Investigation by Edward Adeti with support from by the Media Foundation for West Africa (MFWA) and the United Nations Development Programme (UNDP) Ghana.

A Starr News undercover investigation into healthcare delivery in the Upper East region has dredged up some disturbing findings as health facilities prescribe killer drugs to the public.

The underground mission, undertaken at a number of health facilities to unfold the untold, uncovered health personnel (including some medical assistants) who have taken up an uncertified role as doctors and pharmacy technicians, prescribing and dispensing dangerous drugs which medical experts say have a direct link to such conditions as kidney failure, liver damage, deformities and stunted growth in babies, infertility, low sperm count and premature ejaculation among the individual consumers.

Every health facility is expected to have at least one pharmacy technician among other critical staff, per the international standards of health service delivery. But this is not the case in many places in the region as most of the facilities do not have doctors and pharmacy specialists. As a result, there has been a bold professional trespass everywhere by unqualified personnel into the white coat— the preserve of doctors and pharmacy experts— through which they are issuing killer drugs to the unsuspecting public.

The investigative findings, which development monitors say are a crucial reflection of the silent realities happening on a daily basis at countless health stations across the country, show how deadly treatments given by the same health professionals who should see to the wellbeing of the public alone are a serious roadblock to the pursuit and the attainment of more than a quarter of the United Nations’ 17 Sustainable Development Goals (SDGs) by the year 2030.

The Investigation and the Findings

Starr News acted as a patient seeking medical attention at some of the region’s health facilities and was among the patients who received drugs wrongly prescribed and dispensed by some health professionals.

A number of prescription forms showing some deadly drugs issued to patients were also sighted and snapped during the disguised visits.

In one of the prescriptions, a man diagnosed with taenia corporis (enzyma) and otitis media (earache) was issued with erythromycin and griseofulvin— two drugs that are strictly not supposed to meet inside the human body. The interaction of the two drugs would damage the liver and trigger a diarrhoea which the patient never had in the first place. The wrong prescription would leave the patient untreated and he may return with a worsened condition to the same facility where the same nurse may even hand him a deadlier prescription.

A nurse at another facility, who wrote down “fungi skin infection” on a prescription form as the condition a patient had, also wrote down erythromycin for the patient to buy to cure the disease. Erythromycin is purely an antibacterial drug and, as such, it is the last medicine to recommend as a remedy for fungi. It was a waste of the drug as it also was a waste of the patient’s time.

Another prescription sheet sighted by Starr News shows another ‘poisonous concoction’ prescribed for a baby suffering from anaemia (deficiency of red blood cells) and dysentery (diarrhoea with mucus and blood). A drug called Iron III, which would rather cause more diarrhoea, was included on a list of medicines prescribed for the dysentery-stricken anaemic baby. Also among the medications recommended obviously against the baby’s dysentery was erythromycin— which is not a drug for dysentery. As the deadly dysentery was not treated, the baby’s chances of surviving the childhood diarrhoea looked terribly slim.

In yet another instance in another community, a laywoman with candidiasis (white) which had developed into a Pelvic Inflammatory Disease (PID) was prescribed amoxicillin capsules. The drug recommended for the woman is not a solution to the problem, but rather an antibacterial medicine which, if applied in the private part, would only kill the useful bacteria in the woman’s vagina and expose her to more bacterial infections.

The implications are that, whilst she may suffer infertility in the long run from an untreated candidiasis or PID, she would also infect her sexual partners who in turn would also infect others with the disease. Another baby, who had dysentery and needed maybe just metronidazole, was wrongly prescribed promethazine— a medication only used to treat vomiting. And the baby was supposed to take the wrong medication thoroughly for three days, according to another nurse who prescribed and dispensed the drug.

‘Sick’ Starr News issued killer drug by Medical Assistant

At one of the facilities where Starr News pretended to be down with diarrhoea and went through a malaria test that required an unavoidable agony at the laboratory, a medical assistant also prescribed a wrong treatment, writing amoxicillin with metronidazole and paracetamol in a clinical folder for the ‘patient’.

The metronidazole and the paracetamol he prescribed, according to pharmaceutical experts, were appropriate for the ‘diagnosis’. But the amoxicillin, they confirmed, was wrong— as it would rather worsen the ‘diarrhoea’ he diagnosed. Certainly, the one in charge of the dispensary at that facility could have known better than the medical assistant if he were a pharmacy technician. Checks by Starr News revealed that the facility does not have a pharmacy technician and, as a health worker said, “they may have put just anybody there to dispense drugs to people”.

