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The Korle-Bu Teaching Hospital (KBTH), Ghana�s foremost referral hospital, is now a far cry from what is expected of such a facility, nearly 90 years after its establishment. With an average attendance of about 1,500 patients at its Outpatient�s Department (OPD) and 150 admissions daily, the hospital has to struggle to adequately care for its patients. To enhance the capacity of the hospital to deal with its challenges, the Chief Executive Officer, Professor Nii Otu Nartey, has advocated that the hospital be allowed to run more like a private institution in order to raise the necessary funds to make the hospital more efficient. He said although the government paid the salaries of the members of staff, payment for services under the National Health Insurance Scheme (NHIS) and payments made by patients for consumables were inadequate, causing the hospital to continuously run at a loss. The DAILY GRAPHIC visited the hospital to acquaint itself with the challenges and achievements of the health facility in the face of continuous public complaints over its services. The facility is the third largest hospital in Africa and the leading referral centre in Ghana. It has been grappling with obsolete equipment or the unavailability of it because the old ones have given way and but not been replaced. For instance, there have been periods when there were no operating theatre tables, ventilators, suction machines, monitors and anaesthetic machines. In addition, reports have been made about the erratic supply of electricity and water. Inadequate staff numbers to do the job are also a problem. At the Accident Centre, patients were seen being given infusion as they sat in chairs. Others were being treated at the area around the nurses� table because there were no beds. The same situation was observed at the Surgical Medical Emergency Centre, where some patients had to lie on benches. Clearly, the centre had seen no rehabilitation in a long while. The few beds there had no sheets and patients who came without any slept on mattresses. The washroom was a sorry sight and if we still went by the science books, then passing infection from one patient to another was possible. In addition to all these, patients and the members of staff had to deal with heat at the centre. Some relatives of patients on admission were seen sprawled on card boards outside the gates of the centre because they had to stay around to run errands such as getting prescribed medications for the patients they had brought. The situation at these two centres was pathetic. At the Laundry Department, things were not going the way they should because of the lack of certain equipment, making operations manual. Madam Naomi Hammond, the Head of the department, told the Daily Graphic that the laundry had three washers and two dryers which were not functioning properly. There were no flat work ironers, forcing workers to report to work as early as 5 a.m. to iron manually in order to meet the demands of the hospital, especially linen from the theatres which had to be sent for sterilisation at a particular time. In order to function more efficiently, Madam Hammond said the department would need six tumble dryers, eight washers and other equipment, saying that the situation now was not the best, especially when it rained. The Childrens� Block, with beds meant for15 children, was catering for 60 children at the time of the visit because a number of them slept on one bed as a matter of necessity. The possibility of passing on infection in such situation was very high. To address some of the challenges, Prof Nartey was of the view that if the hospital was run like a private one, doctors, nurses and other members of staff could be paid more and thereby reduce the incidence of brain drain. According to him, that would make doctors and other members of staff more dedicated to their patients �because they will know that if they don�t, they will lose money�. Although he admitted that health services were more for social good, making the charging of commercial rates difficult, �that is the way we would need to finally go, in addition to a change in attitude towards work�. Prof Nartey said he had been walking a tight rope in managing the hospital for the past four years because �you rebuke a doctor for wrongdoing and the doctors gang up against you�. That, he said, made it difficult to deal with issues and that had led to some of the challenges the hospital was currently facing. He described the future of the hospital as �great�, saying it was making great strides with time and gave a recent case of kidney transplant and another scheduled for April as some of the strides. The chief executive said somehow the hospital was neglected in the past when it came to the allocation of funds from the government because of an erroneous notion that Korle-Bu could take care of itself. That, however, changed for the better from 2008, he said. The Korle-Bu Teaching Hospital, which opened on October 9, 1923, has grown from a 200-bed capacity facility to 2,000 now. Presently, the hospital sees an average of 1,500 patients a day at its Outpatients Department (OPD), about 150 of who are admitted. An increase in population, however, and the refusal of most patients to use it as a referral/specialist hospital, not a general one, has rendered it frequently crowded. According to Prof Nartey, �the argument of most patients had been: �Why should I go to the polyclinic when I will be eventually referred to Korle-Bu? I will go there straight�. So they come with even malaria, which could be treated at the polyclinics�. Often patients complain about long waiting time for consultation and other services. To that complaint, Prof Nartey responded that the hospital had set up a complaints desk to address those issues but most patients would rather not want to be mentioned in connection with any complaint, making it difficult to follow up. He added that patients would often arrive at the hospital as early as 5.30 a.m., irrespective of the fact that the clinic they were attending started at 9 a.m., and became very irritated when doctors had to go on ward rounds before attending to them. He thought if an efficient appointment system was run, waiting time could be reduced but it seemed the Ghanaian believed more in the �first come, first served service�. That gloomy picture of the Korle-Bu, however, is about to change because a number of projects have been completed and new ones begun. According to Mr Mustapha Salifu, the Public Relations Officer of the hospital, the state of affairs at the Children�s Block was to change with the construction of a temporary emergency centre for children in the block. The laundry is also to see a rehabilitation with the necessary equipment provided. All 13 lifts which were broken down, including those at the Maternity Block which resulted in women in labour being carried manually up the stairs, have been replaced at a cost of GH�2.4 million. There has been an expansion of water storage facilties to reduce frequency of the water shortages in the hospital which hitherto led to postponement of surgical operations and the hospital now has three generators which ensures continuous power supply to the hospital. A Reproductive Health Centre has been constructed and there are a number of rehabilitation projects, including that of the surgical ground floor theatres for renal transplants and neurological procedures. Last year, Parliament approved $250 million for the purchase of equipment for a number of public hospitals. Out of that amount, about $100 million is for the benefit of Korle-Bu. Prominent members of the Ghanaian society, such as former President John Agyekum Kufuor and Rev Father Campbell, have recently been very impressed by the way they were treated at the hospital. Perhaps with these improvements, the ordinary man may also have the same story to tell about Korle-Bu, the country�s flagship hospital.