The free dialysis exploit, trumpeted by Dr. Bawumia - the prolepsis

The incipience of dialysis activity in Africa was in 1957, only 12 years following Willem Kolff’s breakthrough in the Netherlands. The sole general physician in Krugersdorp, a lilliputian town in South Africa, built the first dialysis machine in the continent, which was a cross between a Kolff coil and a rotating drum. He used it to medicate 2 patients with acute renal failure and although both became totally horizontally shortly after, the event was a momentous watershed.

The next essay was made a year later in Egypt. Professor Nagy El-Mahallawy of Ein-Shams University in Cairo shipper in a primitive Alwall dialyzer, which he used to remedy a woman with acute renal failure who died after a few sessions.

Efforts were renewed in both countries in 1962 to 1963, when both peritoneal dialysis (PD) and hemodialysis were used customarily for the superintendence of acute renal failure and poisoning in Cairo and Johannesburg university hospitals. Two North African universities in Tunisia and Algeria and one in Kenya amalgamated the club during the same period. The first patient in the continent to embrace hemodialysis by a Scribner shunt was treated at Kasr-El-Aini medical school of Cairo University in February 1964. In the ensuing years, dialysis services were led off in Nigeria (1965), Sudan (1968), Libya (1972), Zimbabwe (1972), and Morocco (1977). Dialysis for the administration of acute renal failure subsequently was adopted in other paramount teaching institutions in the bed of Africa. Military hospitals were core and burning in initiating dialysis for treating casualties of war, which supervened for many decades during the past century.

With the fruition of initial maintenance dialysis programs in Africa, it was natural to encounter a staggering demand from the monstrous number of patients with end-stage kidney disease, owing to ecological, demographic, and socioeconomic factors. Eight African countries had the wherewithal to achieve heartened national programs capable of humouring treatment for 100 dialysis patients per million population (pmp): Egypt, Libya, Algeria, Tunisia, Morocco, South Africa, Mauritius, and Gabon. These countries contain only 21% of the total African population. Two other countries (Sudan and Mauritania) have reached about 75 pmp. In all these programs, governments wholly subsume the dialysis expenses in state hospitals and fractionally bankroll private dialysis wherever available.

Hemodialysis was instituted in Ghana as the first Kidney Replacement Therapy (KRT) modality in 1972 at the Korle bu Teaching Hospital. The number of hemodialysis centers has soared up over the years from six centers (three public and three private) in 2015 to 40 functional units currently. Acute PD (Peritoneal Dialysis) was initiated in Ghana in 2012 by Antwi et al and mostly used in pediatric population in the teaching hospitals and some district hospitals _ but not for chronic dialysis in both adults and children in Ghana.

The emergence of Chronic Kidney Disease (CKD) in Ghana is virgin but has a unbridledness of 13.3%. Chronic glomerulonephritis, diabetes mellitus, and hypertension are the rifest seats of CKD in Ghana. According to the first Ghana renal registry published in 2022, the median age of patients submitting to KRT was 45.5 years. Patients in Ghana contract kidney failure (KF) at a relatively younger age and predominantly present late with advanced disease in over 75% of cases with up to 50% in-hospital mortality for patients admitted with KF in a single-center retrospective study due to inability to foot the bill for KRT.

Acute Kidney Injury (AKI) amounted for 5.05% of medical admissions and 24.9% of patients with kidney diseases in hospital admissions in a single-center study. Owing to late reporting with advanced AKI, hemodialysis is required in over 40% of cases but only 14.5% were able to undergo acute dialysis due to towering cost, and this was associated with in-hospital mortality of 51.3%.

From 1972, there has been a systematic elevation in dialysis centers in both private and public centers. The cost of dialysis is higher in the private than the public centers. Although, the cost of dialysis in US Dollars may be proportionally economical in Ghana, cost is still shackling with the bulk only able to bear twice a week dialysis schedule, instead of the prescribed three times a week. In a single-center study in Ghana, only 14.5% of patients demanding dialysis were able to render it leading to high mortality of 32.9%– 45.6%. This perturbs tellingly, the disposable income in most families with untoward financial privations for families with patients with KF. The moderate cost of a session of dialysis is US $53.9, which is averagely subsidized by about US$ 8 in public centers and variable amount in some private centers, and as a result, most patients in Ghana are unable to adjust themselves with it.

The ever - flagship asset for our health sector will be the free dialysis, Dr. Bawumia intends to inaugurate very soon. After having piloted the free dialysis program for months ; to discover wheezes to imbibe the exorbitance nature of it, it has however become efficiently expedient for him to eventuate the operations of it. The age marks outlined by Dr. Bawumia in the free dialysis package conveys the impression that, he has got a rigorous ethos about the grave inception of the disorder,( thus 18 years and below up to 60 years and above ). In fact, this particular malaise crops up precariously when one is 18 - year old and underneath and then, escalates insurmountably when one reaches 60 - year old and above. Moreover, a country doesn't need to acquire a zillions number of dialysis centers/machines, before activating and facilitating this enterprise - as stated before, the number of dialysis centers in Ghana has perpetually augmented from 1972 till date.

And more imperatively, any dialytic cases will be directed to health facilities which are well - equipped with dialytic trappings : not all hospitals, health centers etc in Europe do greet to dialytic treatments ; we have designated ones for that matter. Also, with the saga of including the private health centers onto the free dialysis program _ in South Africa, the government offers free public sector dialysis for those who can't furnish it, but dialysis is rationed due to high costs ; Sudan, Zanzibar, Malawi, Kenya have universal coverage for dialysis for AKI and ESKD ; again, Cameroon, Senegal, Ethiopia have government subsidies for dialysis.

So, at this juncture, Dr. Bawumia could grant subsidies for the private health sectors, such that, they can also expedite the efficacy of this drill. The NPP government has auspiciously materialized the free SHS policy and other stately maestoso programs, hence it will be cinch for the execution of the free dialysis program _ let us subscribe to the free dialysis policy in order to taper our mortality rates drastically, since it is our baby to do that.