Nyaho Medical Center: International Standard of Care to Patients in Ghana

Interview with Dr Elikem Tamaklo, Managing Director of Nyaho Medical Center

What is your assessment of the healthcare sector in Ghana in 2019? What are the challenges?

The Ghanaian healthcare sector or the industry is going through a lot of change, mainly because there is a lot of focus on the need. The need is enormous. No one entity can tackle it. The government sector and the public sectors are beginning to look at quite big investments that are required just to meet that basic demand. But that still is not enough. Currently, the private sector is also ramping up. There is an increasing demand for good quality services. We live in a very globalized economy. Access to information is very open. So, a lot of people are now looking at how they can get the best care here in Ghana. It is very important. The healthcare sector is changing to start becoming a bit more intentional in meeting the demand, but there is still a lot of work to be done. A lot more infrastructure development is required, as well as a lot more focus on more robust regulatory frameworks. As this starts to get stronger, we should start to see a trickle down, possibly also a big focus on the quality of the service, beyond just the clinical care and communication and the level of competence of the staff in nursing care.

Can you explain more about your new family medicine training program?

We want to be Africa’s most trusted name in healthcare. So, we are going all out and we cannot do that alone. That means that we need people who can help fund this, but we need not only the funding, but strategic relationships that can support it.

We started the family physician practice because in the organization we wanted to start to tackle chronic diseases quite intentionally. With chronic diseases, you need a relationship between the doctor and the patient. If you have hypertension or diabetes or any form of chronic disease, it takes a long-standing relationship. So, your doctor has to become like a relationship manager because you have to try different foods, different diets, different tablets all to help you get better and to help get you back to a good quality of life. The family physician is the one who is specialized to really look at you and your health holistically. There was a big gap in the market because there were not enough doctors. The country only started to train family physician doctors over the last ten to fifteen years. This is reflected in the number of people who are practicing family medicine. Instead of repeating the mold and competing on doctors, we became very intentional to work with the Ghana College of Physicians and Surgeons and became partially accredited to train family physicians. That was about two years ago. We always take a disciplined approach. We had one resident come in and last year, 2018, and we had three more residents come in recently. We currently have four residents. The program is ramping up and we are very excited because we need more doctors that are in the system who are not just knowledgeable, but who can take the patient and their community at heart, who are full of integrity and ethics and really have a desire to improve the quality of care. That is really consistent with our values. It is a win-win situation. We are very excited to have the family physician practice in Nyaho, but also the family physician post-graduate training program in partnership with the Ghana College of Physicians and Surgeons.

You also recently opened the Health Hub. Can you explain more?

The Health Hub is an intentional way of being proactive and helping patients become empowered with their health. All of us in the world are tackling chronic diseases. Obesity is a big epidemic, not just in Ghana but globally. Ultimately, we are determined to empower patients to understand a bit more about their personal makeup. Whether that has to do with their blood type, their levels of different hormones in the body, a questionnaire with a doctor and trying to get a risk score based on their family history, or to do with genetic testing. We have partnered with a company based in the UK called DNAFit who helps us to really understand our genetic makeup, especially when it comes to diet and fitness. All of this is data and ultimately, we want to help collate that data. But then, it is more important what we do with that data. For the patient, it helps them become even more aware of themselves. Then, there is a planned, coordinated approach to coming up with a strategy to improving health. We are not just about health, we are about health and wellness. Beyond just being healthy, how do we get you to be in the best state of health possible so you can do the things you want to do? In Ghana, it is even more important because the treatment options are limited. By the time you have a heart attack or a cardiovascular disease, it is too late. The options are limited, it is more expensive to treat, and the likelihood that you will survive beyond a certain number of years is limited compared to other countries. It is significantly cheaper to focus on prevention than to try and increase treatment solutions. We are very proud of the Health Hub. It has been running for less than a year but the interactions have been very intentional, much more so than seeing a normal doctor. We look forward to seeing that grow.

