Tema General Hospital (TGH) was constructed in 1954 to provide health services for workers who constructed the Tema Harbour. Like other metropolises in Ghana, Tema, which is the industrial hub of the country, faces numerous quality health delivery challenges despite efforts by successive governments to improve the sector.
Map of Ghana with Tema Highlighted
Catchment Area and Services
The catchment area of the hospital includes the whole of the Tema metropolis, its surrounding towns and villages, Sakumono, Lashibi, Nungua, Dangme West, and Dangme East districts. TGH has departments which include internal medicine, general surgery, pediatrics, theatre, obstetrics and gynecological care as well as accident and emergency services among others.
TGH supporting services are laboratory, blood bank, radiology, ultrasound scan, pharmacy, and physiotherapy. The hospital also supports services such as laboratory, blood bank, radiology, ultrasound scan, pharmacy, and physiotherapy.
Challenges Faced by Tema General Hospital
Reducing Maternal and Infant Mortality in Ghana
The Medical Superintendent mentioned several challenges the hospital faces:
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- Lack of accommodation for staff
- Insufficient staff of all categories
- Poor infrastructure which has major structural defects such as cracks and major leakages in the roof
- Inadequate security personnel since most of the permanent security guards have retired leaving a few casuals
- Failure of the National Health Insurance Authority (NHIA) to recognize the complexity of providing services in a metropolitan hospital like the TGH
- Delays in the re-imbursement of submitted claims by the various mutual schemes under the NHIS, making it difficult for the implementation of budgeted programs and policies
A tour of the hospital by the sector Minister showed that conditions at the OPD were not favorable for patients as the place is always dark and hot due to the low ceiling of the building. The maternity ward also lacks enough beds. Two or three mothers with babies have to share one bed while those in labor sit on benches waiting for some of their colleagues to be discharged.
Looking at the inadequate doctors at the hospital, the Minister further stated that his ministry would consider distributing medical doctors evenly to all the government hospitals as concentration has been on Korle Bu Teaching and Komfo Anokye hospitals.
Internally Generated Funds (IGF) and Government Support
The paper assesses the impact of Internally Generated Funds (IGF) on Public Hospitals Operations and the adequacy of these funds in support of Healthcare Delivery Figures. Total IGF revenue at Tema General Hospital for the period under review shows that services contributed 22% in 2011 and 30%. The hospital has been the second larger contributor to IGF revenue.
Expenses incurred in generating revenue internally amounted to 4,2 IGF Expenditure. Personnel emoluments accounted for 6%, 5% and 6% of IGF. Revenue generated internally at TGH supports the Government of Ghana subventions (GoG). The amount of Government of Ghana (GoG) subvention to TGH has generally been increasing over the period, thus supporting the hospital’s IGF.
Revenue from GoG in 2011 and 2012 happens to be the highest as against that. A comparative analysis of total expenditure for the period 2011 to 2013 revealed that total expenditure increased by 22%. However, in 2013 total expenditure fell by 21.9%. There aren't any major investment projects due to lack of funds.
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All the major investment activities at the hospital are paid for directly by government.
Many Low-income countries depend on development assistance for health (DAH) to finance the health sector. Since the early 2000s, Ghana has seen an improvement in general health outcomes, partly due to global efforts such as the Millennium Development Goals and Sustainable Development Goals. However, the country continues to experience a double burden of diseases, with an increase in non-communicable diseases.
Ghana's Transition to Middle-Income Status and Its Implications
Since Ghana transitioned to a middle-income status in 2010, however, Gross Domestic Product (GDP) per capita has been on an upward trend and is estimated at USD 2,200 per capita in 2019. In 2010, 15 donors provided an estimated US$300 million in aid to Ghana, with Family Planning, HIV/AIDS, immunization, malaria, tuberculosis and Community Based Health Planning and Services (CHPS) programs receiving the largest share.
External funds from all donors comprised 20% of total health expenditure between 2012 and 2017. Donor agencies like DANIDA have ended direct budget support, and the country is projected to graduate from Gavi, the vaccine alliance in about 2025. A central concern during this transition is how to sustain public health interventions such as immunizations, family planning, HIV, tuberculosis and malaria programs which are heavily donor funded.
The transition from donor aid to self-financing may influence the provision of essential public health services funded or co-funded by support. Public health achievements attained by beneficiary countries seem to be at risk unless the donor aid transition is well planned and executed.
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The perspectives of frontline health workers on DAH transition is crucial for national level planning, since they serve as interface with clients and would better appreciate the impact of transition on service delivery.
Frontline Health Workers' Views on Donor Aid Transition
Frontline health workers perceived donor aid transition as a shift from development partner funding of public health programs to self-financing by the Government. Many of the participants seemed unaware that there is an on-going transition from DAH in the health sector.
