Observations made on Regulatory Agencies
Inadequate funding, inadequate staff and inadequate logistics
The Committee observed that most of the regulatory agencies under the Ministry of Health could not meet their revenue targets in 2016 mainly because of inadequate funding, inadequate staff and inadequate logistics. The total revenue targets of all the regulatory agencies in 2016, amounted to GH¢115,902,000; but GH¢77,077,000 constituting 66.5 per cent was realised.
With a total staff strength of about 83 and with 2 pharmacists in each of the ten Regions to monitor about 10,000 over-the- counter medicine practitioners and huge number of pharmacists across the country, the Pharmacy Council was able to realise an amount of GH¢4,549,000 (63.6%) as against its target of GH¢7,155,000, leaving a shortfall of GH¢2,606,000. Staff of the Council include people on contract who are paid with some of the revenue it generates and this is estimated to be about
Payment of this amount is however going to be difficult for the Council because it would now be required to retain 66 per cent of the funds it generates instead of 100 per cent previously, due to the rationalisation and harmonisation of Internally Generated Funds (IGF) by the capping policy. The reduction in the IGF retention rate applies to all the agencies under the Ministry.
The Committee also observed that the Food and Drugs Authority (FDA), which has inadequate staff to undertake its activities including nationwide product monitoring and surveillance activities, also
has had to grapple with high cost of enforcement and high cost of reagents and equipment for its laboratory. The FDA would even be required to retain a lower rate of 33 per cent instead of its previous 50 per cent of its IGF.
The Ghana College of Pharmacists also has only 5 staff and all are on secondment. The College sought the assistance of the Public Services Commission as regard its staffing issue and therefore budgeted for recruitment in 2016. Unfortunately, it had no financial clearance and so the matter is still being pursued.
The Committee anticipates that the reduction in the IGF retention rate will have adverse impact on regulatory agencies like the Nursing and Midwifery Council (NMC) and the Medical and Dental Council that conduct examinations and engage examiners, since the chunk of their revenue is obtained from the registration fees they collect.
The NMC which has inadequate vehicles for supervision has not received anything for Goods and Services and Assets for the past 5 years. The NMC, unlike the other regulatory agencies, was fortunate to receive financial clearance for the recruitment of 58 new staff including its Deputy Registrar for operations but still has inadequate staff at the top management level.
The Ghana Psychological Council has only 2 staff, with one on National Service, instead of its requisite number of 41. The Council budgeted for an amount of GH¢844,000 for compensation from GoG to enable it recruit more staff but it got nothing. The story remains the same every year.
The Traditional Medicine Practice Council (TMPC) has since its establishment in 2000, received financial clearance to employ only 12 staff. The
Council in the circumstance, largely operates with contract staff paid from its IGF. The Council has no vehicle for monitoring and no funds for the review of the essential traditional medicine list.
Office accommodation challenges
The Committee also observed that most of the regulatory agencies had office accommodation challenges. The Medical and Dental Council is a prime example with the heavy traffic and the inconveniences that one has to go through before getting into its building. According to the Council, this phenomenon is affecting the patronage of their services.
The Traditional Medicine Practice Council currently occupies 3 rooms at the Ministry of Health Headquarters and has also been allocated 5 offices at the old Nursing and Midwifery Council Building at the Seashore. Unfortunately however, the Committee was informed that the old site at the shore has been earmarked for demolishing to pave way for a tourism project soon to begin.
The Mental Health Authority has office accommodation problems and relies heavily on DFID funding which does not support its operational needs. The Authority also needs financial clearance for recruitment.
Non-existence of legislative instrument for the health professions regulatory bodies act, 2013 (Act 857) and other laws
The Committee observed that there is no Legislative Instrument to allow for the full implementation of the Health Professions Regulatory Bodies Act, 2013, (Act 857) to enable the regulatory bodies discharge their mandate effectively.
The non-existence of the Traditional and Alternative Medicine Bill did not also enable the Traditional Medicine Practice Council to fully discharge its mandate.
Observations made on subvented agencies
Inadequate funding, inadequate staff and inadequate logistics
The Committee observed that the subvented agencies which also had funding, staffing and logistical challenges will not be spared by the capping policy. The Centre for Scientific Research into Plant Medicine, which had no allocation for Goods and Services from GoG, will be required to retain only 34 per cent of the revenue it generates and this will impact adversely on its research activities. Staff at the Centre, particularly those with PhDs, leave for greener pastures elsewhere and for this reason, there is the need to replace them.