A nurse at another health station handed a young man, attacked by malaria and taenia carpitis (a ringworm on the head), a ‘poisonous cure’. For his condition, she prescribed artemether and griseofulvin— two drugs with a deadly interaction. If combined, griseofulvin would render artemether inactive whilst the mixture would trigger a dysentery attack and cause a serious damage to the liver later.

Throwing drug cash away to drain Ghana’s economy

It is unclear exactly how long killer prescriptions have been made to the ailing public at the country’s health stations. But certainly, this act is far gone unnoticed for years, killing the public slowly and steadily.

And it is not only causing untold damage to lives both in the rural and the urban areas. It is also a drain on the country’s resources and a burden on the national budget. And, as patients visit the health facilities and their conditions only get worse as a result of ineffective or harmful prescriptions, the public gradually may lose confidence in the orthodox health system and dangerously look elsewhere.

The drugs patients receive at health facilities are mostly funded with the taxpayer’s money or from loans or foreign aids secured by government under the National Health Insurance Scheme (NHIS) to which the subscribing public also makes some periodic monetary contributions.

When drugs are wrongly prescribed, they are being wasted as the ailments remain untreated. The huge sums of money exchanged by government or the patients themselves to purchase the drugs, thereby, equally go wasted. As the conditions of the untreated patients become progressively worse, the patients would either go back to the same facilities for more wrong medications or end up at faraway teaching hospitals where the costs of treatment required to save them can be overwhelming to the national budget and their personal pockets. And the tragic end is often a needles death.

Some of the nurses, particularly in the rural communities, who are prescribing the medicines themselves have brainwashed some community members to believe that the quality or competence of a drug dispenser is in the number of drugs prescribed or dispensed. So, they heap more needless drugs on patients to show that they are more competent than those who prescribe less— causing more drain, causing more damage. Their devoted followers are not told that their body systems, with time, will develop a strong resistance against the overdosed drugs and that it may cost the fortune they do not even have to undo that silent damage later.

There have been reported instances in which the region’s drug storehouse ran out of stock at a pace the supervisors could only attribute to the rate at which needless drugs were being thrown dangerously at patients by health professionals.

Dispatch more Pharmacy Technicians or forget the SDGs— Health Coalition tells Government

With some pharmacy technicians already gone on transfer and some away in school to upgrade themselves, the number of drug dispensers is dwindling in the region. Astonishingly, there are a number of pharmacy graduates who are available to fill as many gaps as there are but have remained jobless for years.

Nobody, says the Ghana Coalition of NGOs in Health, should rule out the fact that the needless toxins already fed to the public so far are ‘ticking time bombs’ waiting to explode in the form of some ‘unfortunate’ side effects on the individuals who have taken wrong prescriptions.

“It is a wakeup call on all the regions of Ghana. Such should not happen again. Otherwise, health professionals risk being sued should the unfortunate happen. This is extremely critical. If you report to a facility over an ailment and you are given a wrong medicine, how would that ailment be cured? How do you get treated? How do you give a patient who has diarrhoea or dysentery an antibiotic drug like amoxicillin and expect the person’s situation not to be worse?

“We need to set our priorities right. If we want quality health service, we must be prepared to expend money in training the human resource. Let’s build the capacity of those who are already there and also arrange for critical staff to be posted to northern Ghana to man the pharmacy units so that it is only professionals who should dispense drugs. If we don’t do that, we are putting the lives of the public at risk. If we don’t do that, we should forget attaining the Sustainable Development Goal number three which is to ensure healthy lives and promote wellbeing for all at all ages. It is dangerous— very, very dangerous,” said the Upper East Regional Chairman of the Ghana Coalition of NGOs in Health, Noble Asakeya Alagskomah.

He stressed that the poisonous medications fed to the public by unqualified hands in many places where there are no pharmacy technicians "constitute the highest barrier" to Ghana’s dream of attaining the SDGs by 2030.

“If we leave our health in the hands of people who are not qualified to render the critical services we patronise, in other words, if we fail to achieve the SDG number 3, we would also find it hard to pursue the first SDG goal, which is to end poverty, and the second goal, which is to end hunger and achieve food security. If a wrong prescription damages your liver, and as a result you are on referral, how do you work to end poverty?

