No Bed Syndrome in Ghana: Time for health system redesign, not just reform

The recurring phenomenon popularly described as “No Bed Syndrome” continues to expose fundamental weaknesses in Ghana’s hospital system. It refers to the inability of a patient to obtain prompt hospital admission or emergency care because health facilities report no capacity. While the problem has existed for many years as a structural health-system challenge—driven by shortages of beds, overcrowding, referral inefficiencies, and weak emergency coordination—the term gained national prominence around 2017–2018 following tragic reports of patients dying after being referred from hospital to hospital.

Since then, periodic incidents have reignited public concern, reinforcing the reality that access to emergency care remains uneven and, at times, unpredictable. Recent discussions among clinicians and emergency service personnel have again highlighted persistent gaps in referral coordination, ambulance readiness, and facility capacity.

Public attention was recently renewed following the death of 29-year-old engineer Charles Amissah, who reportedly died after being referred across facilities in Accra without receiving timely care. The case has triggered widespread outrage and renewed calls for decisive reforms in emergency healthcare delivery.

National leadership has responded with urgency. The Speaker of Parliament, Alban Bagbin, has called for investigations and fresh legislation to confront what he described as needless and unacceptable deaths. The Speaker also expressed support for proposals by Majority Leader Mahama Ayariga urging Parliament to take leadership in resolving the crisis. Parliamentary deliberations have emphasized accountability and the need to prioritize the passage of an emergency care law that guarantees access to life-saving services.

Professional bodies including the Ghana Medical Association and the Ghana National Ambulance Service have also identified systemic challenges—particularly poor coordination across facilities, ageing ambulance fleets, and limited funding—as contributors to the recurring problem.

Emerging policy responses

Several policy responses are currently being advocated:

Passage of comprehensive emergency care legislation

Development of a national monitoring system for bed occupancy and patient flow

Continued infrastructure expansion

Strengthening of referral coordination mechanisms

Increased financing, workforce development, and regulatory oversight

Collectively, these efforts aim to reduce refusal of emergency patients and improve timely access to care. Yet, the persistence of No Bed Syndrome suggests that incremental reforms alone may not be sufficient.

A deeper structural issue: patient flow, not just bed numbers

A central feature of Ghana’s hospital system is the strong upward referral pattern, where patients frequently move toward higher-level facilities such as teaching and regional hospitals. While clinically appropriate in many cases, this pattern contributes to congestion at tertiary centres while lower-level facilities remain underutilized.

This raises an important question: should the system also institutionalize downward referral as a deliberate strategy for bed management?

Consider a typical scenario. A patient undergoing major surgery at a teaching hospital may require prolonged inpatient recovery. However, after stabilization, much of this care could potentially be delivered at a district or faith-based facility closer to home, with continued specialist oversight from the tertiary centre through teleconsultation and structured follow-up protocols. Such a model would free beds at referral hospitals while preserving continuity and quality of care.

Hospital-at-Home: a redesign opportunity

Beyond downward referral, innovative service delivery models deserve serious consideration. Hospital-at-Home (HaH) programmes have emerged globally as alternatives to traditional inpatient hospitalization, delivering acute care at home through multidisciplinary teams. Evidence from North America, Europe, Australia, and increasingly Asia indicates that Hospital at Hom can reduce costs while maintaining comparable clinical outcomes and high patient satisfaction.

Indeed, hospital bed pressures are not unique to Ghana. Countries across Asia—including Singapore, Malaysia, China, and Japan—have introduced Hospital at Home programmes to address inflow-outflow imbalances in hospitals. A recent quasi-experimental study in Singapore (Ko et al. 2026) reported significantly lower costs per episode and per bed day for Hospital at Home care compared with ward-based care, without differences in mortality.

For Ghana, the relevance is clear. With rapid population growth and infrastructure expansion struggling to keep pace, system redesign approaches such as Hospital at Home could complement traditional capacity investments.

Beyond reform: embracing health system design

The legislative initiatives, infrastructure investments, and governance reforms currently under discussion are necessary and commendable. However, the persistence of No Bed Syndrome suggests the need to move beyond reform toward intentional system design.

The 21st century health system must be built around patient flow optimization, distributed care delivery, digital coordination, and flexible models of hospitalization. Downward referral pathways, remote specialist oversight, and Hospital-at-Home programmes represent not temporary fixes but strategic design responses to structural constraints.

No Bed Syndrome is ultimately a symptom—not merely of inadequate beds—but of how care is organized, coordinated, and delivered across levels of the system. As Ghana confronts this recurring challenge, the opportunity exists to transform a crisis narrative into a redesign agenda.

The question is no longer whether reform is needed. It is whether we are prepared to redesign care delivery itself to ensure that no patient is denied timely care because of where a bed happens to be.