What does it take to become an effective healthcare facility in Africa, where much of the continent is marked by extraordinary needs and limited resources? In a series of profiles, GHCi’s Alex Freedman looks at operations and management strategies at three standout Africa hospitals, in Kenya, Nigeria and Ghana. This profile is the third in the series.
In February 2015, a fire broke out in the central pharmacy department of Korle Bu Teaching Hospital, in Accra, Ghana. “That was a very bad day for us, with everything upside down,” says the hospital’s deputy director of pharmaceutical services, Dr. Daniel Ankrah. No one was hurt, and the damage was limited, but the outcome might have been much worse — if it weren’t for the quick response of the hospital’s independent fire service.
Having an in-house fire service is a quirky feature of the third largest hospital in all of Africa. Founded in 1923, Korle Bu has long been a leading provider of specialist care in Ghana, with prominent centers in radiotherapy, cardiothoracic medicine and reconstructive plastic surgery and burns. For decades, the 2,000-bed hospital has drawn patients from across West Africa.
Korle Bu is a public, government-owned facility and, as a long-time home to the University of Ghana Medical School, a teaching hospital. International collaborations have helped raise its profile: The University of Pittsburgh's Center for Translational and International Hematology, for instance, includes two team members from Korle Bu — Dr. E.E. Olayemi, Korle Bu's head of the department of hematology and director of the hospital's Center for Clinical Genetics, and Dr. Amma Benneh-Akwasi Kuma, a hematologist at the hospital. A program that was set to launch in early 2017 will bring medical residents from the University of Pittsburgh Medical Center to Ghana to train at Korle Bu. “The residency will build the image of the hospital and open doors to new collaborations,” says Korle Bu’s acting director of medical affairs, Dr. Roberta Lamptey, of the collaborative training program.
The hospital, like others of its stature, participates in outreach activities. Last fall, a team from the hospital’s reconstructive plastic surgery and burns unit traveled to the small Ghanaian town of Bole and offered free surgical services to 192 people. The six-day program was funded by the the Ghanaian National Petroleum Company. This program has taken Korle Bu’s staff across the nation to under-served communities over the last decade.
The hospital’s public status means that many of its programs, centers and departments receive private philanthropic support from Ghanaian individuals and companies. In 2016, the National Petroleum Authority donated about US$237,000 to the hospital’s plastic surgery and burns center for refurbishments and improvements. That same year, the Ghanaian construction company First Sky Limited donated US$615,000 to cover the care of renal and dialysis services for indigent kidney patients. Ghanaian-based community bank Fidelity Bank provided US$12,000 in seed funds to establish a critical care fund to pay the fees for people who can’t afford emergency care services.
Hospital collection practices are problematic for the hospital. In 2014, Korle Bu made headlines when it refused to release a dozen new mothers and their newborns when the women couldn’t pay their fees. The country’s Minister of Health had to intervene and order the hospital to let the women leave. Ghana theoretically has universal healthcare coverage, which means that anyone can have access to the National Health Insurance program. But enrollment is voluntary and there are premiums and registration fees, which many citizens can’t afford. For those who do have national insurance, reimbursement by the government is often delayed up to six months, says Korle Bu pharmaceutical director Ankrah. “You need money to manage healthcare, and if you don’t get your services reimbursed in the least possible time, it slows everything down — and not just expensive procedures.”
Ghana was one of the first African countries to give greater management authority to its public hospitals. Since the 1970s, the government has encouraged Korle Bu and the Komfo Anokye Teaching Hospital, in Kumasi, to become more autonomous. The Ministry of Health made its first step towards providing full autonomy to the two hospitals in 1988, and by 1996, Korle Bu had the authority to operate semi-autonomously. Korle Bu has its own management board and staff of directors that oversee the daily operations of the hospital. However, it doesn’t have complete control over certain important factors, such as the rates it can charge for its services. “When we want to increase charges, we have to seek government approval,” says Ankrah.
The multi-layered management structure places a lot of responsibility on department heads like Ankrah. As deputy director, he manages more than ten pharmacy units in most of the hospital’s clinical areas, including obstetrics and gynecology, child health, and psychiatry. At the same time, he has to answer to the country’s Ministry of Health, which might drop in for inspections at any moment. “At times, we had very little notification that the health minister was coming,” Ankrah says. “As a manager, I have to be prepared for any eventuality.”
And one eventuality that Korle Bu will have to contend with is the opening of a shiny new competitor: Construction of the US$217 million University of Ghana Medical Centre, which has been in active development since 2011, is nearing completion. The facility is being built with a loan from the Israeli government and is modeled on the Sheba Medical Center in Israel, which in 2013 received accreditation from the Joint Commission International as an academic medical center hospital. In January, Ami Mehl, the Israeli ambassador to Ghana, told the audience at a ceremony for the hospital that staff training and management will be overseen by Sheba. The new center is awaiting government financing to hire staff and start its second phase of construction, but many are already anticipating that it will raise the bar for healthcare standards nationwide. The medical center will also become the new teaching hospital for the University of Ghana when it opens — usurping a role held by Korle Bu since 1962.
— Alex Freedman
Alex Freedman is a freelance healthcare writer based in Portland, Oregon.