Unlocking the cost dilemma: Navigating the cost of dialysis in Ghana

Lately, it has been reported in the news that the price of a single dialysis session at Korle Bu Teaching Hospital has risen from GHS380.00 to GHS765.42. Many people were upset about an increase during these difficult economic times.

The reality is that dialysis comes at a significant cost to the patients and their relations because patients require it for a lifetime or until they undergo a transplant. Let's look at the numbers, a patient needs at least 2 sessions a week to be “stable”.

If a session is GHS500.00; he or she needs GHS1,000.00 per week for dialysis treatment. Let’s multiply it by 4 weeks in a month. That’s GHS4,000.00 per month for the treatment alone without other required services forever. Just imagine you need 4 sessions a week. Let’s pray and protect our kidneys because the cost of dialysis treatment is not cheap and will never be.

Indeed, the expense associated with dialysis in Ghana can fluctuate or vary, this is influenced by several variables such as the dialysis method, the healthcare establishment, the geographical area or location, and whether the patient is undergoing treatment in a public or private facility.

As an investor in dialysis centers and a board member of Dialysis Services Foundation - a nonprofit foundation that supports patients with their dialysis bills; we have conducted some research on this sector, and I can offer you a rough estimate of the cost range for dialysis in Ghana. However, it's essential to be aware that these prices may be subject to change due to the recent price hike at Korle Bu, which was subsequently reversed.

It is advisable to contact specific dialysis centers or healthcare facilities in Ghana for the most up-to-date and accurate pricing information. The cost of dialysis varies, and some general cost considerations influence the pricing of dialysis treatment.

Hemodialysis vs. Peritoneal Dialysis:

1. Hemodialysis is typically more expensive than peritoneal dialysis in Ghana because it requires specialized equipment and a treatment center. The cost of hemodialysis per session can range from GHS 500 to GHS 900 or more.

2. Peritoneal dialysis, which can be performed at home, may have lower ongoing costs once the initial setup expenses are covered.

Public vs. Private Healthcare Facilities:

1. Public healthcare facilities in Ghana may offer dialysis services at a subsidized or lower cost to patients, depending on government policies and funding. As Korle’s cost of dialysis is the lowest in Ghana and has become the benchmark pricing all other centers in the country.

2. Private healthcare facilities tend to charge higher fees for dialysis services. The cost can vary widely between different private hospitals and clinics depending the cost of operating and their projected profit margin.

Frequency and Duration of Dialysis:

1. The number of dialysis sessions per week and the duration of each session can affect the overall cost. Patients requiring more frequent or longer sessions will incur higher expenses. In Ghana, most patients go for 4 hours of dialysis sessions per day and may need a minimum of 2 sessions a week to survive. In addition to other medicines and blood work that needed to be done monthly.

Location:

The cost of living and healthcare services can vary between different regions and cities in Ghana. Dialysis centers in major urban centers may charge higher fees than those in smaller towns or rural areas because of the cost of transporting the consumables.

However, the high cost of dialysis to patients in rural areas cannot be attainable since most rural folks cannot afford some of the necessities of life. The objective of investing in a dialysis center is purely an economic decision but it has a combination effect of returns and impact.

Quality of Care:

Facilities that offer higher standards of care, including modern equipment and well-trained medical staff, may charge higher fees for their services.

Additional Costs:

The fact is the cost of dialysis is not cheap at all. Just imagine aside the dialysis session, patients will have to consider additional costs associated with dialysis, such as laboratory tests, medications, transportation to and from the dialysis center, and dietary adjustments and many more expenses.

Insurance Coverage:

Some lucky patients with good health insurance coverage may have a portion of their dialysis costs covered, depending on the terms and conditions of their insurance policies. However, the national health insurance in Ghana has no coverage for dialysis treatment. For this reason, many of the patients have to depend on the generosity of family and friends to support them with the weekly cost of dialysis treatment.

Just to clarify, dialysis consumables refer to crucial materials and items utilized in the dialysis procedure to guarantee its safety and efficiency. Without consumables, there can’t be a dialysis session. This is how important consumables are to an overall effective dialysis procedure. The expenses associated with these consumables have a noteworthy influence on the overall cost of dialysis treatment.

These consumables are used in both hemodialysis and peritoneal dialysis and include various items designed for specific purposes. None of these dialysis consumables are manufactured in Ghana, they are all imported with dollars being the base currency.

The cost includes the selling price – the manufacturer, shipping – to the vessel, the duty to the Ghana government, and the profit margin to the importer. The list below are some common types of dialysis consumables that the dialysis centers need in other to treat or dialyze patients.

For Hemodialysis:

Dialyzers (Artificial Kidneys): Dialyzers are the central components of hemodialysis. They contain a semipermeable membrane that filters waste products and excess fluids from the patient's blood.