On Ghana’s readiness towards donor aid transition, all the participants perceived that Ghana was not adequately prepared to transition from receiving DAH. In their view, most of the public health programs are largely donor funded and even those with major government funding have complementary support from donors. Thus, the possibility of successfully moving away from receiving aid may take a while to be effective.
Challenges Due to Donor Transitions
The study participants indicated that the country will likely face challenges both at the facility and national level because of donor transitions. The challenges identified were categorized into financial, human resource, logistics and medicines, and challenges with monitoring and evaluation.
Majority of the participants perceived that there will be challenges in terms of human resource allocation in the facilities as a result of donor transition. Exiting may result in a reduction in human resources available for the interventions.
When it comes to immunizations and vaccinations, one challenge is that we run out even presently of weighing cards for popu...
Predictors of Stillbirth at Tema General Hospital in 2019
In 2015, the global incidence of stillbirths reached 2.6 million, equating to more than 7,178 deaths daily. The stillbirth rate in Ghana during this period was recorded at 22.7 per 1,000 births. This study therefore determined the predictors of stillbirth in a Ghanaian referral hospital.
We conducted a facility-based 1:1 unmatched case-control study comparing data of women who had stillbirths to those who had live births at the Tema General Hospital in 2019. Data were obtained from the hospital records using a data extraction form that was specifically designed for this purpose.
Of 552 mothers included in the study, the mean age of mothers with and without stillbirths was 31.4 (SD ± 6.1) years, and 28.8 (SD ± 6.0) years respectively. We identified Mothers aged 40 years and older [aOR = 5.5; (95% CI 1.1-26.9)], Maternal employment [aOR = 2.5; (95% CI = 1.2-5.3)], Caesarean section [aOR = 1.9; (95% CI = 1.2-2.9)], Infants with low birth weight [aOR = 8.7; (95% CI = 5.2- 14.7)], Hypertensive mothers [aOR = 1.9; (95% CI = 1.2-2.8)] to significantly increased likelihood of stillbirth. Primary education [aOR = 0.4; (95% CI = 0.2-0.8)], Tertiary education [aOR = 0.2; (95% CI = 0.1-0.5)], Mothers who attended four or more antenatal care (ANC) [aOR = 0.6; (95% CI = 0.3-0.9)] significantly lower odds of experiencing stillbirth.
Stillbirth refers to the birth of a baby who has no signs of life at or after 28 weeks of gestation with a birth weight of ≥ 1000 g or a body length of ≥ 35 cm. Stillbirth rate is an indicator that reflects the inadequacies of antenatal and intrapartum care in an institution, region, or nation [1, 2]. The major causes of stillbirth include birth complications, post-term pregnancy, fetal growth restriction, congenital anomalies, maternal infections in pregnancy such as malaria, syphilis, and HIV, and maternal disorders such as hypertension and diabetes [13].
In 2019, an estimated 2 million babies were stillborn at 28 weeks or more of gestation globally, with a global stillbirth rate of 13.9 stillbirths per 1,000 total births.
As the largest public health facility in this metropolitan area, Tema General Hospital is a primary referral center for numerous clinics and hospitals in its catchment area.
The study population comprised all births that occurred and were recorded in the delivery register of the Tema General Hospital from January to December 2019.
The dependent variable in this study was birth outcome. This refers to whether the woman had a stillbirth or a live birth. Stillbirth for this study was defined as a baby having no signs of life at or after 28 weeks of gestation with a birth weight of ≥ 1000 g, or a body length of ≥ 35 cm. It is a binary categorical variable that was coded as “0” for babies born alive and “1” for babies born still.
The independent variables in this study encompassed socio-demographic, obstetric, maternal medical, and fetal factors.
We analyzed the data using STATA statistical software version 15. Descriptive statistical analyses, which included frequencies and percentage distributions, were done to describe the characteristics of study respondents.
The average age of mothers with stillbirths was 31.4 (± 6.1) years, and this was higher than those with live births, 28.8 (± 6.0) years. Most of the mothers also had some form of education, with 21.4% of mothers with stillbirths having no formal education compared to 8.3% (23/276) of the mothers with live births.
Fathers of the babies who were stillborn had a higher mean age of 37.2 (± 6.8) compared to those with livebirths of 35.2 (± 6.6). Almost all the fathers have had some formal education except for only one of the fathers of the stillborn babies. The level of unemployment among fathers was generally very low in both groups.
Whilst majority 62.5% of all the mothers had three or more pregnancies, the stillbirth mothers 66.3% were slightly more compared to those with live births 58.7%.
Table 2 indicates that the number of pregnancies ever carried, and children ever born by all the mothers seems to be generally evenly distributed.
Table 1: Parental sociodemographic characteristics
Table 2: Mothers’ obstetric characteristics
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