THE INTERFACE BETWEEN THE HEALTH PROFESSIONALS AND LAY CAREGIVERS AT THE KOFORIDUA CENTRAL HOSPITAL IN THE EASTERN REGION OF GHANA

ABSTRACT

In Ghana as in many developing countries, the quest to provide quality professional health care for patients in the hospital is confronted with many challenges. However, the challenges are evidently articulated in the ward where all the medical challenges coalesce. In Ghana, beside other medical challenges, shortage of professional staff is a great barrier to providing quality patient care. The desire to fill this professional lacuna has, by default, resulted in the use of lay caregivers to provide medical care needs for in-patients. Globally, both developed and developing countries use lay caregivers but in different respects. Lay involvement in health care delivery is believed to add emotional value to the patient‟s therapeutic process. As a result, much has been written on the contributions of lay caregivers in the home, hospice, home for the aged and hospitals. In spite of the usefulness of lay caregiving in the hospital environment, not much is documented on the extent to which lay caregivers go and how they negotiate their roles with the health professionals in the hospital context.

Ghana is one sub-Sahara African country that depends heavily on lay caregivers in the hospital due to inadequate health professionals. In spite of this, there are no clear policies on lay caregivers and neither are their services officially recognised. This hospital ethnographic study, therefore, explored the factors that influence lay caregiving in the hospital environment, the extent to which this is carried out in the therapeutic process and how lay caregivers negotiate their roles with health professionals within the hospital context in a Ghanaian public regional hospital.

The study involved interviews with patients in a medical ward, nurses, doctors and lay caregivers. In all, 32 lay caregivers and 12 in-patients were interviewed. Eight (8) key informants made up of six nurses and two medical officers (doctors) were also interviewed.

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The study revealed that lay caregivers‟ involvement in care is influenced by institutional, socio-cultural and other situational factors. Institutionally, shortage of staff and negative attitude of some health professionals were the main influencing factors. Socio-cultural factors such as the demands of primordial ties - reciprocity and kinship moral obligation were outstanding. Other significant situational factors include the severity of a patient‟s condition, (eg non-ambulatory condition and incontinence) and mistrust of professional health care providers. Negotiation between health professionals and lay caregivers is influenced by a compromise based on win-win approach. The study concluded that although health care providers and lay caregivers appreciate the rationality of the irrational situation, both parties were satisfied in the end: in the face of severe staff shortage, health professionals are assisted to provide care to the sick while lay caregivers derive emotional satisfaction from carrying out their moral responsibility to their sick relations who may not receive love and tender care from health professionals.

It is recommended that as a short term measure, the Ministry of Health in conjunction with the Ghana Health Service should formulate policies that create room for lay caregivers‟ involvement in provision of care for in-patients in the hospital. However, to get a permanent solution to provision of quality professional care for patients, there is the need for government to recruit more health personnel to reduce the workload on the few working in the wards. Logistics such as modern BP apparatus, pulse oximeter, sophisticated laboratory and x-ray equipment and adequate drugs should be supplied to the hospitals to make professional work very effective and to reduce reliance on lay caregivers.