Last Friday evening, I joined the Ghana Connect Show panel on Joy FM via Zoom. In the course of the discussion, a fellow panellist, a working paramedic, said something on national radio that should have stopped this country in its tracks. He admitted that not every ambulance crew member in Ghana is trained to perform basic life support. He admitted, almost in passing, that some of the staff currently riding in our ambulances cannot insert a cannula or initiate fluid resuscitation while en route to A&E. The conversation moved on. We treated it as another talking point. It is not a talking point. It is a national emergency hiding inside another national emergency.
Let me say plainly what that admission means. When an ambulance picks up a haemorrhaging patient, or a stroke patient, or a road accident casualty, the journey to the hospital is not transport. It is treatment. Every minute in the back of that vehicle is a minute in which the patient should be cannulated, given fluids, given oxygen, monitored, and stabilised, so that when they arrive at the receiving hospital, they are still alive and still salvageable. An ambulance crew that cannot do that is not delivering patients. It is delivering bodies. And the most painful part of it is that this is not advanced medicine. Cannulation is taught in the first year of nursing school. Fluid resuscitation is taught in the second. We are not arguing here about pre-hospital ultrasound or trauma airway kits. We are arguing about whether the person in the green uniform sitting beside your bleeding child knows how to put a needle in a vein. That this is even an open question in Ghana in 2026 is a quiet scandal.
What makes it worse is that the state is not the only actor failing here. As CEO of an occupational health and workplace wellbeing firm in Ghana, I have spent the last couple of weeks sending formal proposals to companies in mining, manufacturing, hospitality, and energy, offering exactly the thing this country needs more of, an integrated workplace health programme with basic life support training built in for their employees. The response, in the majority of cases, has been the same. Too expensive. The cost of equipping a workforce with the most basic emergency skill, a skill that could save the colleague who collapses in a meeting room or the customer who has a stroke on the showroom floor, does not, they tell me, fit into this year’s budget. I respect that companies face real financial pressures. But I have learned that the calculation looks very different when a director loses a member of his staff on his own premises, because no one on site knew what to do in the four minutes before the ambulance arrived. We need to stop running that calculation in retrospect. Voluntary uptake will not get us there. The Ministry of Health, the regulatory agencies, and the MMDAs need to make basic life support a licensing condition, not a nice-to-have. None of this is expensive at the system level. All of it is overdue.
But the ambulance is only the first broken link. Once a patient finally reaches a hospital, the next failure is waiting at the door. I have written elsewhere about the no-bed crisis, and the diagnosis from that piece stands. We do not have a bed shortage in this country. We have a flow coordination problem. Beds are occupied by the wrong patients because nobody at the door decides who belongs inside, and nobody inside moves people out of acute beds when they no longer need them. Every functioning health system in the world solves this with a single role. A bed manager. A senior nurse, sitting in the A&E or in a control room behind it, whose only job is to know which beds are occupied, which patients can be stepped down, which can be discharged, and which incoming case takes priority. We have not created this role. The cost of creating it is almost nothing. The cost of not creating it is Charles Amissah.
Behind both of these failures, the ambulance and the door, sits the deeper one. Patients go where the resources are. They have always done so, and they always will. As long as our CHPS compounds are unstaffed, our health centres are out of drugs, and our polyclinics close at five o’clock, every fever, every headache, every routine pregnancy review will end up in the A&E of a teaching hospital, and the genuinely critical patient who arrives at midnight will find no slot. We can build the most beautifully equipped emergency centre in West Africa. If everybody else in the city is also there because their polyclinic was closed, the new emergency centre will look exactly like the old one inside three months.
The fix here is not at the top. It is at the bottom. The NHIA needs to invert the system’s financial gravity. Pay CHPS compounds enough to keep their doors open and their staff present. Pay polyclinics enough to extend their hours. Reimburse a routine outpatient encounter at the primary level at a rate that makes that the rational first stop, and reimburse the same encounter at a teaching hospital at a rate that makes it the irrational last stop. Patients will follow the resources. So will clinicians. So will drugs. The Ministry’s actuaries can show the numbers. Doing this one thing, properly, would empty more A&E beds in twelve months than every infrastructure project currently on the drawing board.
And tying the whole thing together, when we are finally serious, is digital. Ghana needs a national digital primary healthcare platform built around a single principle, that every citizen, identified by Ghana Card, holds one longitudinal health record from cradle to grave. A patient books an appointment at her nearest CHPS, health centre, or polyclinic from her phone. The clinician sees the record before she walks in. Referrals to the next level move digitally, time-stamped, with the full history attached, so that no patient ever again arrives at a teaching hospital with a paper note and no story.
Prescriptions written at any facility are transmitted digitally to a registered private pharmacy of the patient’s choice, where the medication can be collected or delivered. The state stops trying to stock every facility with every drug, and instead leverages the dense private pharmacy network this country already has. Ambulance dispatch is integrated, so that a CHPS nurse facing a case beyond her scope can summon transport and pre-alert the receiving hospital in the same action. NHIA claims are processed against the same record, ending the leakage that drains the scheme today. None of this is futuristic. It is standard practice in countries with a fraction of our talent. What we have lacked is not the technical capacity. It is the political will to commission it.
All of these points lead to one conclusion. The temptation in Ghanaian health policy, every time there is a crisis, is to announce a new building. A new hospital. A new emergency centre. A new specialist facility. A ribbon to cut, a podium to stand at, a photograph for the national papers. We have done this for fifteen years, and the same patients keep dying for the same reasons. You cannot solve a foundation problem by adding floors. You solve it by going down to where the cracks are.
Train the ambulance crews. Put a bed manager in every hospital. Refer to the CHPS, the health centres, and the polyclinics properly and consistently. Wire the whole system together with a digital backbone that lets information move faster than patients. Do those four things, in that order, before you commission another teaching hospital.
This is not glamorous work. There is no ribbon to cut at the end of it. But it is the work that saves the next Charles Amissah. And it is the work that, fifteen years from now, will let us look back and say we finally stopped lying to ourselves about what was actually broken.
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Umar Faruk Mohammed is a health policy analyst and CEO of Crestline Health Solutions, an integrated health services company based in Accra.
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