According to the World Health Organisation (WHO), Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. Health equity refers to the fair opportunity for everyone to attain their full health potential regardless of demographic, social, economic or geographic strata. In essence, health inequity occurs when individuals do not have a fair opportunity to attain their full health potential. Such individuals are disadvantaged from achieving their health potential and mostly die from avoidable causes just because of their economic, demographical or social class.

Health inequity is the reason why most countries in sub-Saharan Africa, as well as Ghana, have a low life expectancy as compared to high-income countries. In most situations, access to healthcare will depend on one’s ability to pay. When access is not achieved then the issue of quality health care cannot even be discussed. 

Quality healthcare is when services rendered are safe, effective, people-centred, timely, equitable, integrated and efficient. Quality health care is a vital component of universal health coverage for all citizens in each country but this comes at a cost which most political heads are not ready to bear.

Universal health coverage means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship according to the WHO. At the core to the attainment of universal health coverage is health equity. UHC is based on the WHO constitution of 1948 declaring health as a fundamental human right and of the health for all agenda set by the Alma Ata Declaration in 1978. But this right is not enjoyed by most people in Ghana. Health has been suggested as a right but not a privilege but most Ghanaians will disagree with this assertion. Only a privileged few are gaining access to quality healthcare in Ghana.

But these ideals are just a mirage in the delivery of healthcare services in Ghana and for that matter in patients with kidney disease. Chronic kidney disease affects 13.3% of the population of Ghana and due to late reporting and ignorance most progress to kidney failure before they even arrive in hospitals. The burden of kidney failure in Ghana is enormous, with most families going bankrupt as they attempt to keep loved ones alive. Kidney diseases are mostly as a result of diabetes mellitus, hypertension, the rampant use of herbal medications, abuse of pain medications as well as numerous chronic infections in Ghana. The situation is also compounded by the fact that there is less attention on education in preventing non-communicable disease such as diabetes, hypertension and kidney disease as compared to communicable diseases.

Kidney disease has been suggested as a neglected non-communicable disease with a large disease burden in Ghana.  A single centre study in Ghana revealed that most patients are ignorant about kidney disease and report late with kidney failure in over 75% of cases. Unfortunately, a third of patients with kidney failure die on admission and more die after discharge as they cannot afford dialysis or kidney transplant.

Is health promotion for kidney disease equitable in Ghana? No!  All the attention in mainly on communicable diseases such as Malaria, HIV and tuberculosis etc. Are we as a country investing in the training of health professionals in the management of kidney disease? No! This is because a country of over 27 million people has less than 10 nephrologists (kidney specialists) who are skewed to the teaching hospitals only. There are none in regional hospitals, district hospitals or health centres. What then happened to patients with kidney disease who need their services in these rural areas. Your guess is as good as mine. This is a major health equity challenge.

Most patients come in with kidney failure due to ignorance, poor socioeconomic status and lack access to early health care, if they access health care at all. They, therefore, resort to other means of healthcare such as herbal medications and other unorthodox means which leads to late reporting and more devastating consequences on the kidneys, hence kidney failure. Kidney failure requires haemodialysis or kidney transplantation for survival but unfortunately, 82% of patients with kidney failure are earning below 125 Dollars a month when they are required to pay about 720 dollars a month for the haemodialysis sessions.

This excludes other requirements for better management of kidney failure such as regular laboratory tests, medications as well as injections to increase their blood levels as kidney disease is associated with low blood levels (anaemia). These medications are very expensive. It is sad to know that these services are not covered by the national health insurance scheme in Ghana that boost of good nationwide coverage.  Patients, therefore, have to pay out of pocket to survive. Is the health of patients with kidney failure a right or a privilege in this case?

The few patients who can afford care, they may have to travel long distances to access dialysis services depending on their geographical location. This is because the delivery of healthcare services for patients with kidney failure is not equitably distributed.  You will be disadvantaged depending on your geographical location. Dialysis services in Ghana are skewed geographically to only a few regions in the country.