"And if health professionals are issuing drugs that are causing deformities in babies, causing dysentery, which is a serious child killer, and generally prescribing wrong drugs to pupils and students, how can we achieve inclusive and equitable quality education or gender equality and empowerment for women and girls in that sort of society? How can we grow the economy if we are killing ourselves with wrong prescriptions and throwing drugs away? You can imagine the burden wrong prescriptions would have on us everywhere as a people! Everything comes to a standstill,” he emphasised.

Doctors shocked at findings; call for rapid action

Some doctors in the region have expressed deep shock at the findings and have called not only for immediate measures to be taken to address the anomalies at the health facilities but also for a complete crackdown on persons who hawk drugs in the streets and at marketplaces.

“The Ghana Health Service in 2002 introduced the CHPS (Community-based Health Planning Services) concept, which is very good. It has helped a lot. The community health nurses, who are supposed to man the CHPS compounds, are allowed to prescribe; but it is difficult for you to let them know their limits. If you go to a clinic and a community health nurse writes amoxicillin for diarrhoea, that is wrong. But he or she has been given the legal right to write; you can’t take them on.

“But if a community health nurse writes amoxicillin for diarrhoea at a hospital, you can take the hospital on because as a hospital, you are not supposed to allow a community health nurse to prescribe there. It’s a dicey situation we need to act on. I’m not saying that in the hospitals people also don’t make mistakes. Some consulting nurses make serious mistakes. And I also agree that this is a drain on the health insurance scheme. But how about those who just pick antibiotics and move from markets to markets and they are selling it like groundnuts? And people are buying. That is even worse! What are we doing about that? The health matter in Ghana is a mirage. If we don’t get good people to dispense the right medicines in hospitals and clinics— it’s dangerous,” lamented Dr. Francis Asaanah, Upper East Regional President of the Health Insurance Service Providers Association of Ghana (HISPAG).

We’re waiting for financial clearance to employ pharmacy technicians— Director General, GHS.

When contacted, the Deputy Upper East Regional Director of Health in charge of Pharmaceutical Services, Diana Awuni, confirmed “there are only 17 pharmacy technicians” in a region of more than one million people.

Per Starr News’s checks on the government-managed health facilities, there are 2 pharmacy technicians at the Zebilla District Hospital in the Bawku West District, 4 at the Upper East Regional Hospital, 2 at the Sandema District Hospital in the Builsa North District and a yet-to-be-specified number in the Bawku Municipality.

There is only 1 pharmacy technician each in the whole of Talensi District, the Kassena-Nankana West District and the Garu-Tempane District. And whilst it has been confirmed that there is none in the Pusiga District, the Nabdam District and the Kassena-Nankana Municipality, there is also no assurance yet that there are any in Bongo, Binduri and the Builsa South District.

The Director-General of the Ghana Health Service, Dr. Anthony Nsiah-Asare, told Starr News in a telephone interview his outfit “is waiting for financial clearance” to employ more health professionals, including pharmacy technicians, and post them where their services are seriously needed.

“Ghana is a developing country. We haven’t reached where others have reached, but we are trying. There is inequitable distribution of staff and it’s only government who is the employer of most of the health professionals. And I can tell you that within the last 9 months we have placed about 15,000 people. Most of them are nurses and doctors. We are also getting financial clearance to place some pharmacists and pharmacy technicians.

“I know we don’t have enough pharmacy technicians in the Upper East. We know there are people who have been trained and are still waiting to be employed. We are doing as much as possible to get them employed and put them into the system. But I can tell you, despite all these things, Ghana has done very well as far as health delivery system is concerned. We are doing everything possible to achieve the United Nations’ Sustainable Development Goal number 3 by the year 2030— to have universal health coverage for every Ghanaian living everywhere in this country— by strengthening our structures bottom up,” the Director General said.

Perhaps, until the technicians are recruited and posted to end the era of the killer drugs, the public may only stick to the advice the Director General also gave. “You, as a client or as a patient, have every right to ask questions when you think what you are being given will worsen your condition. You have every right to ask questions.”

Investigation by Edward Adeti with support from by the Media Foundation for West Africa (MFWA) and the United Nations Development Programme (UNDP) Ghana.