Letter From Ghana


Kill or Cure
Ghana is faithfully following IMF prescriptions. But its health service has fallen sick
as a result, according to Daniel Mensah Brande.

Illustration by SARAH JOHN Frank Aidam was an announcer with a state-controlled radio station in Accra. Frank knew what would happen to him if he went on the air with something unauthorized. But he damned the consequences. After reading the normal announcements, he said: 'I seize the opportunity to appeal to the Minister of Health. The cash-and-carry system is telling on the average Ghanaian. Something must be done about it. If you care to know, my name is Frank Aidam.'

Frank Aidam was frankly speaking. He was appealing for a review of a health-delivery system in Ghana where you must pay on the spot before you get medical attention, a system beyond many people's means.

Amazingly enough, Frank was not dismissed but was instead barred from announcing and transferred to another department. His appeal even provoked a debate in the National Assembly – though it did not result in any reform.

The cash-and-carry system is a product of the structural adjustment programme which the IMF and the World Bank have prescribed and which Ghana has been ready to adopt. It involves the wholesale withdrawal of government subsidies on health delivery. And since its introduction, cash and carry appears to have carried away health services from the people.

'The system is stinking and dehumanizing,' says a medical practitioner in one of the state hospitals. 'Patients who do not have the ability to pay for medical services are turned away from hospitals only to die at home. The poor, the disabled and accident victims are being asked to pay on the spot before getting medical attention. This system has no human face. Our health service is in confusion.'

A pharmacist told me that that many Ghanaians come to him rather than a doctor when they fall ill. 'They come here to avoid paying consultation fees: many of them do not have the money to buy even painkillers like paracetamol. The situation is very critical. I have on many occasions given out drugs free of charge.'

The Korle-Bu Teaching Hospital in Accra, one of the biggest health institutions on the African continent, has been reduced to a showpiece of human neglect and administrative lapses. It has become a breeding-ground for mosquitoes while mice and rats are rife in the wards. A visitor to Korle-Bu recently said: 'This place is no longer a life-saving environment but a death trap. You will certainly contract a disease if you come here.'

Students of the Institute of Professional Studies in Accra went on a peaceful march to the National Assembly last June and presented a petition protesting against what they described as the 'negligence of health officials and the inhuman face of the cash-and-carry system' which resulted in the death of one of their colleagues. Joyce Agyei, a second-year student, was involved in a motor accident and was rushed to the Police Hospital in Accra. Even though Joyce's condition was critical, she was denied intensive care and was referred to Korle-Bu. But no ambulance was supplied to convey her there. Her colleagues finally hired a taxi and requested that a nurse accompany the unconscious Joyce, but this too was refused. Joyce eventually died.

Politicians here still trumpet the slogan 'Health for All by the Year 2000'. But they know very well that the cash-and-carry system is carrying the people to their grave. They also know that the prescriptions of the IMF and the World Bank have failed to heal the national economy. Ghana's President John Jerry Rawlings has said: 'I know the hardships that the structural-adjustment programme is inflicting on you, but there is no better path for us to tread.'

But for how long must people endure these inhuman ordeals? Frank Aidam was prepared to risk his job to speak out. There are many others like him in Ghana today ready to tell it like it is: the health system here is in tatters.

Daniel Mensah Brande is a journalist and broadcaster who lives and works in Accra.

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New Internationalist issue 287 magazine cover This article is from the January 1997 issue of New Internationalist.
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