Dialysis centres are only situated in the regional capitals of five out of the 10 (or now 16 regions after their referendum). This, in essence, means that you are unable to access care for your kidney failure acutely or chronically depending on your geographical location in this country and may have to travel long distances to access dialysis care. This is sad as it worsens the already precarious situation in healthcare delivery for kidney disease patients in Ghana.

It is also unfortunate to state that though kidney transplant has been shown in many studies to be the best form of management for patients with kidney failure, is currently not available in Ghana. Only a few patients with the means are able to travel outside the country to get successful transplantation done. This again is inequity exemplified. This leaves the majority with no access to kidney transplantation and will have to rely on dialysis for survival (if they can afford). Haemodialysis patients, however, have poor survival rates in Ghana.

It is sad to note that I see both young and old, males and females die on daily basis due to the inability to pay for kidney care. The management of kidney disease in Ghana is challenged on various fronts with very high health inequities issues depending on your geographical location, social class and the ability to pay for your own care. The right to health as a fundamental human right is non-existent in patients with kidney disease in Ghana.

The national health insurance scheme does not cater for these well-meaning Ghanaians who develop kidney disease and there is no universal health coverage for patients with kidney disease in Ghana.

As a country, we need to look at the issue of kidney disease again and bring all stakeholders involved to help bridge the inequity gap among the various social classes in the management of kidney disease in Ghana.  When we aim to reduce health disparities, we inch closer to reaching health equity.

We need more aggressive health promotion on kidney health more especially among disadvantaged populations to prevent kidney disease. Those who develop kidney disease will report early and hence prevent kidney failure. Primary healthcare workers also need training in the prevention and screening of kidney disease and there has to be tax waiver on the equipment and consumables for the management of kidney disease. 

There has to be a safety net for patients who develop kidney disease who cannot afford care. Every region should have dialysis units as a country. I believe prevention and early screening of kidney disease especially in high-risk patients will go a long way to decrease the prevalence of kidney disease in Ghana.

Thank you!

 

 

 

Health inequities in the management of kidney diseases in Ghana

Dr. Elliot Koranteng Tannor

Senior Specialist Physician/Nephrologist – Komfo Anokye Teaching Hospital

Atlantic Fellow for Health Equity 2019

According to the World Health Organization (WHO), Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. Health equity refers to fair opportunity for everyone to attain their full health potential regardless of demographic, social, economic or geographic strata. In essence, health inequity occurs when individuals do not have a fair opportunity to attain their full health potential. Such individuals are disadvantaged from achieving their health potential and mostly die from avoidable causes just because of their economical, demographical or social class.

Health inequity is the reason why most countries in sub-Saharan Africa as well as Ghana have low life expectancy as compared to high income countries. In most situations access to healthcare will depend on one’s ability to pay. When access is not achieved then the issue of quality health care cannot even be discussed.  Quality healthcare is when services rendered are safe, effective, people-centred, timely, equitable, integrated and efficient. Quality health care is a vital component of universal health coverage for all citizens in each country but this comes at a cost which most political heads are not ready to bear.

Universal health coverage means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship according to the WHO. At the core to the attainment of universal health coverage is health equity. UHC is based on the WHO constitution of 1948 declaring health as a fundamental human right and of the health for all agenda set by the Alma Ata Declaration in 1978. But this right is not enjoyed by most people in Ghana. Health has been suggested as a right but not a privilege but most Ghanaians will disagree with this assertion. Only a privileged few are gaining access to quality healthcare in Ghana.

But these ideals are just a mirage in the delivery of healthcare services in Ghana and for that matter in patients with kidney disease. Chronic kidney disease affects 13.3% of the population of Ghana and due to late reporting and ignorance most progress to kidney failure before they even arrive in hospitals. The burden of kidney failure in Ghana is enormous, with most families going bankrupt as they attempt to keep loved ones alive. Kidney diseases are mostly as a result of diabetes mellitus, hypertension, the rampant use of herbal medications, abuse of pain medications as well as numerous chronic infections in Ghana. The situation is also compounded by the fact that there is less attention on education in preventing non-communicable disease such as diabetes, hypertension and kidney disease as compared to communicable diseases.

