Danaa: Health is wealth.

Our health and wellbeing as a people give us the impetus, zeal and mental fortitude to take part and lead our development drive.

Tonight, we take a look at health seeking behaviours and customer service in our health delivery systems

To help us with the discussion is Mr. Carl Grant, a practitioner and a health advocate.

Carl, Welcome

Carl Grant: Thank you, Sir

Danaa: Interesting and a very opportune time to be talking about health, don’t you think so?

Carl Grant: Yes, Great time and a great opportunity. I always say Health is life with everything else it can have. Thanks for the opportunity

Danaa: Please what is your full appreciation of health care delivery in our institutions today?

Carl Grant: Health care delivery in our institutions, I would say is average. On a scale of 1-10. My choice would be between 5-6; Worldwide, our Health care delivery system is ranked 135th out of 191 WHO member countries. This is based on an assessment of many indicators such as efficiency, distribution, Quality, etc., in effect we are just above the red line.

Danaa: Just above the red line means we are simply not doing well. What has brought us to that red line indicator given the WHO rankings?

Carl Grant: Several factors led us to this point. These include Response systems and low Research and low-efficiency base practices, etc.

Danaa: Very interesting! We would leave the rankings part for another discussion

Carl Grant: Okay.

Danaa: In seeking health care, what are some of the factors that influence the behaviour of people about facilities?

Carl Grant: This varies from person to person and even from place to place.  Bayor would have different factors compared with Adongo. On a lighter not because Adongo eats dog more than Bayor. (I hope no frafra will beat me here) Some of the factors include:

a. Finances

b. Physical access

c. Education

d. Behaviours of Health personnel

e. Cultural practice

They are many of them. We would look at the above. For purposes of understanding Health seeking Behaviours (HSB) refers to the actions or inactions of persons when they are faced with a health problem or when they are ill.

Danaa: Can you take us through the factors above and educate us on how these factors influence people?

Carl Grant: Now every day. You watch TV, go to hospitals and there are appeal for funds to fund Health care. This is the Economics. Finances as in Rising cost of Health care as population changes draw down certain actions or inactions of patients in seeking care, e.g., if Ayor went to clinic today and is asked to buy medicine for Gh₵100 and she doesn’t have it. Next time she is sick; she will try to treat it at home. This is what led to our NHIS establishment even though the scheme is fraud with financial irregularities and funding gaps. So, the amount of riches a person has, have a bearing on the health seeking behaviours of the fellow.  This is why I wish to see a flourishing private Health insurance regime beside the NHIS.

Physical access to health facilities influences Health seeking behaviours- The nearest is the dearest as the adage goes. This also applies to health care. Patients would always choose a facility they can reach as quickly as possible before any other consideration. Physical access is key.

Cultural practices – A way of a people is in a large context a way of their behaviours. Certain cultural practices inhibit persons from seeking health care. e.g. Some of our cultural practices prohibit children from eating eggs else they will become thieves. if a child is anaemic and needs this nutritious diet to improve health-culture will stand on the way

Another heavy weight factor that influences Health seeking behaviours is Education. 

Education- Education permeates everything and health care is not an exception. what people know about their health and the consequences of its failure would always be at the bottom line of whether they will seek care or not. This is why I wish to see Health promotion Education as a key functional department in Ghana Health service.

Lastly, Behaviours of Health personnel. For this I believe many will have personal experiences to share. (I would love to hear them)

Health is Economics. It is like buying and selling. The attitude of the seller determines the number of buyers. if Health care personnel in the value chain puts Customer service at the heart of their care, more people will access care from them. The converse holds true.

In summary Education, culture, physical access, Behaviours of HP, and finances are key influencers if key behaviours.

Danaa: Interesting education I must admit! ow practical can health institutions have a synergy among these factors in an effort towards quality health care delivery?

Carl Grant: Big Question that demands a full debate on its own. Maybe for another day. Well, for us in Ghana, we already have two concepts CHIPs and Universal Health Coverage (UHC) if we were to implement them effectively as the policy designs contain we could practically deal with all the factors that influences Health seeking behaviours. Health institutions can do this by leveraging on technology e.g. telephone usage, community volunteer mechanics etc to design convenience-based care for patients. This with time will do the magic. In simple terms all our policies must be geared towards tilting these behaviours towards the positives. I hope I don’t get medical or theoretical.

Danaa: So, what in your opinion has served as the main albatross in effective implementation as you pointed out?

Carl Grant: Bureaucracy and low acceptance of innovation in the Health care governance structures.

Let’s train people in communities to cause change and allow them effect fluidity into their practices. We seem so much interested in adding on numbers without allowing the numbers do what they supposed to do

Danaa: Convenience as a factor may also be looked at with regards to red tape, bureaucracy and a host of mal-administrative factors. How can government institutions stay competitive in the face of these bottlenecks?

Carl Grant: This is where innovation is central. Convenience is a growing phenomenon. 

This Question is dear to my heart because I work in a government institution. At times you see very simple process you could just pass by to serve patients but the red line won’t let you cross it otherwise you would break no rule but the pride of the “top dog” would be pricked and he won’t allow you operate. The whole problem that is ripe in the government institutions low involvement of innovation. Innovation is stifled in these institutions creating monotonous and glaringly inconvenient systems. If we allow flexibility and innovation in these institutions. Convenience of service will climb higher. People must be trained to innovate not just to add to the numbers. If we are to make progress we must allow innovation to flourish the system. For instance, I have mentor that developed a symptom checker. With the App you can sit at the comfort of your home to consult a doctor and a pharmacist and have your prescribed medications delivered to your door step of course when you pay(😀) but Almost 2 years down the line he is still looking for patent but the service….. No efforts. Maybe we all to turn our eyes on our Health care system

Danaa: On finance, Health insurance still has hiccups from time to time and institutions at times resort to cash-and-carry strategies. With these difficulties, how would the ordinary man not face a dilemma on finance with regards to choose of facility to visit?

