Re: State of the Nation Address on Health

On the 19th of February 2009, the president Prof John Evans Atta Mills presented the state of the nation address to parliament and the people of Ghana as a whole. Indeed it is was a good address but we noticed a major shortfall when it came to the area of health for which reason we feel obliged to draw the presidents’ attention to it. The president touched on issues of policy and provision of adequate health infrastructure but made no mention of how to get staff to manage these facilities especially in the less deprived areas. Indeed the president made mention of the National Health Insurance and also mention the establishment of new hospital s and other health facilities. Much as these are important, in our current circumstance, we think the issue of motivation of health personnel is more important. For instance in Cape Coast, Sunyani and Ho we have what most people will refer to as the state of the art hospitals yet because of the lack of staff the facilities are grossly under utilized. In Ho for instance it is reported that less than ten 10 doctors are actively working to keep the entire regional hospital of about 240 bed capacity running (with the hospital functioning at about 50% capacity), yet In one of the hospitals in Accra for instance you have about nineteen doctors in one small children’s department alone with total bed capacity of about twenty five (25). In the whole of the Volta Region there is not a single Physician specialist where as close to thirty physician specialists are in the Medical Department at the Korle-Bu Teaching Hospital alone and this excludes the many specialists in training. The same is true for other specialists as well. There are some hospitals in the districts where there is not even a single medical doctor and virtually all the district hospitals have only one medical doctor at post. He works seven days and nights a week and twelve months a year. Meanwhile every year about two hundred new doctors graduate from the University of Ghana Medical School and Kwame Nkrumah University of Science and Technology Medical school together. The story is not too different with other health personnel. In order to bring improved healthcare services to the people outside the cities, the issue of incentives to encourage doctors and other health workers to accept posting to the less endowed areas of the country must be looked at again. Last year we are informed that about 90% of newly posted doctors have not taken post at the new places. The reasons are not far fetched. These include the following:

The postings were indiscriminate and without recourse to normal principles often employed. For instance, colleague doctors who moved out of Accra to the district hospitals and some regional hospital on their own were reposted to other places while those posted from Accra and Kumasi to replace them did not go. Colleague doctors who were married (to their doctor colleagues) were posted to extreme opposite ends of the country and no explanation could make the authorities involved with the postings reverse these postings officially.
The conditions of service or work in most of these districts are unattractive. For instance contrary to the political propaganda of the NPP government about the basic take home salary of doctors going beyond one thousand dollars I can tell you that it is currently not even up to seven hundred Ghana cedis. Therefore most doctors depend hugely on part time jobs or locum in private hospitals to survive. Indeed in most cases what they earn from this part time far exceeds their salaries and most of these part time jobs are unavailable in the districts. More to that if you are unlucky to be the only doctor in the district then it means you will be working every day and night of the week without rest and without any additional source of income. Why would anybody then want to leave Accra and go to these places?
Again because of the current remuneration problems everybody i.e. doctor will want to specialize so as to move to a different salary scale, since it takes at least ten 10 years after becoming a medical officer to be promoted to another level with a commensurate increase in your salary. Now to specialize you will need to write entrance examinations and these are difficult exams which will require diligent studies. In the districts because you are alone and working all day round you can hardly make time to study for any exams and so you find that its the same people in Accra who get part time jobs with comparatively less pressures of work who end up in these specialist programmes. So why will anybody ordinarily want to move away from the city?

Dr. Abiwu Hilarius A.K. Spokesperson, concerned junior doctors group. And former national spokesperson, Jun. Doctors Association. 0242934269 [Email: saharavm@yahoo.com]

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