However, for almost five years, the Centre has not hired staff as to make up for those who leave and this is a major problem. It was therefore gratifying to note that, though the Centre requested for an amount of GH¢6,227,820 for Employee Compensation from GoG, it has been allocated an amount of GH¢10,253,247 which is GH¢4,025,427 more. The Centre can therefore take advantage of the increment to hire workers. The Centre also lacks essential and basic modern equipment such as spectrophotometers and microscopes.
The Vice Rector position of the Ghana College of Physicians and Surgeons is vacant and the College has only 17 full time staff with 7 on secondment and 4 on contract. The Ghana College of Nurses and Midwives also needs more highly skilled specialist nurses and midwives to assist in the delivering of its curricula. The Ghana College of Nurses and Midwives
also had no allocation for Goods and Services from GoG.
The fleet of cars for the National Ambulance Service are inadequate, they are over-aged and breakdown frequently. The Service also lacks utility vehicles for monitoring and performing other official activities.
Office accommodation challenges
The Committee further observed that most of the subvented agencies had office accommodation challenges just like the regulatory agencies. The Centre for Plant Medicine Research has not had any building of its own since its establishment and as a result, its research laboratories are in makeshift structures.
The Ghana College of Pharmacists has no permanent office and operates in a rented accommodation. Due to lack of funds, the college was unable to pay its rent when it expired in 2015. For this reason, in February 2017, it was asked to vacate the premises.
The College now operates from a structure opposite the one it vacated from. The National Ambulance Service Training School also has accommodation problems.
The Ghana College of Nurses and Midwives is in dire need of a permanent site. Where it operates currently is rented and the building is not even spacious to accommodate new staff, should they be given financial clearance to recruit. The College also fears losing its Annex at the old premises of the Nursing and Midwifery Council to the incoming tourist investor.
Observations made on Teaching Hospitals
Inadequate funding, inadequate specialised staff and inadequate logistics
The Committee observed that all the teaching hospitals have challenges relating to funding, specialised staffing and logistics. The Korle-Bu Teaching Hospital has inadequate clinical staff, particularly, specialised nurses and the Tamale Teaching Hospital has inadequate medical doctors, particularly in the sub- specialty areas.
The Committee was informed that the problem of funding of the hospitals was partly due to delay in the payment of claims by the National Health Insurance Authority (NHIA), unrealistic NHIS tarrifs and revenue losses due to the use of manual processes in their billing system. The Committee noted that, the NHIA had not settled its financial obligation (GH¢11 m) to Korle-Bu for about 10 months and for this reason, the Hospital was surviving on suppliers credit. Also, the Authority as at March, 2017, owed the Cape Coast Teaching Hospital an amount of GH¢1,129,367.86.
The total indebtedness of the NHIA to service providers in respect of claims as at the end of December, 2016 was GH¢844 million. The Authority however, explained that the non-settlement of its financial obligation was partly because an amount of GH¢755.18 million owed by Government in 2016, had not been paid.
The GH¢755.18 million represents the difference between GH¢1,497.28 billion which is the Budget Allocation of the Authority from GoG in 2016 and an amount of GH¢742.1 million that it actually received for the period.
Shortage of clinical oxygen, outmoded structures, inadequate equipment and outmoded equipment
The Committee also observed that all the 3 Teaching Hospitals - Korle-Bu, Komfo Anokye and Cape Coast - experience frequent shortages in clinical oxygen and have inadequate and outmoded structures and inadequate equipment including oxygen plants, power generators and laundry machines. Korle-Bu Teaching Hospital is now trying to procure smaller satellite clinical oxygen apparatus instead of the big ones to contend with the situation. The Tamale Teaching Hospital does not have a clinical oxygen plant and so has for some time now been buying its clinical oxygen from Kumasi at a very high cost.
There is congestion, especially at the maternity and accident wards of Korle-Bu and maternity and children's wards of Komfo Anokye Teaching Hospitals. The Korle-Bu Teaching Hospital has old structures and equipment and old sewage systems while the Tamale Teaching Hospital has inadequate essential equipment at some of its Departments. The Cape Coast Hospital in addition to the other challenges aforementioned, have serious problems with encroachment on its land.
Observation on budgetary allocation for goods and services
As already mentioned, most of the agencies under the Ministry of Health including the Mental Health Authority, the Ghana College of Nurses and Midwives and the Ghana Psychological Council received nothing for Goods and Services from GoG and as such could not undertake some of its activities in 2016. This was a result of the meagre amount of GH¢3,646,660 to the whole Ministry for