• KWAKU ANYIMADU

TOPIC: The factors that affect mortality rate and the provision of medical care, laying emphasis on how a reduction in mortality rate ensures provision of quality health care

ABSTRACT

The nation Ghana, like many African countries, agreed to the millennium development goal derived from the 2000 UN Millennium Declaration and has, in fact, made giant steps towards achieving a number of them. Efforts have been made in the field of education and poverty but much more work is to be done in areas relating to health. Infant, child and maternal mortality has increased over the year despite the rapid increase in knowledge and technology. The average number of resources available in the country for the betterment of the health sector is relatively low compared to that of the European countries. Less effort has been put in place in an attempt to salvage the situation. The number of infrastructure available to provide health care services is beyond minimal, the human resource is comparably low , and moderate attention is given to areas relating to public health and also quality healthcare delivery.

Most economies including the highly developed nations have tried various ways to formulate policies which will benefit all citizens. All these intervention is done so as to try reduce the incidence of high mortality rate. This should be taken seriously so as to provide a strong and healthy population which will take part in productivity and also increase life expectancy.

INTRODUCTION

According to Karl Evang M.D, medical care is the term given to the medical attendance provided to patients by general practitioners and practicing specialists in hospitals with outpatient departments, laboratory services for diagnostic and therapeutic purposes, maternity care, provision of drugs, physical therapy, prostheses, transportation.¹ This care provided to patients by mostly doctors and nurses ensures quality of health service provision and reduces mortality rate. This care an aspect of general health care is provided by especially doctors in their service. Other auxiliary health care provider’s optometrist, laboratory technician etc. all has a quota to contribute to the overall health care provision. This health care system can be grouped into primary system, which is the first point of consultation for patient, secondary which involves employing the services of specialists such as urologist and cardiologist and Tertiary which involves specialized consultative health system. There is the last group; the quaternary system which is often used in advance the levels of medicine. All these groups of medical care work toward improving the quality of medical care and reducing the rate of mortality.

Mortality rate has been on the increase over the past decade, because of a setback in the provision of quality medical care. This set back is due to negligence on the part of health care providers, administrators and shareholders of health care which include the government and also citizens. Mortality rate, many African countries will pay less attention to is the index that defines the average number of death within a defined time frame and also population.This index is only possible by the existence of certain factors, which contribute to ensuring reduction in mortality rate. Mortality rate is contributed to child mortality rate, access to health care facilities, maternal death rate and low birth rate, death due to tuberculosis, death due to HIV, availability of sustainable drinking of water. Another factor which affects mortality rate, especially in Ghana, is the occurrence of diseases such as malaria, tuberculosis, hepatitis, HIV/AIDS, cancer, cardiovascular diseases, kidney diseases and diabetes. Also mortality rate is also affected by environmental factors and genetic changes in a newly formed baby. If not detected early the child dies at a very tender age.

Due to the importance of quality health care provision much effort is being put in place to reduce mortality rate. Many counties, including the Europeans, from the latter part of the 19^th century continue to experiment various ways in order to come out with a life changing health care policy all in an attempt to reduce mortality rate. Many different health care policies have been put in place to regulate the financial aspect of health care provision, legal aspect of health care provision, special treatment to target groups such as mothers attending pre-natal and post-natal heath care services, payment of healthcare practitioners, making health care institutions easily accessible, upgrading the material and human resources, ensuring security of patient data and for easy communication between healthcare providers. In Ghana, the mortality rate in the year 2012 was 7.7 for any 1000 deaths with a life expectancy of 55.²if proper health care provisions are sought for the mortality rate may further reduce and the life expectancy moved further. Other countries such as Bulgaria have the highest record of mortality rate in the Europe.³

Because of the importance associated with keeping a low mortality rate, which also indirectly affects providing quality medical care, this essay seeks to discuss the factors that affect mortality rate and the provision of medical care, laying emphasis on how a reduction in mortality rate ensures provision of quality health care? Also, at the end discussion, I would have identified the problems that prevent the above mentioned goals from being achieved and suggest ways in which the millennium development goal concerning health can be realized.

BODY

Factors that affect good medical care

Quality medical care is of great importance to ensure safety of people who decide to seek proper medical care. For this reason many countries as part of their total budget for the year inculcate in it an appreciable amount of money which is to be used in the health sector. Right from the 19^th century, after the Second World War, many countries including the undeveloped countries try to formulate various policies to provide quality health care to its citizens. Taking Ghana for example, under the leadership of Jerry John Rawlings, the cash and carry system (1990) was introduced to replace the fee for service system(1985). This system, however, was later abolished due to problems associated with it. By 1990 clinical attendance had dropped markedly to about 25% because of the inconsistent in pricing of prescriptions and over prescription.⁷this scheme was later on replaced by the national health insurance. In other nations, other policy programs were implemented such as the sickness insurance policy which was first initiated in Eastern Europe but was later abolished and also the Obama healthcare Bill. In Africa, specifically Ghana,the National Health Insurance Scheme was implemented to regulate the financing of healthcare. These policies are to ensure that equal health service is provided to both the rich and the poor and if considered which must seriousness can have a huge impact in quality medical care.Also target groups within the society have been provided with special healthcare packages. Various companies decide to cater for the charges of acquisition of health care for their staff. In Ghana, maternal mothers have been provided with the ability to acquire and enjoy pre-natal care and post-natal care all in an attempt to ensure quality medical care.

