The warning has been given, by tragedy at home and by corridor care abroad. Our national task is to turn this warning into action. That action must begin with a simple discipline: Ghana must measure emergency pressure before it becomes catastrophe. Without data, it is impossible to know where the failures are, how often they occur, who is affected, and whether conditions are improving or deteriorating. Counting unsafe overcrowding does not solve unsafe crowding, but it turns hidden pressure into visible evidence.
England’s present difficulty should not erase the fact that earlier emergency-care reform in England did produce major improvement. In the early 2000s, long waits in emergency departments were reduced not by targets alone, but by visible data, central direction, clinical engagement, investment and sustained operational discipline.
Ghana cannot simply copy reforms designed for a much richer health service, but it can adapt the lesson: pressure must be measured, thresholds must be clear, clinicians must be involved, leaders must be accountable, and identified problem hospitals must lead to practical support. Done properly, this approach can produce early gains at relatively low cost. Without sustained discipline, even well-intentioned directives may fail to become real reform.
Ghana should know how many admitted patients remain in emergency departments beyond six, twelve, twenty-four, forty-eight and seventy-two hours, and how many wait even longer. We should know how many emergency patients are waiting for hospital ward beds, theatre, imaging, laboratory results, blood, oxygen, specialist review, or discharge decisions. We should know ambulance handover delays, equipment unavailability, and patient deterioration while waiting.
These measurements could begin with teaching hospitals and major referral centres, where congestion is most visible and the consequences are greatest. The goal should not be to overwhelm every facility from the start. The goal should be to build a simple, continuous and useful system that can grow. Data must also be linked to action. Hospitals that fall short should not merely be named and shamed. They should be required, and supported, to improve.
The practical starting point for teaching hospitals and major referral centres is straightforward. Every major hospital should know, at least twice daily, how many patients are in the emergency department, how many have been admitted but not moved, how long each has been waiting, what each patient is waiting for, and who has responsibility for the next decision. This information should not sit passively on a noticeboard or spreadsheet. It should trigger escalation, ward action and executive review.
Daily flow meetings should therefore be decision meetings, not ceremonies for describing congestion. They should identify discharges that can safely happen earlier, delayed investigations that require follow-up, patients awaiting specialist review, transport obstacles, and wards that can receive patients with support. A meeting that describes pressure but cannot move patients is not patient-flow management. It is an audit of helplessness.
Reform must also clarify ownership. A ward can say it has no bed. A unit can say it is full. But declaring that a hospital cannot receive an emergency patient should never be made casually or by the most junior person answering a phone. It should be a serious institutional statement made only by the chief executive, medical director, or designated hospital flow lead after the whole hospital position has been reviewed. A full ward, or even a full emergency department, is not the same as a full hospital. “No bed” must become an accountable hospital-wide decision, not a convenient phrase.
This matters because “No Bed Syndrome” is often a failure of coordination before it becomes a failure of space. A hospital may have patients ready for discharge, elective admissions that can be paused, investigations that can be accelerated, stable patients who can move to step-down care, or to other wards that can accept patients with additional support. When no one owns flow, every department protects itself. The emergency department becomes the buffer, ambulance crews wait, families plead, and the patient carries multiplied risk.
Transfer discipline is another essential reform. Many emergencies do not fail only because the first hospital lacks the capacity to provide definitive care. They fail because movement between hospitals is uncertain, communication is incomplete, acceptance is unclear, and responsibility is not firmly handed over.
Ghana needs enforceable interfacility transfer protocols. Referral should include stabilisation, prior communication, documented acceptance where required, transport arrangements, receiving facility readiness, and feedback after arrival. The aim is not to make transfer bureaucratic. The aim is to prevent transfer from becoming abandonment.
Financing also matters. Emergency care cannot be safe if the first question is payment. Emergency screening, resuscitation, stabilisation, oxygen, essential medicines, urgent imaging, blood products and transfer should not be delayed by upfront payment barriers. The precise financing model can be debated, but the principle should not be negotiable. Life-saving care must come first.
Ghana must also invest deliberately in emergency-care workforce expansion. This includes the Ghana College of Physicians and Surgeons (GCPS), the Ghana College of Nurses and Midwives (GCNM), emergency physicians, emergency nurses, pharmacists, ambulance services, emergency medical technician programmes and prehospital care providers.
Training should reach medical students, house officers, physician assistants, nurses, and all health care staff who may encounter emergencies outside specialist departments. The aim is not to turn everyone into an emergency physician, but to make emergency thinking part of ordinary clinical culture.
National support for ATLS and similar trauma, cardiac, paediatric and emergency life-support courses would strengthen frontline care quickly. Emergency nursing deserves particular emphasis. A crowded emergency department can only remain safe if nurses are trained, supported, supervised and protected from impossible ratios. Emergency physicians matter, but they cannot substitute for skilled triage, observation, timely medication, documentation and early recognition of deterioration.
