Ghana has since time immemorial been saddled with various pertinent health challenges. One of such is having a doctor-to-patient and population deficit. A report by the World Bank indicates that the doctor/patient ratio of the country is 1:1000; a situation the Ghana Medical and Dental Association has described as dire. This alarming doctor to patient ratio has several ramifications for the country’s already ailing health care. Successive governments have enacted several policies to improve the doctor/patient ratio by building more health facilities and also enrolling more health workers. Data available show that the doctor/nurse ratio was trending downward till the surface of COVID-19 and its associated migration of health professionals to countries such as the UK, Canada and the USA.
Before we move to COVID-19 and the exodus of nurses to Europe and America, it is essential to evaluate the strategies of successive governments in further reducing the doctor/patient ratio. The strides which have been made so far through various governmental interventions typically involve the training of health professionals, and also encouraging some of them to accept postings to rural areas.
The training of more doctors has historically been of grave concern due to the inadequacies of teaching hospitals across the country. Successive governments have tried to build faculties in new universities such as the University of Development Studies, Tamale; and University of Health and Allied Sciences at Ho to augment existing medical schools at the University of Ghana, KNUST and UCC. These measures have increased the number of doctors in the country, but as the population of the country is increasing, these measures have not been so effective in bringing down the doctor/patient ratio substantially.
Doctors who are trained in Ghana know their worth, and some have bluntly refused postings to rural areas. A segmentation of the doctor/patient ratio shows that some regions like the Upper West Region have a very appalling doctor/patient health ratio. A large proportion of the country’s doctors are in Accra and Kumasi. This means that the life expectancy of those in rural areas lags behind their counterparts in urban areas such as Accra and Kumasi – by a wide margin.
The figures are not rosy with the nurses either. The nurse/patient ratio in Ghana currently is 1:18; which means that at any point in time one nurse is attending to approximately 18 patients. Clearly, this picture implies that there are more nurses attending to patients than doctors – a common situation that poses an essential question as to the extent nurses should be empowered to serve across the country’s rural, urban and peri-urban communities in the light of major deficits evident due to unavailability of doctors in Ghana. Because of how doctors are ‘scarce commodities’ in Ghana, some health facilities have only one to three doctors manning them.
Imagine a hypothetical situation where a patient has been rushed to a medical facility on the verge of death, and is told to “wait for a doctor to arrive”. If you live in a community where there are only two doctors, it means that the probability of your ailment worsening is higher. Death at that point becomes nearly inevitable. Currently Ghana’s life expectancy is 64 years, and these are the little things that make us have such a lower life expectancy.
As we see many nurses looking on helplessly, beyond the initial care they have given they are unable to do much in instances beyond their given mandates. Some of the deaths which occur in our various health facilities are preventable. A solution to this can be found by an examination of what is a common practice in the United States of America.
Let’s examine the case for the United States of America (USA), currently one of the highly ranked countries in health care delivery. As part of a nationally accepted healthcare policy in the USA, there has been an emergence of a considerable number of nurse-practitioners across the country – who have formally received Nurse Practitioner Training (NPT) to diagnose, write prescriptions and perform certain medical procedures in addition to their core function. The training usually spans an average of two and half years – approximately one-third of the total training period for a medical doctor! This can be implemented in Ghana, together with the training of more Physician Assistants.
Thankfully, there have been recent partnerships between some universities in Ghana and the USA to facilitate this training programme right here in Ghana; thus eliminating the high cost associated with having nurses travel abroad to pursue this kind of training. For instance, Aspire Business Network led negotiations between Valley View University and Andrews University to introduce a Doctorate in Nursing Practice programme, which can be particularly targeted at highly motivated and committed nurses who are already in rural and deprived communities across Ghana. These nurses, who may have had a considerable number of years’ experience at their current facilities, have most likely already built deeper relationships with the communities in which they live.
Due to this enhanced community trust and high community involvement, these nurses can for instance be government-sponsored to undertake the Nurse Practitioner Training (NPT) programme. Subsequently, their allowances can be slightly adjusted upon programme completion and assumption of this new role.
I believe that this initiative is one of the most effective ways to provide impetus for directly addressing and bridging the healthcare quality gap between rural and urban communities; and also to reduce death rates that may be rising due to doctor unavailability in some situations.
Moreover, Covid taught us many lessons – and one of those lessons was how vulnerable our healthcare system has been over the years. Nature spared us this time. Africa/Ghana didn’t suffer a lot of the craziness the virus delivered to the Western world. But just imagine if what they had predicted about Africa had happened. We can’t continue leaving life to chance.
Introducing this programme will also help to correct the nurse distribution anomaly in Ghana, by influencing more nurses who are mostly in the urban communities to migrate to some of the needy rural communities. This could be a follow-up solution to earlier concerns raised by the Health Minister in June 2019 during a three-day tour in the Volta Region, that: “Although it appears we (Ghana) have enough nurses, they are all centred in the urban areas”.
Beyond the borders of Ghana, implementing innovative solutions such as these will aid in putting Ghana on a higher pedestal when it comes to mentioning significant strides that have been made in line with helping the United Nations attain Sustainable Development Goal No 3 – ‘Good Health and Well-being’.
The potential and opportunity in using nurses as active drivers in the improvement of Ghana’s healthcare delivery system is simply limitless, and I remain optimistic about the positive benefits this proposed initiative will bring to bear on the quality of healthcare every Ghanaian can receive; no matter where they find themselves across the country.
The writer is the Chief Executive Officer of Aspire Business Network and its Subsidiaries