Bishop Joseph Afrifah-Agyekum’s Spicy 10th Anniversary Address
“My dear health workers … all that matters to the ordinary man on the “tro-tro” is that our hospitals and clinics are places of hope to the sick and those in pain. By this I mean within the hospital or clinic, the registration places should be like the home where visitors are received with smiles and warmth; the emergency rooms or vital signs areas where the patient is first physically handled will feel a gentle touch that exudes love; the consulting rooms will be places of assurance and communication; the wards will be a place of peace and rest; the maternity will be a place for expecting life and happiness; the theatre a place of hope and trust; the pharmacies a place of confidence; the communities will trust any message and counseling you provide as well intended; and the nursing training schools are places of acquiring both professional and ethical training for future health workers.” – Bishop Joseph Afrifa-Agyekum, Episcopal Chairman for Health, Ghana Catholic’s Bishop’s Conference, October 2012.
The minute Bishop Afrifah-Agyekum, the Catholic Church’s Episcopal Chairman for health and Bishop for Koforidua Diocese, preceded his 10th anniversary address by leading all stakeholders in stretching exercises while in priestly robe, it ought to have dawned that this was not going to be your typical humdrum keynote monotone .
But like a good priest, he preceded the thought-provoking fireworks with words of compassion for hardworking staff of the National Catholic Health Service (NCHS) when he asked the Health Directorate to start and deepen interventions that put the “worker at the centre of our plans and ensure that he/she retires in dignity and becomes proud, looking back on his/her life that he has served the Church and the Church has acknowledged it.” Touching on initiatives in the pipeline like Employee Safety and Well-being policy and Pooled Provident fund, he pledged the full support of the Catholic Bishop’s Conference to improve the fortunes of its health workers, asking for these initiatives to be “implemented soonest.”
With “Deepening the Quality Improvement and Sustainability Agenda within the NCHS” as the theme for the 10th Anniversary, Bishop Afrifah-Agyekum then went to town on grave matters deserving of the attention of the NCHS, Ghana Health Service (GHS) and the Ministry of Health.
Two years ago, the Ghana Catholic Bishops Conference charged the NCHS to start a Pooled Procurement Programme. This programme saw the church’s 32 hospitals and 66 clinics procuring drugs in bulk after jointly negotiating significant price reductions. This had the primary objectives of reducing the cost and eliminating counterfeit and sub-standard drugs. Bishop announced “an average 25% savings on medical inputs…” running into millions of Ghana cedis year within the first half year with higher discounts and savings being anticipated in the second. Managers of health facilities whose actions, either deliberately or inadvertently, threaten the Pooled Procurement Programme were seriously advised to “to give up whatever their motivation is for doing so.”
The sometimes troubling relationship of the Church with the GHS at some levels of its hierarchy came next on Bishop’s radar. He recalled that “Church-Government partnership pre-dates our independence and it has been nurtured and flourished over the years to the extent that Church health services is supported mainly by way of staff salaries and sometimes equipment donations. In all this it is remarkable to note that government respects the Church’s ethical issues in health care.”
Regretting that this this partnership has by now not blossomed into a seamless relationship, he decried the mistrust that sometimes exhibited itself in unfortunate ways, citing the worrying trend of duplicating health facilities in parts of the country. “For example at Chinderi in the Volta Region, we are operating “rival” services on the same premises. A Catholic Clinic has operated in the town until recently when a GHS clinic has been sited about 50 metres apart where services contrary to our ethics are provided. Another is at Nkwanta where a hospital has been set up even though the St. Joseph Hospital has is in the same town…”
Why duplicate the siting of these facilities when other Ghanaian communities do not even have a clinic? How do we expect to accelerate achievements of Millennium Development Goals if resources are not evenly distributed to tackle the diseases of burden affecting our development? He then lamented his observation that the fact that we all work to the serve the patient, I believe, is sometimes lost on us all. Bishop then called on the Ministry of Heath to better coordinate the health system by making the role of the Regional and District Directors of health “one that goes beyond the Ghana Health Service to cover all providers of health in their respective jurisdictions” thereby shunning all negative competitive tendencies in welcome of partners working towards common goals.
Bishop then raised the issue of the effect of health insurance’s Capitation pilot in Church facilities in the Ashanti region. With the number of enrollees on capitation increasing but with reducing attendance in some instances, he wondered whether nine months into the pilot, enough evidence has been gathered on its impact on adequacy and quality of health care including considering “how to cushion the sick and vulnerable?” He pointed out that health and well-being are a matter of life and death, with any harm done not easily reversed if we waited for over a year to assess the pilot. On cost, the NCHS revealed data to show that “compared to the GDRG regime, the institutions are experiencing about 25% loss of revenue, with the clinics worst affected.” Bishop thus directed the NCHS to take immediate steps to engage the relevant institutions to have this issue resolved sooner than later.
Commending the NCHS’s partnership with the Institute for Healthcare Improvement, Boston USA which has brought a new impetus to improving health outcomes through Quality Improvement (QI) methodology, he urged the NCHS to continuously design a system that “understands and respects patients’ values, preferences and expressed needs as the foundation of patient-centered care.” He acknowledged the role of Continuous Quality Improvement in achieving 24%-65% under- five mortality reduction across 32 NCHS hospitals.
The Episcopal Chairman for health called for patients to be empowered to take control of diseases of life style like obesity, hypertension, diabetes etc. “My lay man’s view is that deepening quality improvement and sustainable effective patient care should begin and end with the recognition that patients are the most important managers of their health and care. Like the Church which recognizes the family as the smallest unit of evangelization, let you, health providers also accept this reality and extend your services to address the individual and family as basic units and the entry point to the health care delivery system.”
He urged health professionals to deploy the internet and technology to improve care querying what difference it would make if patients could have the opportunity of using a monitoring device to report on their health status over an entire month as opposed to a single report around the time of the routine checkup. He called for the next generation of health professionals to be taught not just technical professional work, but also ethics and leadership as a means of improving and maintaining the church’s ideals in healthcare.
He ended with a call for a redefinition of the Chaplains role as an integral part of the health system, asking it to extend beyond end of life interventions but to commence from the onset of care because God is always at work in our lives.
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