AVAILABLE STATISTICS indicate that the doctor-patient ratio in Ghana is about 1:12,000 – a figure which is far below that of the World Health Organization (WHO) global standard of 1: 5,000.

This can be attributed largely to the exodus of medical practitioners from Ghana to seek greener pastures abroad, thus, the country is in dire need of medical practitioners to make up for the large deficit, especially in rural areas for an improvement in health service delivery throughout the country.

It is in view of this that some medical students who studied abroad and have returned to the country say they do not understand why the Ghana Medical and Dental Council (MDC) seem to be slowing down the process of their absorption into the health service, to help provide for the health needs of Ghanaians.

According to the returnees, who pleaded anonymity for fear of victimization, most of them who write the Council’s registration examinations, which is written three times in a year (February, June and October) are failed, for unexplained reasons. Some of them are therefore made to re-sit the exams for as many as four times.
Absorption into system
According to the young doctors, after their parents and families have sponsored them to study medicine in countries like Ukraine, China, Cuba, Czech Republic and Russia, with high hopes and enthusiasm to serve their nation after their medical course, they are now faced with the hurdle of “absorption into the system through the Medical and Dental Council, which is very frustrating.” Already, the first two batches of Ukraine-trained doctors have returned to the country.

These young doctors are facing serious challenges because their frustration stem from the fact that the failure rate of the examinations conducted by the MDC is so high and it would potentially deter those currently training outside, including some 118 in Ukraine alone.

They emphasized that “this high failure rate is because of how the programme is organized by the MDC”, such that there were no materials, syllabus or lectures to prepare them for the examinations.

According to one of the frustrated doctors, “in other jurisdictions like the United States and the United Kingdom, they are given Compact Discs (CDs) with questions and other related materials, but here in Ghana, we have no past questions to guide us, virtually nothing!”

He also said “though the exam questions were not too difficult, medicine is a very broad subject, which includes surgery, general medicine, obstetrics and gynaecology, pediatrics and public health, as well as English language, and without any clue on what to expect in all the areas in which they are to be examined, it poses a problem for them.

Additionally, the graduate doctors do not seem to understand why they have to write English language as part of their examinations. “You know one surprising thing, we are made to take English language which is meant for foreigners who do not speak English as their first language. We schooled here and we still have to write English,” one of them fumed.
Open & Liberal policy
The obviously irritated doctors said, now that Ghana needs many medical practitioners to improve the poor doctor to patient ratio, the deliberate policy to discourage them is bad for the country and, therefore, advised the government to run an open and liberal policy to attract many foreign-trained Ghanaian medical practitioners.

Among other things, they averred that it was difficult to get letters for attachment from the MDC, due to delays in verifying certificates from their schools, and even when they eventually obtain the letters, they are not given guidelines to follow for the attachment.

One of the doctors who said he had already written the exams twice, and was waiting to write again this October, was of the view that there should be designated hospitals where foreign-trained doctors would have their attachment, and be properly coached towards the exam.

According to them, they would prefer that the current system of attachment, which is optional, is made compulsory for about four months whilst the Ministry of Health prepares to absorb them into the system.

They also alleged that the MDC did not have enough sources of funding, thus the registration fee of GH¢460.00 per student, provides the Council with considerable revenue, saying “huge sums of monies are paid as exam fees, which the applicant continues to pay until he or she passes the exam.”

Frustrations of Doctors
The frustrated doctors were also of the view that the treatment they receive in the country is unfair, since the Ghana embassies and consular services in the countries they studied had to virtually come and beg them when they were in their final year, to convince them to return to Ghana to practice after graduation, which was the reason why their plane fares to Ghana were catered for by the government.

“I did not want to come back but my father insisted I return to Ghana to practice, and now see what I have to go through”, cried one of the doctors.

Some parents, who are also worried about the trend, suggested that the MDC should organize a short fee-paying orientation of about three months duration for these overseas trained doctors, instead of subjecting them to rigorous examinations.

In the same vein, the graduates believe a housemanship programme like the one for Ghanaian trained doctors would be better preferred to the examination they were currently writing.

The parents argued that the quality of training that these doctors receive was of equal quality to that in Ghana, thus “it is unfair to subject these young doctors to the ordeal they go through.”

They are, therefore, seeking to bring the issue to the notice of the Minister of Health, who they claim to have made many attempts to meet, but have not been successful, noting that “the early intervention by the President will go a long way to lend a hand in the reform process for their early completion.”
Registrar reacts to allegations
Responding to these issues, the Registrar of the MDC, Dr. Eli Kwasi Atikpui said the Council was not just failing candidates, but “when they pass, they pass, and when they fail, they fail.”

According to him, the examination was instituted in 1972, when the MDC was established, but had to be stopped after two examinations, because some specific individuals thought that the examination was targeted at preventing them from practicing in the country.

He said in the year 2000, when exams was reintroduced, the Council realized that there were certain limitations because these people trained in different environment, and the processes of training were quite different to that of Ghana.

