This article focuses on Accra because the recent case that sparked national concern unfolded within the capital. When ambulances moved from hospital to hospital in search of capacity, the fragmentation of a major metropolitan system became visible. Accra therefore provides a natural case study, though the lessons apply to every growing urban centre in Ghana.
Accra’s challenge is not only the number of hospitals. It is also how they function together.
Within the Greater Accra area stand major institutions such as Korle Bu Teaching Hospital, 37 Military Hospital, Greater Accra Regional Hospital at Ridge, University of Ghana Medical Centre, LEKMA Hospital in Teshie, Police Hospital in Cantonments, The Trust Hospital in Osu, and The Bank Hospital in Cantonments. Each has skilled staff, beds, and clinical facilities capable of delivering lifesaving emergency care. Each works hard every day.
Yet when ambulances move across the city, they often move blindly. While the public sees one city, the system behaves like separate islands. This is the heart of the problem.
We often speak about “No Bed Syndrome” as if it is purely an individual hospital issue. Often it is a network issue. It is what happens when a metropolitan emergency care area functions without a central nervous system. Accra is one urban health ecosystem. The same roads carry trauma victims. The same population lives with hypertension, diabetes, stroke, and obstetric emergencies. Pressure in one hospital inevitably spills into another.
When one major hospital becomes saturated, waiting times lengthen across the city. If one hospital is overwhelmed and another has space, yet neither knows the status of the other, the patient suffers.
The problem is not always absolute bed scarcity. Often the problem is fragmentation. Capacity may exist, but it is invisible. Decisions are made phone call by phone call. A junior doctor searches for a bed through colleagues in another facility. Ambulance crews arrive at one facility only to be redirected elsewhere. Sometimes there is no prior communication at all, only redirection at a hospital gate.
Each individual is trying to solve a problem. But the system itself remains disconnected.
When multiple hospitals appear to fail in similar ways during the same emergency journey on one night, the problem can no longer be understood only as isolated bedside lapse. It points to deeper weaknesses in supervision, escalation, bed management, communication, governance, and continuity of learning across the wider system.
Focusing only on the final visible error risks mistaking the last link in the chain for the whole chain. In aviation, serious incidents are investigated not only for pilot actions, but also for failures in training, communication, equipment, operational control, and system design. Emergency care deserves the same depth of reflection.
This view also raises uncomfortable questions. What lessons were learnt from the “No Bed Syndrome” incident eight years ago, or from similar incidents since then? Were those lessons embedded into policy, escalation protocols, staff orientation, and institutional memory? If they were not retained and passed on to new generations of staff, then the system did not truly learn.
In many large cities around the world, emergency care functions as a coordinated network. Ambulances do not simply head to the nearest gate without guidance. There is visibility of capacity. There are agreed diversion thresholds. Hospitals retain their identity and autonomy, but they operate within a shared framework during periods of stress.
A networked solution does not require structural merger or the erasure of management boundaries. It requires agreement on shared information, shared protocols, and shared responsibility. It requires recognition that emergency care is critical infrastructure, not private territory.
Imagine a simple system. Not futuristic. Not overly expensive. Just functional. Major public hospitals update key operational indicators in real time. Selected private facilities may participate in the network. Emergency department occupancy, boarding numbers, intensive care capacity, oxygen availability, and imaging functionality are visible across the network. Hospitals and ambulance services can identify which facilities are nearing saturation and which still have capacity.
Such a system would require prior agreement, basic digital infrastructure, and consistent reporting standards. A metropolitan coordination hub, perhaps situated within the regional health directorate, would help coordinate emergency flow across the city during periods of pressure. Its role would be straightforward. See capacity. Share capacity. Balance capacity.
Hospitals across the network would share information on beds, emergency department trolleys, oxygen availability, and Intensive Care Unit (ICU) or High Dependency Unit (HDU) capacity. This information could then be relayed to ambulance services and participating hospitals to guide transfers, referrals, and patient movement more safely.
In high income countries, emergency care across large cities is often organised around mature ambulance dispatch systems. Accra’s reality is different. Many critically ill patients arrive not by ambulance, but by private vehicle, taxi, or commercial transport, accompanied by relatives making urgent decisions under stress. A realistic emergency system for Accra must therefore support not only ambulance services, but also the wider public seeking emergency care.
This makes the challenge more important. In systems where families themselves become the transport network, the need for reliable guidance becomes even greater, not less. Careful thought must therefore be given to how a city wide bed visibility and emergency flow system would function within a largely decentralised pattern of patient arrival. The goal is not to direct every taxi from a control room. It is to ensure that once patients enter the healthcare system, hospitals and clinicians no longer operate in isolation from one another.