(NB: Members can send the questions directly to me as the session progresses)

Carl Grant: I see ordinary people face this dilemma almost on daily basis. Some we have to resort to friends to contribute to fix their situations. This is why issues about Health insurance must be an unending conversation for us.

To tell you the truth, Health insurance is not in good shape right now. Huge funding gaps and lagged payment of debts to service providers. If you ask me I would advise everyone to get an active NHIS. If it does nothing at all, certain services are free on it and it helps reduce the burden that would otherwise have been huge. It deserves attention at least to protect the ordinary man.

My proposal at times to people, never spend all your earnings. Always find a private Health scheme or do group Health scheme. Illness never announce when it will come

Danaa: Succinct! Moving on to Customer service in health care delivery. “Your health, our concern” is the motto of the Ghana health service. How has the service made practical this motto in institutions that take revenue as a priority rather than prioritizing help?

Carl Grant: Averagely. As it is with most of our public institutions; Slogans have always been ahead of the practicalities (This might be harsh but it must be said). The bureaucracy red tape seems so wide and tight and sometimes this delay actions from weeks to months. We can improve this if we allow innovation. Even the revenue we claim to always focus on we miss the targets. If we are to prioritise help, we can always find a way to do so and to get the revenue. When people feel cared or help they will always pay the system. The vice versa but any Health system that prioritizes revenue over help of its people is bound to struggle

Danaa: Indeed, you are so right. According to studies, health outfits that provide excellent health care are likely to have robust processes and systems.

Moving on; Customer service in health care tend to be an end-to-end experience with each step giving the customer an opportunity to evaluate the outfit. In institutions with high populations, how effective do authorities monitor end-to-end points to achieve efficient systems?

Carl Grant: It is a very difficult one. It is the key reason some relatively smaller facilities seem better at service provision than the public institutions. It is a hard thing to do so you would find most of the facilities only conduct annual surveys that end up locked in cupboards or drawers. Some don’t even attempt at all. No feedback! it is that feedback is often ignored or underrated. For me no matter the population the institutions can always find a way of treating each individual as a person. Frequent surveys and public forums will always help them get pass it. But unfortunately, once it doesn’t have immediate cash return few cares. Or it is done only for peer review purposes.

Danaa: Interesting drift! That said, most private entities have employed technology in the value chain of health care delivery by avoiding cumbersome procedures that have to do with paper. Efficiency has become the result, leaving customers with greater satisfaction. Shouldn’t we embrace a total revolution in health care infrastructure and systems to match modern practices and deliver the efficiency that customers relish?

Carl Grant: I agree entirely with this. In short, employing innovation to do the magic of customer service. In recent times there have been efforts from Ghana Health to digitize health services at hospitals and make them paperless system using the GHMIS software from consultation to dispensing of medications. We may have to vigorously pursue this agenda to improve Customer care. I don’t see why regular BP patient without symptoms or any Health complain will have to trek miles to go for refill of routine drugs. When it can be delivered and Bp monitored at home. We must employ all available technology to ease the systems and provide prompt services to our people. That’s allowing innovation grow in the service.

Danaa: Allowing innovations to grow it is. In restaurants and banks, personnel are effectively monitored to deliver on customer care. How effective are customer care codes applied among personnel in health care delivery systems, especially in the era of smart phones and social media addictions?

Carl Grant: It is effective more in the private facilities than our public institutions. The underlying reasons poor tracking systems and loose monitoring systems. In fact, it is one if the areas affecting Customer service

Danaa: COVID 19, a vaccine not yet in sight and infected numbers are on a high side worldwide. Apart from the safety protocols, how relevant has our health institutions been in carrying out mitigating measures on the spread and havoc of COVID 19?

Carl Grant: Our Health institutions have been very relevant in treating, coordinating and training of other officials on the pandemic.  And they will be needed every step of the way until COVID 19 is eradicated. Most of them innovatively created departments to contain the COVID 19 cases, some manufactured hand sanitizers to support the fight and as you may have read recently the breakthrough genome identification by Noguchi and the yet to come into force, RDT test kits by KNUST etc with more funding and support these facilities can help us out of the woods.

Questions from READERS..

AZIZ DAUD: If one suffers an injury as a result of negligence of a health care professional what remedies exist for redress? And how can one access such remedies?

Carl Grant: The remedies come in two folds; 1. Institutional- The hospital where the professional works. He or she will be taken though the GHS code of conducts and if found guilty would be punished accordingly. 2. Legal. Negligence is a crime punishable by law under criminal codes of conduct. You can pursue both as separate or one to follow the other.

Dr. Siddique: Thank you for the education on this important subject. From all the troubles you people are confronted with, would you say that the Ghana health service is fit for purpose? Is it possible that your share vision from the bottom to cause change?

Dr. Elias: How do we ensure that men and women have equal access to quality health care?

How do we ensure that men seek health care early, and not behave culturally as ‘men’.

Carl Grant: Thank you for the Question.

Like I have said before our system is just above the red line. For me, I prefer being calmly disruptive using Education to throw light on all aspects of Health care. This can engineer change from bottom.

Family and community care concepts would aid in this regard. If we make we get to a point families seek care together and with each other they will serve as checks to keep both genders afloat in health care

Danaa: It has been a worthwhile encounter! Thanks, so much Carl, we would surely make time again to talk more about health. Thanks so much.

Carl Grant: I am humbled Sir. Thank you very much for the opportunity.

Danaa: Good night to all