The work of practitioners is regulated because of illegal practice and also controls negligence amongst doctors, nurses and other healthcare providers. The lives of people rest in the hands of these practitioners hence their activity should be religiously regulated. For this to happen various countries have enacted laws that regulate practice even in the private sectors. The mental health bill, the abortion law and the also the Hippocratic oaths are all a set of rules and regulation, governing the practice of medicine. Doctors are required to recite the rules outlined and also allowing these bills and oaths guide our practice. All these bills and laws are being formulated to ensure quality of healthcare by regulating their practice. Also other laws are to make practitioners comfortable enough to perform their duties.This comfort gives them the motivation to pour their heart out in their practice in an attempt to reduce mortality rate.

In another aspect of healthcare provision, the subject has been expanded to various fields such as public health and community nurses. Healthcare provision does not rely on just the providers but those receiving this care have a role to play in order to synergistically ensure quality healthcare. These people have a special role to play in this system since they go as far as the rural areas, educating them on the need to keep a safe environment and ensure long and quality lives. In the Acheson’s report, public health is the science and the art of preventing disease, prolonging life and promoting health through organized effort of the society.^9-12Based on this, we can say that public health helps practitioners to understand the causes of certain diseases due to community lifestyle and culture. Continues education to the less deprived areas reduces the incidence of mortality rate.

Also ensuring quality medical care in an attempt to reduce mortality rate is also possible if there is the availability of various healthcare institutions, equipment and also adequate human resource. Ghana has failed to reach the millennium development goal, although the government has been able to deal with poverty, hunger and also education to some aspect. Outside the cities the average number of people per healthcare infrastructure is not acceptable. Our equipment’s have been concentrated in just the cities but it should be extended to the rural areas also. A typical example which shows the regional distribution of hospitals in the upper west region of Ghana usingin 10 different towns is tabulated below.

Health Facilities – Upper West Region

SOURCE:http://www.ghanahealthservice.org/upperwestregion

If the millennium development goal is to be achieved in ensuring quality healthcare, healthcare institutions should be easily accessible in such deprived areas. When made easily accessible, number of avoidable deaths decreases and the overall mortality rate reduces. As effort is being made to improve healthcare infrastructure another area to be considered is increasing the human resource available in the healthcare system. Many modern medical facilities exist in Ghana, but these are not evenly distributed across the country. Ministry of Health figures for 1990 showed that there were 18,477 beds for the estimated national population of 15 million. According to the World Bank figures, in 1965 the doctor-patient ratio was one to every 13,740 patients in Ghana. The ratio increased to one to 20,460 in 1989. In neighboring Togo, the doctor-to-patient ratio of one to 23,240 in 1965 improved to one to 8,700 in 1989; it was one to 29,530 in 1965 and one to 6,160 in 1989 for Nigeria, whereas in Burkina, the ratio of one to 73,960 in 1965 worsened to one to 265,250 in 1989. These figures show that while the doctor-patient ratio in Ghana gradually became less favorable, the ratio in neighboring countries, with the exception of Burkina, was rapidly improving. This calls for an immediate look in this area to help reach the standard we want to achieve. ¹³Having highlighted on some areas which needs to be looked at in an attempt to providing quality medical care, we will turn our focus to how mortality rate has been on the rise due to failure in providing good healthcare.

Mortality rate and relationship with medical care Mortality rate is less considered in the African diaspora. The World Health Organization (WHO) in reference to Checchi and Roberts (2005) defines mortality rate as the number of deaths occurring in a given population at risk during a specified time period. This period is also known as the recall period). In special emergencies, the number of deaths is expressed as 10000 persons in a day or deaths per 1000 persons in a month or year. ¹⁴Ghana focuses mostly on the first and second millennium goal relating to poverty, hunger and education. But others relating to health have been sidelined which include infant mortality rate and maternal mortality- in fact circumstances for expecting mothers have worsened toward the end of the past decade. Even in the 21^st century where technology has risen to higher levels most Africans still die to Malaria, HIV/AIDs and other deaths caused by diseases. All these deaths which are avoidable come about due to the poor quality of medical care provided to citizens and also negligence in the part of the healthcare practitioners.In 2010 it was recorded by the World Bank that out of a 1000 live births in Ghana 50 dies. However in countries such as Portugal and the Republic of Czech the infant mortality rate recorded is 5 deaths per 1000 live birth.¹⁵ This rates confirms the work that needs to be done. As mortality rate is increasing in Africa that of Europe and other developed nations is decreasing with an increase in life expectancy.

If quality of healthcare is provided, mortality rate can be reduced and also safety and trust in the part of patients is assured. Also,an extension in the life expectancy age and an improvement in productivity is assured if this sector is paid much attention. The result is reflected in the decline in infant mortality from 120 per 1,000 live births in 1965 to 86 per 1,000 live births in 1989, and a rate of overall life expectancy that increased from an average of forty-four years in 1970 to fifty-six years in 1993.¹⁶

It is easier said when it comes to the ways in which quality health care and a reduction in mortality rate can be provided but difficult to implement. In most cases the reasons why these policies fail to be implemented is due to political reasons.Each government in Ghana fails to meet this goal set because of different political differences. Every new government which comes has a different way to improve the healthcare system and at the long run inconsistency results in failure. Also poverty and hunger is another reason why this happens. The financial quota pushed into the health care system is not encouraging due to the poor economic status of the country. Lastly another reason is the old fashioned mentally of Ghanaians due to their illiteracy level results in failure to achieve this goal.

CONCLUSION Africa, unlike the Europeans has suffered a major setback in their progress in development. In other sectors, other health, the level of damage due to this state of underdevelopment is not that much. The most vibrant of the population die premature when there is a solution to those reasons. To be able to achieve the millennium development goal, effort to improve the health sector must be hastened so that quality medical care is enhanced.

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