The 2023 (46th ) AHSAG AGM: The Hospital Administrators' Poor Conditions of Service and the harsh Ghanaian Economy

As the year 2023 steadily grinds to an end to pave way for a new year called 2024 on the Gregorian Calendar, members of the Association of Health Service Administrators, Ghana (AHSAG) are warming up for their 46^th Annual General Meeting and Continuing Professional Development Programme (AGM & CPD) at Hill View Guest Centre at Abokobi in Accra.

The 46^th AHSAG AGM/CPD will hopefully take place from 5^th to 8^th December 2023 and the thematic focus of the event is, “Appointment of Hospital Administrators: A new dawn in the Health Administration Profession towards achieving Universal Health Coverage.”

Why this Theme?
In tandem with Article 190 of Ghana’s Fourth Republican (1992) Constitution, the Ghana Health Service (GHS) and the Teaching Hospitals were legally established as distinct Public Services. The law that established them is thus called the Ghana Health Service and Teaching Hospitals Act, 1996 (Act 525). However, the GHS became operational in February 2002.

Section 30 of the Act 525 provides for the appointment of a Hospital Administrator for each public Hospital whereas Section 29 of the same law provides for the appointment of a Medical Superintendent for each Hospital in the GHS. Unfortunately, even though the GHS became operational over two decades ago, the Service until January 2023 did not appoint Hospital Administrators as the law mandated. Instead, Health Service Administrators had been deemed as Hospital Administrators over the years who performed the roles without any conditions of service.

Hospital Administrators’ Conditions of Service

As indicated above, the GHS appointed 96 Hospital Administrators only this year and they were duly assigned to different hospitals to manage. As the law (Act 525 of 1996) demands, the GHS Council appoints Medical Superintendents as a managerial grade with specified conditions of service, but the same Council authorized the appointment of 96 Hospital Administrators as a non-managerial grade and therefore, the new Hospital Administrators appointed by the GHS do not have any conditions of service. They only draw monthly salaries. Could this be the result of the usual discrimination against non-clinical grades in the Service or a mere oversight by the GHS Council, which anomaly the Council will be willing to address with a request for same by AHSAG?

As it stands, only the Medical Superintendent and the Hospital Administrator have been mentioned in the law (Sections 29 & 30) to be appointed as managerial grades within the Hospital Management Team in the Service. We are aware that since the inception of the GHS, the Medical Superintendents have been appointed to offices with certain conditions of service. In the case of the Hospital Administrators, the Service had not only delayed their appointment for about 27 years but also denied them conditions of service when the GHS Council decided to appoint them upon a request made by AHSAG. Also, appointing the 96 Hospital Administrators without conditions of service constitutes administrative unfairness, methinks. I further opine that the GHS Council does not need to be compelled with the remedy of mandamus to address this unfairness. I believe that the respected advisory body will see wisdom in addressing the error in the appointment of the Hospital Administrators without any judicial review action.

Membership of AHSAG
Currently, membership of the Association of Health Service Administrators, Ghana (AHSAG) is made up of Health Service Administrators and Hospital Administrators. The difference between the two is that a Hospital Administrator is a qualified and seasoned Health Service Administrator who has been appointed as Hospital Administrator in tandem with Section 30 of Act 525 of 1996. Suffice it to say that the Hospital Administrator grade in the GHS is higher than all the Health Service Administrator promotional grades.

Qualification Criteria
Also, membership of the Association is based on the pursuit of the Healthcare Management or Health Service Administration Programme in a recognized academic institution after which the newly qualified professional called Houseman Health Service Administrator (HHSA) must undergo a one-year mandatory training on a departmental rotational basis at a recognized public hospital and under the supervision of a seasoned and practicing Health Service Administrator or Hospital Administrator.