Who is this service geared towards?

Ghana is an interesting country. Like any developing country, you have a full spectrum of different income brackets. What we find in Ghana is that the biggest funders of healthcare are actually the corporate institutions. Increasingly, it is becoming a very important part of your pay package that as a benefit you get healthcare. The healthcare costs for companies are continually increasing as more and more of the staff have these chronic diseases. Once you are diagnosed with a disease, there is the recurring cost of refilling your prescription, and when you are ill, it is the indirect cost of absence and sick leave. These are all costs for companies. We find that this focus on prevention is really two-sided. One, for the individual because ultimately, we all want to be healthy and it is an internal driver. We find that those who can afford it pay. We try to be creative by giving a tiered option so you can pay over a period of time. These are ways to try and increase the accessibility and empower people, but we also position to corporate bodies as well. We do the annual health screen and we offer different packages at that time. But we do not want you to just have a snapshot of your health. If you are just doing one annual health screen, then it is great and you understand where everyone is at that point in time. But what you really need is a relationship over time because you want to increase and improve your health outcomes. That is quite measurable. It is very simple when you look at any business strategy. You have a five-year plan and you just break it down by year, but you need data to support that. That is what we offer through the Health Hub.

Do you have a strategy to attract funds or interest about what you do? What is your approach towards funding?

Funding in healthcare is so critical because healthcare is a social good. It is in everyone’s best interest. Any equity investor coming into the country needs a good hospital to go to if something happens. Health equals business, mainly because you can attract good businesses into a country that has good healthcare and, of course, good education. These are basic needs. Currently, there are a lot of options available when it comes to funding and that is a good place to be. Depending on the industry or the hospital, not a lot of hospitals are positioned to access those funds. That has to do with how that business runs in terms of its corporate governance and its management team’s ability to execute. Over the last few years, we have focused on our governance to the point where we are now looking at international accreditation. This positions us to attract very interesting financing solutions. Currently, we are fundraising, mainly because we have a bigger vision in mind. Our vision statement is quite bold. We want to be Africa’s most trusted name in healthcare. So, we are going all out and we cannot do that alone. That means that we need people who can help fund this, but we need not only the funding, but strategic relationships that can support it. We are currently in a good place. We have already invested in the organization and that is to do with local bank support but also internally generated funds. We are building a Mother and Child Unit with its own unique LICU (laparoscopic intracorporeal ultrasound). We will be building our Critical Care Unit by midyear of this year. The fundraising that we are going for is really for the big picture which is to have this international standard of care at the tertiary level. That is where you need patient capital, low interest, and grace periods. So, the call would be for every investor coming in to a developing country to invest in healthcare because it is a win-win. It is a business that has a defined market. If you can grow and build the economies of scale, you can reduce cost. Everyone wants good quality healthcare. We are well-positioned for that and we are definitely taking the bull by its horns, so to say.

Can you explain the Critical Care Unit project?

Currently, in the private sector, there are not many hospitals that are positioned to treat the full spectrum of disease. A lot of private sector players can do the diagnosis, the consultation, and perhaps the inpatient care. But when it comes to critical care, there are not enough competent doctors who can actually deliver that service. What we find is that in the main teaching hospitals in Ghana, for example, Korle Bu or 37, the total number of ICU beds or critical care beds is less that 20 for the city. There is a big gap and a big need, but there are not enough doctors to deliver the service. So, we as an entity became very intentional because we found that we had patients that would deteriorate and we would need them to be sent to a critical care unit, but there was no space. So, we had to start to look at those solutions here, attract some of the best minds, and develop partnerships. We have a partnership with the Royal Liverpool Hospital in the UK where we just sent our critical care matron to shadow and learn and develop the relationship for skills transfer. We hope that will develop over time. Our Critical Care Unit will be opened in June and the aim is to ensure that we can start to meet the patient throughout the entire patient journey. That is really important for us.