Particularly, Council recognized issues of language barrier, exposure to patients and certain materials, as well as issues of specific disease entities, which were peculiar to specific environments such as communicable diseases in under-developed countries.

Dr. Atikpui explained that because the doctors trained in developed countries, where usually there were no endemic diseases as pertains here, it becomes difficult for people to handle them well, because they may just have read about it but not have had specific experience or exposure to them.

He said in view of this, the Council introduced a programme where prospective candidates were to do some clinical attachment in identified facilities, saying “Council went ahead and paid consultants to take prospective candidates through the programme, but the report we had was that they did not show interest, so council realized that it was a waste of money and time to have continued the exercise.”

He added that the attachment has never been compulsory, but there were plans to make it so by developing programmes to be carried out at the Tamale Teaching Hospital for candidates, prior to the exams.

He indicated that some fourteen candidates who were unsuccessful in this year’s February exams were sent to the Tamale Hospital in preparation for the June exams, thus “currently, we have a system in place to provide them with enough orientation even though not as comprehensive as we would have wished.”

He further stated that the Acting Director of the Ministry of Health has also promised funds for the programme.

He observed that there were currently over six hundred Ghanaians training outside the country in Russia, Ukraine and China, and hinted the MDC was planning to allow students to come home in the cause of their training to do clinical attachment before they complete to acclimatize themselves with the practice in the country as a measure to the problem.

Dr. Atikpui refuted the claim that candidates were failing on a high margin and provided figures, which indicated that in October last year, the pass percentage was 66% for nine general duty doctors who took the exam, 50% for dental, written by two people, and 66% for specialist doctors, written by six people.

In February 2010, twenty seven general doctors wrote and only 47% passed, which he said was about the lowest pass so far, one dental doctor wrote and passed (100%), and all the four specialists who wrote passed (100%). In June 2010, twenty six general doctors wrote the exam and pass rate was 65.4%, one person wrote the dental and passed (100%), and four specialists wrote and pass was 75%.

‘Deficit budget’

He therefore disputed claims that it was to derive revenue that the Council was failing people since the cost of conducting the exams such as paying examiners among others was more than the fee collected, saying, “I always have to justify for council to use money to support the examination. We continue to run a completely deficit budget as far as the examinations is concerned.”

“It gives us a lot pressure to organize this examination and I would have wished that I had fewer people writing the examination at a time”, he intimated.

Giving possible reasons for failure by some students, he said some candidates registered only about a week or few days to the examination, indicating unpreparedness, and the kind of qualification they took to medical schools outside Ghana.

He stated categorically that “these are not qualifications that could earn them qualification into schools here,” and though they may sometimes meet the standards of those countries, if one wanted to come back home to practice, then “they must meet our standard.”

“So people who think that they are interested in doing medicine or dentistry should sit up and learn, and get the requisite qualification and if they know that they cannot meet the minimum standard, they should not go and start it.”

Dr. Atikpui pointed out that though these countries have assured us of using their minimum requirements, but at times, certain situations were compromised because – “some people wish to run the training as a business”, therefore, “people should not say because Ghana needs doctors, they will take any qualification to go and do whatever training.”

He was, however, quick to add that this did not mean that all those who traveled outside to study medicine and dentistry did not have the requisite qualification.

Again, he refuted claims that there were no past questions available for candidates and said that there were Council approved questions that were provided to candidates upon registration, and also said he personally provided past questions through the consultant at the Tamale Teaching Hospital for those who undertook the programme.
‘We run the best exams’
On the matter of English language, he noted there was no basis for Ghanaians to be exempted when foreigners were writing it, especially when there has been evidence to the effect that some Ghanaians do fail in that paper, whiles the foreigners pass it, stressing “you do not have the justification per empirical evidence that Ghanaians who were trained here would pass. “

This, he noted, was worsened by the fact that some of the countries where Ghanaians trained in non-English speaking countries and were not obliged to study the native language of the people, thus such Ghanaians became handicapped in communicating with the patients.

Furthermore, he indicated that the exams was the best and only way to examine people who the council did not have a hand in their training.

He explained that the guiding principles of Council is to guide the profession and protect the public, thus Council has the mandate to accredit facilities for training in medical and dental schools in Ghana.

It also has the mandate to continuously visit any major examination conducted by any medical or dental school in Ghana, so that at the end of the day, Council knows that whatever product comes from any such school in Ghana meets its requirement.

“We do not have the right to go and supervise any institution in Ukraine, Russia or China. The only way we can say or justify that they meet our minimum requirement is for us to conduct an examination, and this examination, apparently, is conducted in various countries in Africa, like Nigeria and South Africa”, he said.

Finally, the MDC registrar said allowing those who studied with government scholarship to write and rewrite the registration examination when they failed, did not constitute a waste of government resources, because “the fact that you are on government scholarship does not mean we should just accept anything.”

“The fact is you need to meet a certain qualification, so if the government spent money on you, sit and learn, come back, revise and pass the exam. We need the doctors so we do not wish to send them away, but we should also not say that because we need the doctors, we are going to compromise with standards, no!” he stressed.