hospital was completed in 1946 from where it is currently
located and was opened to the general public. However, the indigenes rarely
used the clinic. Instead, they preferred traditional African medicine.
CURRENT STATE
Today, the Regional Hospital has
total staff strength of 612 out of which 491 are permanent and 121 temporal.
Confronted with an uncontrolled population growth of 2.6 and estimated current
demography of about 83.4 percent, it is disheartening that the Upper East
Regional hospital today lacks doctors to comfortably execute its core values
despite its progressive expansion and scope of services from successive
governments of Ghana.
TARGETS
The 71-year-old facility ideally
should have come to a halt considering the Doctors as core managers of the
facility around whom every important work on the patient rest.
Sometimes, one is tempted to
doubt if there shall ever be any breakthrough on the targeted achievements so
focused by past and present management of the hospital as it holds the vision
“To become a well-resourced regional referral hospital; with adequate physical
infrastructure, adequate number of well trained and highly motivated human resources;
and the needed modern technology, systems and processes to provide secondary
and tertiary health care; as well as adequate facilities for medical education
and research.”
Surprisingly however, the
hospital runs wide range of services in spite of its numerous challenges. The
success behind what it has achieved so far rests on its untiring, business
focused sacrificial oriented professional dedicated staff (even though under
staffed), and headed by a strong human centred Paediatrician with solid backing
from professionals constituting its Management team.
THE GNA OBSERVATIONS AND CHECKS
Several visits to the hospital by
the Ghana News Agency (GNA) to establish why people seeking health care spend
hours at the facility before health delivery, revealed that one doctor attends
to about 300 patients daily. It is not surprising that patients spend virtually
the whole day at the facility to see the few doctors who practically sleep at
the hospital to save lives.
For instance, the Paediatric Unit
of the hospital has only one Medical Officer, Dr Ernestina Addah who sees a
minimum of 60 children on admission a day, and still does consultations at the
OPD throughout the seven days of the week.
Dr Patrick Atobrah, Medical
Director of the hospital, usually support her with rounds at the Unit,
especially on Saturdays and goes on to other units for same duty-call ward
rounds, and further perform surgical procedures assisted by a Medical Officer,
who has completed his house officer’s job at the hospital and only sacrificing
by giving support and augmenting efforts of the skeletal Doctors at the
facility pending his posting.
On several occasions, the
Director moves to the facility as early as 0300hours to start consultations all
in a bit to reduce the congestion, and afford patients easy access to health
care at the hospital.
From a distance, one would be
tempted to conclude that patients enjoy to seek health care late at night, the
fact is patients, especially women with their children queue as early as
0600hours for folders and still queue again to see a doctor who would usually
be on ward rounds.
The Regional Hospital, which
equally suffers the challenge of dwindling financial resources and undue delay
in reimbursement for National Health Insurance Authority claims, coupled with
inadequate human resources, characteristic of most health institutions, the
facility in the face of these challenges made remarkable progress in its quest
to improve on the status of its clients.
Checks by the Ghana News Agency
again at the facility revealed that there was growing confidence by clients in
the health delivery facility manifested by its Out-Patient Department (OPD)
attendance of 8.3 per cent and improved quality of care resulting in general
decline in mortality although admissions increased by 8.4 per cent in 2016,
while majority of its clients were subscribers of the National Health Insurance
Scheme with 97.5 per cent for OPD and admissions respectively.
The checks further revealed that
there was significant improvement in maternal and newborn care as the hospital
delivered more babies in 2016 than it did in the last four years and still
recorded the lowest maternal mortality in the same period.
Speaking to the GNA in an
interview, the Director of the Hospital, Dr Patrick Atobrah, said the facility
currently has a Paediatrician and a Gynecologist without Surgeon and added that
the absence of such a vital specialist at a hospital of such grade was not
befitting and confirmed that the facility would need 30 medical doctors of various
disciplines to function effectively.
Dr Atobrah hinted that “we do not
easily get doctors at the Out-Patient Department” and appealed to government to
post more doctors to the facility to ease the pressure, since the hospital was
run by only seven Ghanaian doctors including three Cuban doctors made of an
Intensivist, Gynaecologist and a General Practitioner who were currently on
vacation in their home country.
The Medical Director, who is a
Paediatrician, said although initiatives were put in place to attract doctors
to the area, the hospital was constrained and could not fund such initiatives
and reiterated the need for government to intervene.
