Unilateral Decisions at the Metropolitan, Municipal, District Health Directorate Levels:

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 …Its Consequences On Service Delivery And Health Outcomes


It is with a saddened heart that I write to convey the dissatisfaction of almost all health care professionals especially at the lower facility levels such as the Polyclinics, Health Centres and CHPS Compounds, etc across the length and breadth of this country Ghana as a result of the selfish and personal interests of some Metropolitan/ Municipal/ District Health Directors and their Allies.

Ghana as a country in order to achieve the Sustainable Development Goals (SDGs) as espoused/ set up by the United Nations, depends solely on Donor Agencies and other Developed countries in order to achieve the goals set up by the Global Body.

In furtherance, the Ministry of Health and for that matter its implementing Agencies such as the Ghana Health Service (GHS), Christian Health Association of Ghana (CHAG), Quasi, Private, Security and Teaching Hospitals have braced themselves up in order to achieve the Health Related Goals set up by the UN but because of the self -enriching mentality of some health care managers and administrators, the efforts put in by the working force such as Doctors, Pharmacists, Physician Assistants, Midwives and Nurses, etc are not seen to be working. If the majority of the health sector workforce is disgruntled and dissatisfied, how can goals and objectives be achieved?

However, typical of we Africans, we see the donor influx as an opportunity to enrich a few at the Health Directorate Levels rather than improving the positive health outcomes of our citizens.  Supports have been garnered in Adolescent and Reproductive Health but Ghana and Africa as a whole leads in teenage pregnancies among the community of nations and continents respectively across the globe. Malaria Control programmes, Family Planning, Disease Surveillance, Health Information and Data Assessment programs among others have all been sponsored by donor countries but Ghana and Africa as a whole continue to lack behind in all health indices/ indicators. Why? Program funds do not reach the implementers of activities.

Ghana and Africa as a whole can no longer give excuses to the world in relation to the accomplishment of positive health outcomes of its citizens in all indicators as we can boast of all the requisite supports from NGOs/ Donor Agencies/ Developed Countries.

The Physician Assistants, Nurses and Midwives among the lot under whose jurisdiction and empowerment that most of the Health related SDGs could be accomplished are relegated to the background during the planning and decision making processes.

One very important health care professional who has continuously been undermined and unrecognized in the health care delivery machinery is the Physician Assistant, the Sub District Head, one who is to spearhead all activities of nurses (Midwives, Staff Nurses, Enrolled Nurses, Community Health Nurses, etc), key implementers of all health programmes at the peripheries.

Executive Officers, District Accountants, District Health Information Officers and Metropolitan/ Municipal/ District Directors have become arbitrary decision makers even when their knowledge or expertise in a particular field is challenged or limited.

How can someone just by virtue of his/her position, despite his/ her limitations in the health needs of a health facility be the sole procurement officer for drugs and other non- consumables without inputs from clinicians?

How feasible is it to account for GHC 5,000.00 when you were only given GHC 3,000.00? These are real realities on the ground. When you challenge them, they brand you as disrespectful, arrogant, among others. It is only in Ghana that these abnormalities happen and we still allow those health care managers at their posts? They have formed gangs and allies to silence the majority of the disgruntled health force. Different receipts booklets could be seen at the Directorate levels and they are always seen filling in the blanks especially when auditors are coming, to the detriment of health service delivery.

Physician Assistants in this Country Ghana are about One Thousand, Two Hundred (1,200) – MDC, Ghana Permanent PAs List (2017) with a teeming Ghanaian population of about Twenty Six Million (26,000,000) – Ghana Statistical Survey, 2010, thus putting the Physician Assistant Ratio at 1: 21,666. How can these cadres of health professionals be relegated to the background for so long a time?

The Ministry of Health and its allied agencies had neglected us for so long a time in their administrative and managerial structures to the extent that nobody knows us in the health sector when health practitioners are mentioned. We have been put under the regulation of the Medical and Dental Council without benefits. We are seen doing all the jobs in the Consulting Rooms across the length and breadth of all Out Patient Departments in Ghana but we are paid little. When Doctors fight for their interests, they forget about us the Physician Assistants. Everyone who sits in the consulting room and consults or sees to patients/ clients is regarded as a Doctor but we are not paid the same and recognized as colleagues.

Physician Assistants who hold the health system together at the peripheries cannot be neglected or by –passed if we really want to achieve our set goals as a health sector. Enough is enough. Don’t use the facilities and the workforce to enrich yourselves at the directorate levels. We have woken up from our deep sleep. No intimidation can hold us forever.

To the NGOs/ Donor Agencies, without mention of any particular group or organization, get to the implementers of your policies at the grassroots, know their plights and address them directly. Also change your modus of operations and we can assure you of improved health outcomes.

Current morale is low among health workers but it can be reignited.

We shall surely overcome.

Stay resolute and blessed always.


Thank you.


BY: Peter Eyram Kuenyefu

Senior Physician Assistant

Acting General Vice Secretary, Ghana Physician Assistants Association

Contact Numbers: 0249883933/ 0206384991/ 0274883933

Email: pkuenyefu@yahoo.com/ gpaanational@yahoo.com

The writer is a practicing Senior Physician Assistant, Acting General Vice Secretary of the Ghana Physician Assistants Association, Volta Regional Resource Person for Malaria Case Management and Adolescent Health, Trained NHIS External Clinical Auditor & Sub District Head, Nkonya- Ahenkro, Biakoye District.






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