Dialysis Solution: Also known as dialysate, this solution is used in the dialyzer to help facilitate the exchange of waste products and electrolytes during hemodialysis. It comes in various formulations and concentrations.
Blood Tubing Sets: These sets connect the patient's bloodstream to the dialyzer. Blood tubing sets consist of arterial and venous lines, along with connectors and ports.

Needles and Catheters: Needles or catheters are used to access the patient's vascular system for blood withdrawal and return. The type and size of needles or catheters may vary based on the patient's vascular access.

Anticoagulants: Anticoagulants are medications that prevent clotting within the dialysis circuit. They are added to the patient's blood as it passes through the extracorporeal circuit to prevent clot formation in the tubing.

Hemodialysis Machines: While not consumables themselves, dialysis machines are essential equipment used in each hemodialysis session. These machines control the flow of blood and dialysate, monitor vital signs, and ensure the overall safety of the procedure. The average cost of some of the new dialysis machines is about $20,000.00 each.

Blood Leak Detectors: Blood leak detectors are used to identify any blood leaks or abnormalities in the extracorporeal circuit. They are critical for patient safety.

For Peritoneal Dialysis:

Peritoneal Dialysis Solution: Patients undergoing peritoneal dialysis use specialized solutions that are instilled into the peritoneal cavity. These solutions facilitate the removal of waste products and excess fluids through the peritoneal membrane.

Peritoneal Dialysis Catheters: Catheters are surgically implanted into the abdominal cavity to allow the introduction and drainage of dialysis solution. The type of catheter used can vary based on the patient's needs.

Transfer Sets: These sets are used to connect the dialysis solution bags to the patient's catheter. They typically include tubing, connectors, and clamps.

Peritoneal Dialysis Solution Bags: Patients use disposable bags containing the dialysis solution. These bags are available in different volumes and compositions, including various concentrations of glucose.

Clamps and Connectors: Clamps and connectors are used to control the flow of dialysis solution during exchanges and drainage procedures.

Personal Protective Equipment (PPE): Healthcare providers conducting peritoneal dialysis may use PPE, such as gloves and masks, to maintain sterility and protect against infection during catheter care and solution exchanges.

Exit Site Care Supplies: These supplies include antiseptics and dressings for the care and maintenance of the catheter exit site to prevent infections.

Peritoneal Dialysis Cyclers: Some patients use automated peritoneal dialysis cyclers to perform exchanges, which may include disposable components like tubing sets and cycler bags.

I just want to emphasize that the particular supplies employed in the dialysis process may differ based on the dialysis type (hemodialysis or peritoneal dialysis), the specific dialysis apparatus, the unique requirements of the patient, and the healthcare facility's preferences and protocols.

Again, dialysis consumables play a crucial role in ensuring the safety, efficiency, and quality of dialysis treatment for patients with kidney disease.

The primary factors and cost drivers contributing to the expenses of dialysis facilities have been detailed earlier. However, the issue at hand is: What measures can be taken to lower the cost of dialysis treatment in Ghana?

In my proposal, I recommend that the government eliminate all taxes on dialysis equipment, consumables, and supplies. Additionally, consider offering reduced utility rates, such as ECG tariffs, Ghana Water, and support for solar power, to help dialysis centers lower their operational expenses.

A typical center is expected to allocate approximately GHS5,000.00 for rent, GHS5,000.00 for Ghana Water, GHS6,000.00 for ECG, and an additional GHS8,000.00 for diesel to fuel the standby generator in the event of an unstable power supply. This is in addition to expenditures related to salaries, statutory deductions, and the procurement of all necessary consumables.

These are the main cost drivers that make the cost of dialyzing very expensive. The government needs to engage in discussions with the owners/directors of these centers to collaboratively develop an effective solution that can make a meaningful difference and create an impact for all. The government should also consider adding dialysis treatment to the National Health Insurance, which will be a great relief to all.

We are collectively tackling this challenge, and you might not fully appreciate it now until someone dear to you requires weekly dialysis, and you must provide support. We must extend assistance to one another now and always.

The author of this work is a board member of Dialysis Services Foundation, and the Chief Executive Officer of EcoCapital Investment Management Limited (EIML), a company incorporated in Ghana and licensed by the Securities and Exchange Commission (SEC) as an Investment Management firm, and by the National Pensions Regulatory Authority (NPRA) as Fund Manager of both second and third tiers of the national pension scheme.

The corporate mandate of the firm is to deliver premium financial solutions and investment management services to both retail and institutional investors in Ghana. Services on offer at EcoCapital include Wealth Creation and Management, Investment Portfolio Management, Pension Fund Management, Mutual Funds, Retirement Planning, Investment Research and Advisory. The firm has three mutual fund products under management, namely; Prime Fund, Nordea Income Growth Fund, and the Weston Oil and Gas Fund.