Prehospital care also belongs in this discussion. Ambulance services, emergency medical technicians and referral communication systems are part of hospital flow. If ambulances arrive without warning, wait without handover, or move patients between hospitals without agreed acceptance, risk travels with the patient. A referral phone that is not answered, a senior decision maker who cannot be reached, a ward that does not respond, or an ambulance crew left waiting without instruction may look administrative. In emergency care, each is a clinical risk that can cost lives.
Regional coordination is equally important. Accra, Kumasi, Tamale, Takoradi, Cape Coast, Ho, Sunyani and other growing urban areas cannot manage emergency care as isolated institutions. Patients, ambulances, disasters and surges cross hospital boundaries.
Regional emergency care coordination centres could track hospital pressure, ambulance availability, critical care capacity, oxygen risk, transfer requests and mass casualty readiness. They could support ambulance routing, distribute patients deliberately, coordinate support between hospitals and alert leaders before pressure becomes collapse.
At some point, reform must move from operational improvement to statutory obligation. The United States Emergency Medical Services Systems Act of 1973 did not appear simply because that country wanted more ambulances. It responded to fragmented emergency care by supporting regional emergency medical services, training, communications, transport, emergency facilities, critical care, patient transfer, disaster planning and system evaluation. Its enduring lesson was that emergency care must be organised as a system, not left as a collection of disconnected ambulances, hospitals and heroic individuals.
In the past couple of decades, Ghana has taken very important steps to improve our system of emergency care. The May 2001 stadium disaster exposed the cost of weak emergency response – and in response the National Ambulance Service (NAS) was started.
The Ghana Emergency Medicine Collaborative helped launch formal emergency physician specialist training and emergency nursing training from 2010. The Ministry of Health produced Accident and Emergency Policy and Guidelines in 2011 and Referral Policy and Guidelines in 2012. Parliament passed the National Ambulance Service Act, 2020, Act 1041. These were major advances.
But ambulance response, training programmes, policy commitments and national directives are necessary, not sufficient. They cannot by themselves solve the problem when receiving hospitals are full, transfers are uncertain, emergency departments are crowded, oxygen is scarce, critical care access is limited and no one has real-time visibility of system pressure. Ghana’s next step is to connect ambulance response to receiving-hospital readiness, emergency department capacity, interfacility transfer, critical care access, financing, data and accountability.
Ghana may therefore need a broader National Emergency Care Systems and Access Act, or similar legislation, to connect the whole chain from first call to definitive care.
Advocates could begin with a technical policy paper, later adopted by government as a green paper for consultation or a white paper for statutory reform. They should build a broad national coalition including the GCPS, the GCNM, the Ghana Health Service, the Ghana Medical Association, emergency physicians, emergency nurses, the NAS, ambulance and prehospital care providers, universities, academic researchers, Civil Society Organisations, patient advocates, affected families, hospitals, legal and policy experts, NHIA, HeFRA, NADMO, Fire Service, Police, the National Road Safety Authority, Parliament and relevant ministries.
Such a law, if passed, should not remain a symbolic declaration. It should require emergency screening and stabilisation without upfront payment, regional emergency care coordination, real-time bed and critical care visibility, enforceable transfer protocols, minimum emergency unit standards, protected financing, workforce credentialing, mortality review, disaster readiness and public reporting. It should make clear what every part of the system must do when time is life.
Operational discipline is necessary, but not sufficient. Money, beds, oxygen, monitors, trolleys, laboratories, imaging, blood, theatres, ICU beds and reliable power all matter. Resources without daily discipline can still fail, and daily discipline without resources will eventually be overwhelmed. Patients and families should not be asked to accept indignity as normal. Nor should they be encouraged to abuse staff who are doing their best under pressure. The public conversation must be firm but fair.
Ghana has fewer reserves, so Ghana must be more deliberate in this effort. The opportunity is to begin with practical measures that are visible, measurable and achievable: count patients, track delays, escalate early, move admitted patients, strengthen emergency teams, train rapidly, support struggling hospitals and learn continuously. Ghana has built an ambulance service. Ghana has introduced emergency medicine and emergency nursing specialties.
Ghana has written Accident and Emergency and Referral Guidelines. Ghana has passed a National Ambulance Service Act. The next task is to build the system that connects ambulance response, emergency expertise and hospital readiness into reliable care for patients who need urgent help.
A senior professor of medicine once remarked that in Ghana, all patients present as emergencies. He may have been stretching the point, but there is truth in the warning. When access is delayed, disease advances. When routine care fails, patients arrive later, sicker and more fragile. That is why emergency care cannot be treated as a marginal service. It is the front door through which the failures and hopes of the whole health system often arrive.
Written by Dr. George Oduro, FRCS, FRCEM (UK), FGCS
Consultant in Emergency Medicine
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