Despite budget increases, adequate medical training and staff shortages remain a concern. The government has rolled out several projects to raise the quality and quantity of properly trained staff across the sector.
Human Resources
The Ministry of Health (MoH) has submitted a new sector-focused human resources policy to the Cabinet for approval by the end of 2014. The staff training programme incorporated in the policy is made up of three segments: pre-service training (leading to professional certificates at the introductory level), post-basic training (leading to specialisations for serving health professionals), and specialised training (leading to graduate programmes and fellowships).
In its 2014 budget, the MoH allocated GHS6.6m ($2.52m) toward training and quality assurance capacity building. The ongoing pilot will provide substantial monitoring capabilities to staff recruitment and retention. New offices for the College of Nurses and Midwives, the Allied Health Professionals Council, the Health Facilities Regulator Authority and the Ghana College Pharmacists will provide necessary capacity to enhance staff recruitment and training, as there is a high failure rate on licensing examinations.
Material Mortality
While maternal mortality has decreased by 49% between 1990 and 2013, the current maternal mortality rate of 380 deaths per 1000 births is still far off from the fifth Millennium Development Goal (MDG) of 185 by 2015. According to a UN report in May 2014, an estimated 3100 women died between January and December 2013 due to complications resulting from pregnancy.
Indeed, according to MamaYe, an advocacy group focused on maternal health care in sub-Saharan Africa, Ghana has a 29% shortage of midwives, illustrating that an additional 1459 midwives are necessary to achieve the 95% skilled birth attendants coverage target by 2015. Research shows that 69% of maternal deaths and 61% of neonatal deaths could be prevented by 2015 if all women could deliver in facilities with midwives and basic emergency obstetric equipment.
The government is beginning to supply handheld ultrasound technology to all community clinics and health centres in order for midwives to properly deal with high-risk pregnancies. Enhanced training options for nurses and midwives as a result of new regulatory oversight and teaching programmes is also expected to help provide extra capacity. While much work remains, Ghana is one of the few sub-Saharan African countries making progress toward this MDG target.
The most recent statistics on the subject show that the doctor-to-patient ratio is far from optimal, at one doctor to 15,259 patients per year. Medical brain drain remains an issue: according to a 2011 study from the American Medical Association, the number of African doctors practising in the US increased by around 40% from 2001 to 2011, while the emigration of doctors is increasing from around sub-Saharan Africa, particularly from Ghana and Nigeria. A combination of policy reform and infrastructure investment will be necessary to retain Ghana’s medical graduates.
Hospital Expansion
Many hospitals are due to undergo upgrades, although challenges will remain. For example, the University of Ghana Teaching Hospital is due for completion by 2015. According to the ministry, the hospital, costing $217m and funded via a loan facility from the Israeli government, can train 1000 more doctors within five to seven years, which would bring the doctor-patient ratio down to around 1:10,000.
Many doctors will be posted to rural areas to help achieve the fourth and fifth MDGs, child mortality and maternal health, respectively. In the Volta and Central Regions, MoH funds are financing work to assist with the construction of regional teaching hospitals and expansion of the Kwame Nkurumah University of Science and Technology Teaching Hospital.
“Even after completion of the current round of new hospitals, nearly 200 districts remain without a proper hospital,” Kojo Hastings, chairman of Genelec Support Services, told OBG. “The medical centres serving those areas are often poorly equipped and understaffed.”
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