A turning point for patients in Ghana?

Bribes for medical services can cost lives, but citizens are driving change.

When 16-year-old Abdul Rahmana Shakina collapsed in 2017, her parents rushed her to Ghana’s Tamale Teaching Hospital seeking emergency treatment.

The hospital serves the country’s five northern provinces, so Amama and Jusif hoped for the best available care for their daughter.

Arriving mid-evening, Shakina was diagnosed with acute anaemia and her parents were told she needed an urgent blood transfusion. However, health workers later refused to provide treatment until her parents paid 108 Ghanaian cedi (approximately US$20) for what was supposed to be a free procedure.

With only 20 Ghanaian cedi (US$4) in their pockets, Amama and Jusif begged doctors to give their daughter the transfusion anyway, promising to return the next day to pay the balance. But without the money up front, the doctors refused to act promptly.

Amama lay next to her daughter all night, trying to comfort her. In the morning, hospital staff told Amama to leave while the hospital was cleaned. When she returned, doctors were finally giving Shakina the blood and oxygen she needed — 12 hours after she had arrived.

But it was too late. During the procedure, Shakina died.

Sadly, this is an all-too familiar story in Ghana.

In 2017, the Ghana Integrity Initiative (GII), a chapter of Transparency International, received multiple reports of bribery and extortion at Tamale Teaching Hospital.

Supported by GII’s Advocacy and Legal Advice Centre (ALAC) and other Transparency International ALACs, patients described unofficial charges for services that are supposed to be free under the country’s health insurance service, and medical negligence if bribes weren’t paid.

Those who paid were never given receipts. Unable to afford the illegal fees demanded by hospital staff, some families reluctantly turned to traditional medicine.

GII recognised the complaints as part of a wider picture. According to the latest Global Corruption Barometer (GCB) — Africa, which surveyed more than 47,000 people in 35 African nations about their day-to-day experiences of corruption, 14 per cent of citizens who used public services paid bribes to health care workers in the last year. In Ghana, the bribery rate for health care services is 12 per cent.

GII staff suspected that the complaints about the hospital indicated a bigger problem, and commissioned an investigative journalist to explore the allegations at Tamale. Operating undercover, the reporter videoed medical staff demanding payments for services that should be free, including emergency treatment and maternity care.

The reporter met with families like Shakina’s, who either lost children and other family members to wilful negligence or narrowly escaped a similar fate.

Riding on the back of a motorbike, he joined Alhassan, a frantic father-to-be, on a desperate tour of family and friends in search of money to pay a bribe so his wife could have an emergency caesarean.

While Alhassan managed to scrape together enough money in time, including an additional “ward fee” to see his child after the ba

The investigation uncovered large-scale administrative corruption, including the sale of expired drugs and widespread breaches of procurement rules, diverting hospital funds and undermining service delivery.

Denying knowledge of these abuses, Tamale’s chief executive, Dr. David Akolbila, condemned the culture of corruption and threatened heavy consequences for those who continued to neglect or extort patients. The hospital has since begun investigating several specific corruption cases.

In a documentary aired on Ghana’s Joy TV and radio, patients and their families spoke out about their experiences, and the investigation fuelled public debate in Ghana. As follow-up, GII is working with government health officials to address broader corruption issues affecting Ghana’s health service, while also ensuring hospital managers and health officials at Tamale carry out their promises.

The investigation has already created a ripple effect, deterring health personnel from demanding bribes and encouraging people to speak out against corruption. Our research shows that 60 per cent of Ghanaians believe ordinary people can make a difference in the fight against corruption. GII hopes that investigations like these will spur more people to report corruption when they see it and, by doing so, drive positive change.

This article was written as part of the Global Corruption Barometer 2019 — Africa, the largest, most detailed survey of citizens’ views on corruption and their direct experiences of bribery in Africa.

See the Ghana Integrity Initiative’s two-part Joy TV investigation here: Part 1, Part 2.

GII’s Advocacy and Legal Advice Centre (ALAC) and other Transparency International ALACs provide free and confidential legal advice to witnesses and victims of corruption. With more than 100 offices in more than 60 countries, ALACs provide an accessible, effective way for people to report corrupt and demand action. Learn more at www.transparency.org/reportcorruption.