In practical terms, this approach could include referral hotlines between hospitals, emergency coordination numbers for the public, strengthened hospital switchboards, simple mobile phone accessible status system, WhatsApp based referral coordination, and digital bed visibility systems for clinicians and ambulance dispatchers. The aim is to reduce dangerous uncertainty for patients, families, clinicians, and ambulance crews moving through an increasingly pressured city.
A growing city cannot respond safely to emergencies if every institution functions in isolation while patients and families are left to solve the gaps alone.
Without a connected system, congestion behaves like a flood. One reservoir overflows while another remains half empty. When one hospital operates at full occupancy while another still has capacity, the city is not functioning as a balanced system.
When hospitals function as a network, diversions to and from emergency departments become strategic rather than desperate. If one facility crosses agreed boarding thresholds, ambulances can be redirected earlier. If a CT scanner fails at one site, stroke capable centres elsewhere can be prioritised. If a surge follows a major road traffic crash, flooding, or other mass casualty event, reinforcement protocols can activate across institutions.
Such actions should follow predefined agreements rather than personal relationships or informal phone calls. When fishermen prepare for a storm, they do not wait until the waves are high before deciding who will secure the nets. They prepare before the wind rises. A city wide escalation protocol is that preparation.
Data sharing requires trust and clarity about how information will be used. Shared information should allow leaders to recognise strain early and respond before crisis develops. If one facility is persistently overwhelmed, support can be directed appropriately.
Private hospitals cannot remain outside this conversation. In many global cities, private facilities play a critical role during public sector surges. Partnership agreements can define payment models, case categories, and transfer protocols. Emergency stabilisation should not depend solely on ownership structure. A life does not know whether the building is public or private.
Governance will determine success. A bed visibility dashboard without clear authority and response protocols will achieve little. Thresholds without enforcement lose meaning. When occupancy crosses agreed levels, coordinated action across the city must follow.
This is not only a technical challenge. It is also a cultural one. Courage will be required to move from isolated autonomy to shared responsibility. Hospitals must shift from saying, my hospital is full, to asking, how does the city respond together. Competition may drive innovation in some domains, but in emergency care collaboration protects lives.
Consider a simple scenario. A man collapses with stroke symptoms. A shared system identifies which stroke capable hospital has CT availability and bed space. The receiving team is alerted early. Time is saved and brain tissue is preserved.
Providing emergency care cannot rely solely on heroics. It must rely on design. If Accra continues to function as isolated hospitals, congestion will persist even when individual facilities improve internally. If it begins to function as a connected metropolitan system, resilience increases without necessarily building new hospitals.
Some will argue that coordination cannot create beds. That may be true. But poor coordination destroys effective capacity. When information is fragmented, time is wasted, and beds appear less available than they truly are.
Accra already possesses many of the essential components of a functioning emergency network. What is missing is the coordination to tie them together.
There should be an agreed city plan. There should be a city emergency care network. There should be a city wide escalation policy supported by real time operational data and clear governance oversight. None of this will be easy. It will require sustained discipline, institutional trust, and leadership willing to maintain coordination even after public attention fades. But if the will exists, this can be achieved. Most importantly, improving coordination across existing hospitals may prove faster, safer, and considerably less expensive than relying solely on building new hospitals to solve the problem.
As the capital, Accra has both responsibility and opportunity. It can build a model of regional emergency care for other cities in Ghana. What is required now is steady leadership and willingness to act together.
If we continue to protect only our own compounds, the city will continue to suffer at the seams. If we protect the network, each hospital will stand stronger. Accra does not need isolated excellence. It needs connected strength.
Before we move on, we must reflect together.
If you work in healthcare, would you support a regional bed visibility system and what obstacles do you foresee?
If you are part of hospital management, would transparent city wide metrics strengthen or threaten your institution?
If you are a member of the public, would you feel safer knowing that emergency capacity across Accra is coordinated in real time?
These questions are not theoretical at all. Reform always depends on honest answers.
In the next article, we step back even further. Coordination is essential, but it rests on a deeper principle. Emergency care must be treated as critical infrastructure. Preparedness cannot be optional or episodic. It must be built into the design of the system.
We now turn to emergency care as infrastructure.
By Dr. George Oduro, FRCS, FRCEM (UK), FGCS
Consultant in Emergency Medicine
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