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Opinions Tue, 3 Feb 2009

Health: Handing- over Notes

Two reasons inspire this article; Maya Angelou and false propaganda.

Reacting to disagreeable comments from some men to her poem Phenomenal Woman, she would taunt with a twinkle in her eye, “Write your own poem.” Also, a well recognized mantra of false propaganda is that a lie well told and repeated may over time assume the cloak of truth. And God knows enough lies have been told in this country about doctors’ salaries in these past three years.

The spirit of handing over notes bloweth. One is however not too sure what story may be told on the health front. To worsen matters, a member of the government’s transition team on social services would be heard on Ghana Television complaining bitterly about ‘the scanty nature of the notes handed over” to him. To make assurance doubly sure, I’d rather tell my own story.

Mental Health Let it be handed over to the incoming government that we have a loose coalition of mental health advocates including the Commonwealth Human Rights Initiative, Ghana Mental Health Association, NGOs including Basic Needs, health professionals in and out of mental health, Ghana Medical Association etc who are sworn to see the Mental Health Bill see the light of day. Let it also be said that according to Dr. Akwasi Osei, Acting Chief Psychiatrist, a draft bill sat for all of three years on the table of the Minister of Health waiting to be sent to Parliament. The grapevine has it that Ghana’s draft MHB is one of the most progressive on the continent seeing that it factors in human rights concerns of the mentally ill.

There is a hitch though. While one school of thought maintains that the law as it currently stands may end up creating parallel structures to those already in place, another school of thought is of the opinion that mental health by its very nature ought to be handled differently. These have gone on to add that an appropriate Legislative Instrument could be drafted to streamline the practical workings of the law in order not to duplicate structures and systems.

As for me, I want more. I wouldn’t want the incoming administration to think for one second that the fight is going to stop with the mere passage of the law. The passage of the law is simply a means to an end characterized by more mental health professionals, better conditions of service, newer drugs and also improved rehabilitation. Fortunately for me, the NDC adopted a very progressive stand on Mental Health, promising to pass the Bill into Law.

We are holding our breath.

Illicit Drug Trade and Use This is yet another area under Mental Health. When the celebrated Dr. J.B. Asare talked about the small scale production of heroine in Ghana, I thought I was dreaming. The fight against the booming narcotic trade therefore has clear health implications as regards addiction etc with the youth most at risk. Hopefully, it is not our aim to get to the point where addiction to hard drugs rivals malaria. And so I hope it is also in the handing over notes that the fight against the narcotic trade should be fierce and unyielding.

But I would appreciate it more if a Ghanaian of the order of Dr. Kwesi Ennin could be put in charge of the Narcotics Business. O how the drug barons will run for cover!

Insufficient/Inequitable Distribution of Health Workers I hope it is also in the notes that when Dr Constance Bart-Plange says Malaria is killing the children, it means it is actually killing them. Yes, prevention is good but while we grapple with that, I tell you, so many children die because of lack of qualified professionals on the ground to give prompt attention. My ultimate conclusion is that while treating Malaria lacks the glamour of a triple by-pass heart surgery, I have come to appreciate the difference that professionals on the ground and prompt attention can make in reducing morbidity and mortality.

But you have a doctor: patient ratio of 1: 12 000 with over 50% of the doctors in Greater Accra. These doctors are not loafing around. They are working. When you post my brother Dr. James Duah to Northern Ghana and he actually goes, you freeze his salary and he spends his Christmas in Accra doing the Ghana Health Service, Ministry of Health, Accountant General Rounds. Also, what he earns in Northern Ghana is exactly the same as what his counterpart earns in Accra although as the only medical officer, his work stops when everybody has been healed which is to say that his work never stops.

So let the handing over notes reflect that when you talk about health indices, you also talk about redistribution which as we have shown, is inextricably linked to conditions of service.

Salary This is where the health notes get jucy. You see, if the members of the Social Committee of the Transitional Team have been living in this country, then I would hardly be surprised if they are already under the delusion that Ghanaian doctors have collected all the public sector monies in Ghana. Never believe everything you hear. The fact of the matter is that every agreement that could possibly be breached under this labour law by our employers has been breached. We have had no salary review for three years in clear breech of our Memorandum of understanding. Fuel allowance which was unilaterally abrogated in June 2006, and which under threat of industrial unrest was reinstated in January 2008 is still in some cases in over a year’s arrears in spite of a directive from the former Minister of Health to all Budget Management Centers to do justice to the health workers.

If the new government will sit down for managers to be negligent in painful ways that would be ultimately attributable to it, well, that is their choice. But we know what our people are entitled to.

I will let you in on a secret. At a high-powered meeting with a Minister in the former government, the government would provide a powerful pay structure, allegedly of doctors containing “gbecious” figures that we ourselves had never seen before. When we produced our pay slips, step by step, band by band, it was the Minister who asked us, “So where is the enhanced salary we have all along been talking about?”

I beg, if anyone submits a “gbecious” pay structure claiming the least paid doctor earns 1500 Ghana cedis and the highest paid, 60 million old cedis, please call for our pay slips. You might be aware of how the GMA President out of frustration silenced former government spokesman Amponsah Bediako on Citi FM by producing his pay slip. At the Negotiation Table, it would serve our mutual interests to talk straight, avoid lies and implement the decisions.

NHIS The NHIS is a good intervention. Some health facilities are being crippled by delays in reimbursement in claims. The Ghana Medical Association has also said that free maternal delivery would have positive implications for the reduction of maternal mortality. But you see, piecemeal implementation of policies has never helped much. We are aware of how in many cases, waiting times have increased tremendously. This is hardly surprising considering that some have documented an increase of up to 150% in OPD attendance. Do we have the men and women on the ground to attend promptly to the pregnant women?

By all means let health managers who have complained about negligent health professionals apply the rod but in the same breath when they work over and above what you are paying them, the least you can do is to discriminate in the emoluments on account of competence, level of responsibility, volume of work. Etc The point has also been made that the NHIS should begin to take a more serious look at how health facilities and infrastructure may be improved. Invest in the hospitals and give the professionals the tools.

Finally there is a new thinking that the concept of decentralization ought to be practicalized. There are many including the current Director General of the Ghana Health Service and Dr Kofi Ahmed who have asked whether it is not possible to decentralize the employment of health professionals such that a District may have more clout in determining its health personnel needs and having so done, to evolve packages and incentives to attract the requisite doctors and other professionals to these deprived areas? Perhaps this is a discussion we could all engage in more rigorously. The state could pay a certain basic salary while the various facilities and Districts top up.

University for Development Studies I pray the rapid development of the UDS including the medical school and the Tamale Teaching Hospital also come highly rated. O how good and pleasant it will be to have about 200 medical students in the Tamale Teaching Hospital at various stages of their training. At some point, they would go out to do some District Rotation and the communities would get to see more than the one doctor to 90 000 patients that we are saddled with.

It would certainly be worth the while of the new administration not to view the health labour unions as antagonists but as constructive partners with whom they can sit and dialogue over how far reaching changes in health can be made that go well beyond salary fights. It should also be possible to ameliorate the hurt people feel when they recall bitter encounters with our health facilities.

Sodzi-Tettey, Sodzi

sodzitettey@gmail.com

Columnist: Sodzi-Tettey, Sodzi