Dr Atobrah advised young doctors
to accept postings to the Region, especially to the Regional Hospital disclosing
that “they will see all the conditions they learnt from their textbooks
manifest in patients, and would boost their level of experience than staying in
the urban centres.”
He expressed concern about the
lack of water supply to the facility as most of the units had no source of
water to run the hospital’s daily activities adding that “although the Region
was deprived, its natives were Ghanaians and deserved the maximum comfort in
seeking health care services.”
Apart from the lack of doctors,
which is one of the major concerns to management, the facility has only one
X-ray Technician and four Pharmacists, the former, according to the Director,
had worked alone for about 10 years.
This, he said exerted pressure at
these units, especially at the pharmacy and laboratory, where the GNA observed
was usually choked by patients waiting to be served.
Mr Zakariah Yakubu, Head of
Administration speaking to the GNA, appealed to duty bearers to ensure that
Medical Doctors posted to government facilities reported without fail.
He prescribed decentralisation of
appointments to the Regional level so that when doctors turn out every year,
they are distributed accordingly, and opined that “If you post someone and the
person refuses to come, no government hospital should absorb that person.”
Mr Yakubu called on government to
institute special packages for doctors who accepted postings to deprived areas
as a means to motivate them to stay at rural areas where their services were
most needed.
He said peace is a cardinal
component that would further attract people who may want to work in the Region,
and appealed to stakeholders to uphold the peace in the Region to attract
professionals, especially doctors to the area.
Even though the dispensary has
been split into two sub-units with one serving In-patients and the other
Out-patients as part of measures to ease pressure, the situation will remain
the same if more pharmacists and dispensing technicians are not posted to the
hospital to remedy the situation.
To further acquaint itself with
issues of the facility, the GNA was surprised that almost all the units
including critical ones, depended on what the nurses call “Veronica Bucket”
which compelled dedicated and self-motivated staff, especially nurses to carry
water, from overhead tanks situated at vantage points to fill them in order to
improve health delivery.
No wander its mission statement
is to “offer quality health care to all persons living in Ghana, delivered by
well-trained, highly motivated, and client-focused health professionals”.
RECOMMENDATIONS
Health, it is usually said is
wealth, ought to be taken seriously by all stakeholders in the region if the
Regional Hospital must remain a referral point for all ill health cases in the
Upper East Region.
The Tamale Teaching Hospital, a
major referral hospital for the three regions in the north of Ghana suffers
series of unnecessary congestions because simple ailments and conditions that
could be handled by a minor referral point like the Regional Hospital in
Bolgatanga are sent to the already chocked Teaching Hospital in Tamale to
compound the already stressed Doctors and other specialists.
As suggested earlier by the Head
of Administration for regional level postings of health professionals to be
decentralized, a steadfast decision by the country’s health Management
authorities to insist on Doctors staying at post and punishing those who refuse
to accept postings are done under the decentralized regimes.
A fine could be slapped on
recalcitrant Doctors, they could be banned from practising for some years, and
facilities that accepted their application to practise could be liable to fines
and other deterrent punishments.
Special packages should be
designed, especially for Doctors who accept postings to rural and deprived
communities. These motivational packages should not only rest on the
facilities.
The Ministry of Health which is
the decision-maker for all health institutions should take the initiative to
design the package attractive enough to motivate and sustain Doctors who accept
postings to rural and deprived communities and the Regional Hospital in
Bolgatanga.
These packages should be extended
to other health workers including; Nurses, Biomedical Scientists and laboratory
related staff, paramedics, and any other group of workers in the health sector
helping to save human life.
A second look should be given to
one worrying issue confronting the health sector; which is the movement of
Doctors from the consulting room to do administrative work.
Dr Atobrah, a Doctor and
Administrator’s case may be unique as one cannot decipher his roles as
consulting Doctor and Administrative Doctor. Where a Doctor decides to limit
him or herself in such situation to do Administration, especially in a facility
struggling like the Bolgatanga Regional Hospital, it is the innocent patients
that suffer these consequences.
If health is wealth, then
managers of the country’s health sector must begin to overhaul the sector for
the citizenry to appreciate the health needs in order to begin to create the
wealth we all vie for. A health to the wise is in wealth.
GNA
Photos showing front view of the
Upper EastRegional Hospital
Dr
Patrick Atobrah examining a child on admission at the paediatric ward
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