Kidney disease has been suggested as a neglected non-communicable disease with a large disease burden in Ghana.  A single centre study in Ghana revealed that most patients are ignorant about kidney disease and report late with kidney failure in over 75% of cases. Unfortunately, a third of patients with kidney failure die on admission and more die after discharge as they cannot afford dialysis or kidney transplant.

Is health promotion for kidney disease equitable in Ghana? No!  All the attention in mainly on communicable diseases such as Malaria, HIV and tuberculosis etc. Are we as a country investing in the training of health professionals in the management of kidney disease? No! This is because a country of over 27 million people has less than 10 nephrologists (kidney specialists) who are skewed to the teaching hospitals only. There are none in regional hospitals, district hospitals or health centres. What then happened to patients with kidney disease who need their services in these rural areas. Your guess is as good as mine. This is a major health equity challenge.

Most patients come in with kidney failure due to ignorance, poor socioeconomic status and lack access to early health care, if they access health care at all. They therefore resort to other means of healthcare such as herbal medications and other unorthodox means which leads to late reporting and more devastating consequences on the kidneys, hence kidney failure. Kidney failure requires haemodialysis or kidney transplantation for survival but unfortunately 82% of patients with kidney failure are earning below 125 Dollars a month when they are required to pay about 720 Dollars a month for the haemodialysis sessions. This exclude other requirements for better management of kidney failure such as regular laboratory tests, medications as well as injections to increase their blood levels as kidney disease is associated with low blood levels (anaemia). These medications are very expensive. It is sad to know that these services are not covered by the national health insurance scheme in Ghana that boost of good nationwide coverage.  Patients therefore have to pay out of pocket to survive. Is the health of patients with kidney failure a right or a privilege in this case?

The few patients who can afford care, they may have to travel long distances to access dialysis services depending on their geographical location. This is because the delivery of healthcare services for patients with kidney failure is not equitably distributed.  You will be disadvantaged depending on your geographical location. Dialysis services in Ghana are skewed geographically to only a few regions in the country.

Dialysis centers are only situated in the regional capitals of five out of the 10 (or now 16 regions after their referendum). This in essence means that you are unable to access care for your kidney failure acutely or chronically depending on your geographical location in this country and may have to travel long distances to access dialysis care. This is sad as it worsens the already precarious situation in healthcare delivery for kidney disease patients in Ghana.

It is also unfortunate to state that though kidney transplant has been shown in many studies to be the best form of management for patients with kidney failure, is currently not available in Ghana. Only few patients with the means are able to travel outside the country to get successful transplantation done. This again is inequity exemplified. This leaves the majority with no access to kidney transplantation and will have to rely on dialysis for survival (if they can afford). Haemodialysis patients however have poor survival rates in Ghana.

It is sad to note that I see both young and old, males and females die on daily basis due to inability for pay for kidney care. The management of kidney disease in Ghana is challenged on various fronts with very high health inequities issues depending on your geographical location, social class and ability for pay for your own care. The right to health as a fundamental human right is non-existent in patients with kidney disease in Ghana. The national health insurance scheme does not cater for these well-meaning Ghanaians who develop kidney disease and there is no universal health coverage for patients with kidney disease in Ghana.

As a country, we need to look at the issue of kidney disease again and bring all stakeholders involved to help bridge the inequity gap among the various social classes in the management of kidney disease in Ghana.  When we aim to reduce health disparities, we inch closer to reaching health equity. We need more aggressive health promotion on kidney health more especially among disadvantaged populations to prevent kidney disease. Those who develop kidney disease will report early and hence prevent kidney failure. Primary healthcare workers also need training in the prevention and screening of kidney disease and there has to be tax waiver on the equipment’s and consumables for the management of kidney disease.  There has to be a safety net for patients who develop kidney disease who cannot afford care. Every region should have dialysis units as a country. I believe prevention and early screening of kidney disease especially in high risk patients will go a long way to decrease the prevalence of kidney disease in Ghana.

Thank you!