The one-year mandatory training on the job after the academic programme is a prerequisite to appointing either Health Service Administrator or Hospital Administrator by any hospital in Ghana. This makes the Health Service Administrator/Hospital Administrator a unique and specially trained managerial support staff in the health sector of Ghana. Unfortunately, issues regarding their conditions of service have been treated with disdain, envy and discrimination over the years making them endangered species in the face of the harsh Ghanaian economy. They are as though cheap labour when it comes to work performance and therefore, they are not valued when it comes to designing and appropriating conditions of service or remunerations in the health sector. How can a poorly paid and dissatisfied Administrator contribute meaningfully to achieving universal health coverage?

Presently, the Health Service Administrators (from the beginning grade to the Chief Grade) have been given minimal market premium on the Single Spine Salary Structure whereas the Hospital Administrators have been given a bit higher market premium without any other conditions of service. This is why both the Health Service Administrators and Hospital Administrators receive salaries far lower than even some of the workers they supervise.

Job-related Risks
Despite the foregoing, the job of the Health Service Administrator and Hospital Administrator is challenging, full of financial and other risks apart from being time-consuming. In most cases, the Health Administrator (Health Service Administrator or Hospital Administrator) becomes the scapegoat whenever there is a managerial problem in the health facility of which he or she is not the CEO or overall boss. They are also the first to be blamed and re-assigned or removed as a form of punishment in times of identified managerial challenges.

Perhaps this was why a group of murderous minds of Atronie in the Bono Region killed an innocent Health Service Administrator in 2007 after they accused him wrongly for murder. The said deceased Administrator, Anthony Yeboah Boateng (38 years) was equally the Presiding Member of the Asunafo North District Assembly at the time.

In 2006, the writer of this article was also nearly lynched by some members of the Nima Community in Accra due to a missing corpse at the Ridge Hospital Mortuary.

It is also public knowledge that Dormahene, Osagyefo Oseadeeyo Agyemang Badu II had banished a Health Service Administrator from his traditional area in 2014 due to issues pertaining to a mortuary owned by the community and a hospital mortuary slated for construction which the chief thought was going to compete with the community mortuary. The chief declared the Health Service Administrator a persona non grata in Dorma hence the Administrator’s security could not be guaranteed in that community.

Despite these and many risks involved in the job roles of the Health Service Administrators or Hospital Administrators, the public sector employers (Ministry of Health, Ghana Health Service) and the Christian Health Association of Ghana (CHAG) as well as other faith-based health facilities only employ the Administrators without conditions of service. This poor treatment to Health Service Administrators and the Hospital Administrators is caused by the Government of Ghana itself through the misdeeds of the Fair Wages and Salaries Commission. It is high time this was corrected. We do not necessarily need labour unrest or demonstrations to address such thorny labour issues.

Legal Lacuna
Since 1996 when the Ghana Health Service was legally established, the Government of Ghana has failed to enact a Legislative Instrument (LI) to guide effective enforcement of the Act 525 of 1996. This legal lacuna thus serves as the impetus for managers at various echelons of the Service to choose and pick issues regarding procedure and job roles sometimes to the detriment of the Health Service/Hospital Administrators. In the absence of the LI, the Service at its pinnacle is continuously eroding the job of the Health Service/Hospital Administrators.

Harsh Economic Conditions
In the absence of conditions of service, the Health Service/Hospital Administrators are exposed to the harsh conditions of the Ghanaian economy in addition to their numerous job-related risks including but not limited to those enumerated earlier herein. It is high time the Association of Health Service Administrators, Ghana (AHSAG) made bold demands from their employers for better conditions of service. They must ensure unity of purpose and eschew professional rivalry and rancor within their fraternity and forge ahead as a unified professional force.

The government itself must address the legal concerns raised herein and also address the poor conditions of service concerns of the Health Service/Hospital Administrators who are members of AHSAG.

Conclusion
To this end, I wish the members of AHSAG fruitful deliberations at their upcoming 46^th Annual General Meeting and Continuing Professional Development Programme. Advisedly, their AGM communique must touch on issues relating to their conditions of service. Afterall, the Health Service/Hospital Administrators must be well motivated to work effectively and contribute meaningfully to the universal health coverage agenda attached to the attainment of the Sustainable Development Goals ~ Asante Sana ~.

Philip Afeti Korto
Hospital Administrator
[email protected]