- Salutations
- Representative of His Royal Majesty King Tackie Teiko Tsuru II, Ga Mantse
- Prof Aaron Mike Oquaye, Former Speaker of Parliament
- Presidential Advisor on Health
- President of Ghana Kidney Association
- Rector of the Ghana College of Physicians and Surgeons
- Heads of Hospitals
- The Media
- Distinguished Ladies and Gentlemen
I wish to express my profound gratitude to you and the leadership of Ghana kidney Association for inviting me to be part of this history – Commemorating 50 years of dialysis in Ghana.
The theme for this symposium which is 50 years of dialysis in Ghana, the Past, Present and the Future gives us the opportunity to reflect on the past and the present, and plan for a successful future.
Mr Chairman, Dialysis started in Ghana at the Korle Bu Teaching Hospital in 1972. Until this time, patients in Ghana who were diagnosed of kidney disease died without access to this lifesaving treatment.
We are eternally grateful to the pioneers who brought dialysis to Ghana – The late Dr Yaw Anim-Addo (Consultant Physician), Sister Ohene-Ampofo Department of Medicine at Korle Bu Hospital, The late Professor J.K.M. Quartey (Urology), Professor Edward Yeboah (Urology) and Dr B.F. Ribeiro (Urology).
Mr Chairman, dialysis treatment has advanced over the years. Today, we have seen great improvement in the manufacturing of dialysis machines which has resulted in less complications than before. The duration of dialysis has reduced from several days in 1945 to about 4 hours per session.
In Ghana, the number of dialysis centers has also increased from just one center in Korle Bu Teaching Hospital to about fifteen as published by Tannor et al. in 2018. Between 2018 and now I believe this number of centers has doubled if not tripled. There are more specialist doctors and nurses now than we had 50 years ago. All these achievements and more account for the successes chalked over the past 50 years.
Despite these achievements, there exist many challenges:
a. High cost of dialysis – This is the major challenge. The cost of treating a person with kidney disease is very expensive. However, the high cost of dialysis has led to the premature death of many people who could not afford to pay. For example, a patient undergoing 3 sessions of dialysis will need to pay an estimated 50,700 Ghana Cedis per year for treatment. This amount is exclusive of laboratory investigations, medications, and transportation to the hospital.
b. High cost of kidney transplant – Although kidney transplantation is the preferred treatment it is expensive and beyond the reach of most of these patients.
c. Limited access to dialysis – Hemodialysis is the most common form of dialysis in Ghana. There are few dialysis machines in Ghana compared to other African countries like Egypt and Nigeria. It is sad to know that majority of the regions in Ghana do not have dialysis centers and machines.
This limited access to dialysis treatment in Ghana has led to pre-mature deaths among people with chronic kidney disease. In 2016, the number of dialysis centers in Ghana were 15 with 103 dialysis machines serving over 30 million people. Out of the 103 machines, 65 machines representing 63% were located in Greater Accra Region only (Tannor et al., 2018).
- Other challenges include:
Uncontrolled advertisement and sale of certain herbal concoctions – The proliferation of herbal medical centers and their advertisement on our main and social media platforms needs to be monitored by the Food and Drugs Authority. Some studies have shown an association between herbal medication use and the incidence of kidney disease. Acute kidney injury from the use of herbal remedies is said to account for about 30–35% of all cases of acute kidney failure in Africa (Akpan and Ekrikpo, 2015). - Pollution of soil and water bodies – The pollution of water bodies and our soils can have serious effects on our kidney health. We as a people should be worried about the consequences of illegal mining popularly known as “galamsey”. The continuous pollution of our water bodies with chemicals will cause kidney disease in the people who drink from these water bodies. Some of these chemicals may find their way in our plants when we plant in these contaminated soils. For instance, arsenic and mercury used in processing the gold have been shown to predispose to kidney disease.
These challenges if not addressed will negatively affect the quality of care given to patients on dialysis.
Mr Chairman, as we move into the future, there is the need to increase the number of dialysis centers in the country and ensure their equitable distribution across the sixteen regions of Ghana. This status quo cannot continue. In addition to the teaching hospitals, ideally every district and regional hospital should have a functioning dialysis unit that can take care of patients under their care. Our Agenda 111 hospitals will also address the geographic imbalances that currently exist.
There should be a conscious effort to increase the training of doctors and nurses to meet the ever-increasing demand for dialysis treatment in Ghana. The more people we train, the more specialists we will have to provide dialysis treatment even at the district levels.
A lot more must be done to make dialysis affordable to the average person. This calls for concerted efforts from everyone including government and the private sector. One of the clear areas that we have seen, and all the presentations have repeated, is the high cost of consumables as a major factor in the treatment because many of these consumables are imported.
Of course, that means we are at the mercy of the high import cost. We have to find foreign exchange to import them in the first place. But a significant part of it is that we have to import all the Dialysate and the other consumables that we use in dialysis.
One of the lessons we learnt from Covid 19 was the need to build our capacity to produce vaccines. Last week for example, we had a meeting where we were looking at the progress on vaccine manufacturing in Ghana. One of the lessons we learned is that the Covid vaccine manufacturing is actually a lot more complicated than if we were to manufacture some of the consumables for dialysis in Ghana. I believe very, very firmly that in collaboration with the private sector, what we have done to bring in vaccine manufacturing in Ghana, we can do the same for Dialysate manufacturing.
We can do it. It’s less complicated than what we have for vaccines. And so, government would be prepared to support in whatever way to make sure we manufacture here.
Therefore, we reduce the cost component and make sure there is affordability.
I’m sure the private sector will be willing, and government is not averse to tax incentives for the private sector to do this.
One other issue that has come up here is the request for Government to take steps to make sure that the NHIS is able to cover dialysis treatment. This is a very good point, and I think that at the very least, the NHIS at least could cover treatment for children on dialysis to start with.
The last couple of years, one of the areas Dr Nsiah Asare (Presidential Advisor on Health) and I have worked on is to look at sickle cell disease, for example, where we’ve made sure the NHIS is covering Hydroxyurea for people with sickle cell disease and that has come to pass and it is now the case.
18. We also pushed to make sure Childhood Cancers are also now covered under the NHIS. So I think the third goal now for us is to push for dialysis.
But, when we were pushing for childhood cancers to be covered, we saw the difficulty that the NHIS was facing because all the tests showed that there was going to be a major stress on their finances. So, whilst we also advocate for the NHIS to come in for dialysis treatment, we should also think about their finances and also advocate for more financing for the NHIS to make whatever challenges they take on sustainable. We don’t want to break the NHIS in the process; then everybody loses out.
So, we should look at our willingness to pay a little more to make sure that the NHIS is functioning.
Mr Chairman, Distinguished Guests, let me conclude by appreciating Ghana Kidney Association for continuously championing the course of kidney health. Together we can achieve more for the progress of this country.
Happy 50 years celebration of dialysis in Ghana.
God bless us all.
Thank you for your attention.
