Public Health, Healthcare Quality and Patient Safety Practitioner, Augustine Kumah, has argued that Ghana’s challenges in delivering quality, affordable healthcare stem not from flawed policy design, but from persistent execution failures, particularly around staffing, financing discipline and the placement of trained health workers where they are most needed.
In an analysis of the major barriers currently undermining access to quality healthcare in Ghana, Kumah outlined the key structural weaknesses in the system, while proposing a set of priority interventions government must pursue to strengthen the Community-Based Health Planning and Services (CHPS) system and relieve mounting pressure on the country’s hospitals.
According to Kumah, the National Health Insurance Scheme (NHIS) fundamentally transformed healthcare access when it replaced the “cash-and-carry” system in 2003, yet significant affordability gaps have remained, including benefit-package exclusions, non-covered medicines and informal charges levied at the point of service.
He highlighted the uncapping of the NHIS in 2025 as the most significant recent policy shift, noting that government says this move has restored prompt claims payment and lifted active membership from roughly 18 million to over 20 million people, close to 60 percent of the national population.
While describing this as genuinely significant progress, Kumah cautioned that sustained attention is needed to ensure funds continue flowing and that the depth, not just the breadth, of coverage improves over time.
Workforce Paradox at the Heart of The Crisis
Among the challenges identified, Kumah singled out what he termed the “workforce paradox” as perhaps the most damning issue facing the health sector.
He described a troubling coexistence of brain drain, with nurses, doctors and radiographers emigrating abroad, alongside skilled nurses sitting unemployed locally due to delays in financial clearance and posting, with inducted pharmacists similarly left waiting for deployment.
“We train the workforce, then fail to place it where the shortage is,”
Mr. Kumah
Geographic, Quality and Information Barriers
Beyond financing and workforce issues, Kumah pointed to geographic and physical barriers, including poor roads, long travel distances and unreliable emergency transport, describing the so-called “no bed syndrome” at referral facilities as a real and deadly failure of patient flow within the system.
He further noted that provider attitudes, long waiting times and medicine stockouts continue to drive patients toward late presentation or bypassing of primary care altogether, ultimately raising both the clinical severity and financial cost of eventual treatment.
Demand-side factors, including health literacy gaps, cultural beliefs and weak data systems, were also cited as barriers complicating efforts to reach underserved populations effectively.
CHPS as The Gatekeeper to Hospital Decongestion
Turning to solutions, Kumah argued that strengthening CHPS represents the most direct route to relieving pressure on hospitals, describing the underlying logic as a gatekeeper principle, where a credible and functional primary care layer prevents most conditions from ever reaching a district hospital in the first place.
He called for CHPS compounds to be fully staffed and equipped at a minimum with a midwife and a Community Health Nurse per zone, alongside reliable power, water, cold chain capacity, and basic diagnostic tools such as rapid diagnostic tests, blood pressure machines and glucometers.
He also stressed the importance of formalising the position of Community Health Volunteers, whose unpaid status continues to drive attrition from the system.
Kumah further cautioned against expanding screening programmes for non-communicable diseases such as hypertension and diabetes without a corresponding treatment and medicines pathway in place.
“Screening without a treatment and medicines pathway is a trap, you detect thousands of hypertensives without the medication or follow-up to manage them, and you generate demand you cannot meet while losing public trust,”
Mr. Kumah
Seven Priority Interventions for Government
Kumah outlined seven key interventions he believes government should prioritise, beginning with clearing the backlog of trained but unemployed health workers and posting them to underserved districts with appropriate incentives.
He further called for consolidating gains from the NHIS uncapping, securing dedicated financing for the Free Primary Healthcare programme, guaranteeing essential inputs at the community level, strengthening referral and emergency systems, institutionalising the preventive and NCD care shift, and improving governance, data systems and accountability across the sector.
Kumah concluded that Ghana’s core health system frameworks, including CHPS, the NHIS and the newly rolled-out Free Primary Healthcare Programme, remain sound in their underlying design.
What has been missing, he argued, is the discipline required to staff the front line, protect financing streams, and deploy the country’s trained health workforce to where it is needed most, describing the current reform window as a rare opportunity that must be matched by concrete action on the ground to be fully realised.
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