Accountability

Accountability is one of the biggest frustrations here. You can see it anywhere you go, from small shops to big corporations to government agencies. One of the most frustrating places is in the small stands on the side of the street and taxi drivers and their inability to produce change. As a foreigner, you take money out of the ATM quite frequently, and it never comes in very small increments. Every week when I take out money it comes out in 10 cedi increments, which would be fine in the US but makes it impossible here. IT IS SO DIFFICULT TO TRY TO BREAK A 10, AND EVEN A 5 HERE. You might as well be broke if all you have is a 10 cedi. And then the frustrating thing is that when you attempt to buy something and the seller can't make change with it, it is presumed to be YOUR FAULT. This is when the issue of accountability comes in. If I'm the consumer, and want to purchase something, it should be the responsibility of the seller to accept my money and give me proper change. Or that's what we're taught in the States. But here, sellers refuse to accept accountability, because essentially there is nothing they can do either.

This translates into much more important issues, like the National Health Insurance plan. Of the 180 districts in Ghana, each has their own health insurance scheme. When they run out of money to reimburse the hospitals and doctors, they petition to the government. This makes sense, but is yet another way of diverting accountability from the source. If each district argues that they should have the authority and sovereignty to create their own program, they should be held accountable for its shortcomings and provide what it claims to provide. If the higher government is unresponsive to the district's petition for funding, then whose fault is it? NO ONE.
So when hospitals and community clinics in smaller and poorer districts of the country aren't being reimbursed for the services they provide to their poor community members, who can they turn to? NO ONE. So rather than being able to pinpoint the source of the dilemma, services are withheld from the patients that need them. Because of this, many Ghanaians who belong to the National Health Insurance program are often rejected JUST FOR BEING A MEMBER, REGARDLESS OF THE KIND OF THE TREATMENT THEY NEED. Therefore, the system created to help them has disadvantaged them.

In addition to issues of payment are resource distribution. While the National Health Insurance program has increased the number of Ghanaians who are able to access the health care they need, nothing has been done to maintain an appropriate ratio between patients and doctors. So a clinic that used to see 10,000 patients a year and now sees 20,000 patients a year as a result of the insurance plan, does not obtain any new doctors, new machines, or new pharmaceuticals. The ratio of doctor to patient becomes even more distorted, and the resources are spread even thinner.

Essentially, the idea for the National Health Insurance program was very progressive and addresses the issue of access, but lacks the proper infrastructure and resource system to support it. So a country like the US, which has a substantially more developed infrastructure for health care should be able to adopt a revised but similar program and make it work right?

Eh.

On a brighter note, I get to see impoverished and very ill Ghanaians come into the clinic I volunteer at and receive the ARVs and other HIV/AIDS treatments they need, which normally cost hundreds and even thousands of dollars, for just 5 cedis a month. Maybe it pays to live in capital region where there is sufficient funding for the insurance program. But if only 1 or 2 regions out of 10, and within those only a couple dozen districts out of 180 can afford to properly conduct the insurance program, how effective is it?

And whose fault is it when it doesn't work?