When is the Mother and Child Unit due to open?

It is currently in construction, but we are looking at a May/June date. The construction work is ongoing, but then the limitation in the hospital is always about space. So, we are creating space and it takes time for us to build that. Once the space is created, it becomes an easy option for filling those spaces. We decided to use that opportunity to then start focusing on our people. Currently, our people are actually going through the different workshops and training of their skills to then be ready for the opening and deliver at a higher quality of care. We are very excited about this because we already have a large patient population of mothers and children, but we are really upping the level of quality.

Are you looking for partnerships with other international bodies?

Healthcare in Ghana cannot deliver international standards of care if we do not develop good partnerships. We cannot do it by ourselves. It is having the awareness to understand exactly what skills we need. As we have started to develop international partnerships, it has been really based on the competencies that they bring to add value to what we are already doing. We are very grateful that we have a number of global companies that have found themselves in Ghana, but some of those conversations started beforehand as well. We do not just look at what is already in Ghana, but we are also intentionally looking out. We are very excited to see that the attention around the world is focused now on Africa. It is interesting because people see that there is a huge gap in healthcare in Africa and the African economy. There is an opportunity not just to get good investments but to partner with people to really solve some of the world’s biggest problems. We are definitely positioned in Ghana to attract and have conversations and what is really important is whether we can find the synergy, the alignment of values, and if it is the right timing for doing those partnerships.

What are your plans in the technology field?

Technology is an enabler. It is critical. It is not just about the technology, it is really about the process and how streamlined that process is. Currently, we are focused on what is a quality standard. What exactly do we want to deliver on? How do we use technology to help us to do that? With our Octagon branch, which is a satellite, we are using the methodology as a pilot. It is very much a business initiative, but we are learning. We are doing small projects here and there using telemedicine, looking at how well we can secure the information, the data, looking at how well we can coordinate between the doctor, the nurse, and the patient. With this, we are looking at how to then scale it. After the process of testing, that becomes a great opportunity to then start to look further afield. That technology and the internet mean that you have access not only to Ghanaian doctors who are in the diaspora, but you have access to any doctor. So, with the relationships that we have built in the UK, and our relationships we are developing in the US, we are developing relationships within Ghana. Ultimately, how do we work better through using technology and apps? For example, we have a PACS system, Picture Archiving and Communications System, used for imaging. We have a strategic relationship with GE where GE gives us the equipment and we have the software, but the software is throughout the entire organization. Our equipment is actually internet enabled and we want to be able to integrate this equipment into our hospital information system. If you are in the Octagon or here, any image that you have is stored in your medical record. Because of the quality of the diagnosis, any doctor can look at a scan and give a diagnosis, but you really want someone who is doing that all the time. That is where a radiologist is really key. Involving the radiologist early means that you have a better diagnosis faster. For the radiologist to be able to diagnose it and look at it and give that diagnosis very quickly is how the technology enables better quality of care. Once you know what the problem is, you can start treating. These are small ways that we have used technology to improve the quality of our care. So, technology funds a really interesting part because ultimately, we want patients to have access to their data. We are building the framework for that and it is obviously going to take a number of years, but it will happen soon and we are taking it one step at a time. It has been exciting and it is a great opportunity for us.

What do you want to achieve for the clinic in the medium term, the next two to three years?

Nyaho has started to deliver an international standard of care to patients in Ghana. For me personally, it is an injustice that based on where you live, you can survive or you can die. Everyone acknowledges that. People who live in western areas have a better chance of survival. For us, in three to five years, we want to create that environment which really bar none gives everyone that chance to have that extra number of years and to be able to use that time in the fullness of health so they can run with their grandchildren, they can live a good quality of life. Anything that we do will be in service of that vision. In terms of our vision to be Africa’s most trusted name, trust is not based on the equipment or the building, it is based on the human interaction. Through intentionality and focus on this, hopefully, in five years we will be at least building trust in the Ghanaian healthcare sector.

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