Access to doctors deteriorates

The availability of doctors in medical facilities across the country has decreased over the past couple of years in the midst of the seemingly expanded healthcare infrastructure access with the situation worse in the three northern regions.

This means that tens of thousands of people especially those that live miles away from urban communities have minimal or no contact with doctors at all, placing healthcare delivery in the country largely in the hands of traditional healers.

SEND-Ghana, which recently undertook a study on the availability of doctors to patients indicated in its report titled: “Making safe motherhood a reality, the issue of financing”, that many patients do not get to see a doctor when they fall sick, with the numbers far above the standard World Health Organization’s (WHO) doctor-to-patient ratio average of 1: 600– that is one doctor for every 600 patients.

According to the findings from the SEND-Ghana study, even though the situation where in a country of an estimated 27 million people, one doctor in 2012 attended to 11,515 people has improved marginally to where a doctor is now attending to 10,170, in the three northern regions, about 36,000 people have access to only one doctor.

The report showed that in the Northern Region for instance, which boasts of one of the country’s three teaching hospitals, one doctor sees about 22, 894 people, with the situation deteriorating as one moves farther north with one doctor in the Upper East Region attending to 33,896 people while in the Upper West Region, one doctor attends to 53,064 people.

Access to doctors across the country is even worse when computed on the district-wide level with the Bawku West district for instance having one doctor attend to about 94,034 people. The Tolon district, however, does not have a single doctor available, the report said.

One inhabitant of Tolon, whose identity remains anonymous, told SEND- Ghana that “the failure of government to upgrade the Tolon Health Centre into a district hospital despite many appeals is the leading cause of our health care problems…it is the main reason why Tolon has no medical doctor, no proper infrastructure and other core staff…visit the centre and you will be sorry for the district.”

According to the latest SEND-Ghana report, the poor infrastructural facilities accounts for this situation.

But the deteriorating access to doctors in the country has induced discussion on how to boost doctor population and also enticed more others to accept postings to rural and deprived communities where the risk of maternal death is very high.

Currently, there are about 3,000 medical doctors in a country of more than 27 million people, with anecdotal evidence suggesting that Ghana needs about 45,000 more doctors to enable it to meet its healthcare needs amidst a shortfall in public spending on healthcare.

The situation thus requires concerted efforts to encourage the private sector to deepen investment in medical education and facilities so that the country can match its new middle-income status with its healthcare needs.

However, by the annual turnout of medical doctors in the country’s four medical schools, it is estimated that it will take about a century to produce the number of doctors that are required to meet today’s needs, which puts Ghana’s healthcare in a dire position.

Ghana healthcare expenditure is just about 4.8% of GDP, which places the country at 167th in the world in terms of spending on healthcare.

As per the SEND-Ghana report, the country is still below the Millennium Development Goals (MDG). According to the report, in 2013, Ghana recorded maternal mortality rate of 380 per 100, 000 against the Millennium Development Goals (MDG) target of 185 per 100,000. Based on this trend, Ghana is projected to miss MDG5 by the end of 2015, which aims at reducing by three quarters, between 1990 and 2015, the maternal mortality ratio.

A WHO report shows that unlike in the developed world where a woman's life time risk of dying during pregnancy and childbirth is 1 in 3700, the risk of maternal death is very high at 1 in 38 in sub-Saharan Africa.

The case of Ghana is not different as the SEND-Ghana report shows that maternal mortality rate in the Northern and Upper West Regions exceeded the national average of 154 per 100,000 at 174 and 193 per 100,000 respectively.

The research work states that a critical contributor to the slow pace Ghana has experienced is inadequate financial support of lower level health facilities.

“Assessments of allocations and spending by district health facilities by this study point to inadequate and untimely release of funding by the Government of Ghana. From 2012 to 2014, many district health management teams and health facilities hardly received their quarterly allocations.

“In a related study conducted by SEND-Ghana (2015), the situation has compelled most health facilities to impose unapproved charges on pregnant women and nursing mothers in spite of the fact that they were registered members of the NHIS and entitled to benefits under the Free Maternal Health Care. Such practices had compelled some pregnant women to deliver at home, a situation which undermines efforts to boost skilled delivery in the country,”

The report further recommends that government needs to systematically increase budget allocations to the health sector, in line with its health sector to meet their health targets and outcomes.

Again, government, MMDAs and donors need to ensure regular and speedy transfer of quarterly funds for District level health service delivery. This will help in reducing the drudgery of indebtedness to creditors and enhance speedy delivery of services.

On the availability of logistics, the report recommends government to take urgent steps to address the limited supply of medical equipment including delivery beds, blood banks and ultrasound machines. Limited supplies account for the challenges identified as hindering effective utilization of health services with its related effect.