Where the Money Flows...
Looking over the past 2 ½ weeks in Accra, much of our work has been around the money. And when I mean the money, I mean the twisty-turny routes that both money and products take to arrive at their intended goals. Some of you may call this supply chain management, but in a culture where relationships rule supreme, that “chain” becomes very knotted.
Ghana has a fairly well-established healthcare market with both public and private institutions. Each of these institutions, however, frequently receive money from both sectors. There is even a official category for funding specific hospitals called “quasi-government”(that’s an official term, folks). Additionally, many government hospitals and healthcare centers, particularly in rural areas, receive the bulk of their income from the government but maintain a certain amount of self-sustained revenue. This revenue comes from patients, who often have to pay for consumables like blood bags, medications and even gauze. But more often than not, other donors will support government hospitals by donating equipment or staff support.
Though this support is gladly welcomed, it can be difficult to regulate when the government seeks to upgrade equipment across the multiple regions. Each hospital then has piecemeal services and no one hospital can maintain the same quality of care across all departments. When this equipment is donated, there's often issues of maintenance where the device breaks down within 2 years with nothing to replace it.
Luckily, the Ministry of Health has recently received multiple financial backings from various US banks to raise the level of care at most hospitals. With a focus on capacity building and maintenance in regional, district and teaching hospitals, state-of-the-art x-ray, oxygen generation systems and surgical theatres (operating rooms) have made an appearance across the country.
Great news for more urban hospitals, however, many rural health centers have yet to receive basic point-of-care equipment. These places have an opportunity to be stocked with sleek, new equipment that can free the centers from dependence on infrastructure.