Ghana Health Service: How the state is being robbed of Revenue.

As the state injects more cash to improve healthcare services, some healthcare staff are engaged in acts that deny the state of revenue it ought to get from the healthcare services rendered.

These healthcare workers generally operate by deliberately failing to issue receipts to patients after treatment and payment. At times, they produce receipts but they under-declare— quoting figures that are lesser than the amounts patients are charged to pay at the health facilities.

The Community Health Planning and Service (CHPS) is mostly the first point of visit and it is the primary care point. Followed are the health centres and clinics.

Next are the district and regional Hospitals, being the secondary. The teaching hospitals, more equipped with specialists, are referred to as the final referral health facility point.

The Herald Newspaper’s investigations centred on the primary health care facilities. And for the purposes of this undercover investigation, a pseudo-patient whom I choose to call Jabon Satang visited various health facilities as we unearthed the complaints in the Ashanti region.

The team toured the following health centres:

St Peter’s Health Centre is located at Ntobroso, a cocoa-farming-cum-mining community in the Atwima Mponua district of the Ashanti region. On Saturday April 19, 2025, a reporter from The Herald Newspaper walked into the facility with Jabon Satang. He was welcomed by a female staff. She could  later be identified as Gloria Agyemang, and another male nurse, named Antwi Dominic. . 

This health Centre is one of the numerous Health facilities of the Christian Health Association of Ghana (CHAG). With its operations duly regulated and supervised by state regulators.

The green-flowered surrounding of this facility welcomed Jabon.

Jabon’s vital signs were taken. A middle-aged worker joined the staff, identified as Josuah Kewura. He was said to be one of the two physician assistants (PAs) manning the facility. It is the only health facility in the area manned by two PAs. The patient was asked to meet Kewura in the consulting room. 

After the consultation, a laboratory test was conducted on him. It has few structured rooms housing the facility, with flowers adorning the surroundings. 

Per the general practice across all health facilities throughout the country, patients are usually given attendance cards. This card is supposed to be presented on any subsequent visit to enable healthcare providers locate the client’s folder easily. Jabon was not given an attendance card.

A health worker in a state of anonymity disclosed that when an attendance card is not issued, it is usually a deliberate scheme to avoid capturing the patient details into the hospital attendance register — and by doing so, the patient payments might not be captured in the hospital records although he or she visited the facility for healthcare.  

It could also be done so that staff would deposit a lesser amount paid by the patient to state coffers. On April 19, 2025, Jabon Satang was charged Gh¢270 ($26.34) after he was treated and his take-home medications handed over to him. Prior to collecting the take-home oral medication, Jabon objected to an infusion. After payment was done, the health workers did not issue any receipt covering the payment made.

With a smile, Mr Dominic exchanged telephone contact numbers with Jabon and asked us to come again should the need arise.

The team also visited the Nkroma Community-Based Health Planning and Services (CHPS) compound also in the Atwima Mponua district, the Adankwame Health Centre in the Atwima Nwabiagya South district and the Asakraka Health Centre in the Atwima Nwabiagya North district of the Ashanti region on May 2, 2025. All the facilities did not issue us receipts. 

At the Asakraka health Centre, no record of Jabon was taken. Not even the name was written. No basic vital signs were monitored as required. We were treated not differently from someone who visited an over-the-counter seller for a medicine. 

On May 18, 2025, we visited the Aboaso Health centre in the Kwabere East district of the Ashanti region. We were not issued a receipt too.

 At the Sekyere South district health centre of Kona. We were directed to the pharmacy unit for our oral medication after treatment. The Kona Health centre is one with separate departments, with a bit-wide Outpatient-Department.

Jabon was charged GH¢ 55 ($ 4.99), but only GH¢15 ($1.36) was captured on his receipt. This means that an amount of GH¢40 ($ 3.63) of the amount paid, representing 73% of the said amount, has not been captured on the receipt.

A worried middle-aged man, Yusif Adams told this reporter that he was  treated as an Out-Patient client ,but the Apramprum health center, at Sepe in the Manhia North sub-metropolitan assembly failed to issue him a receipt after he paid the charged amount.  

This practice violates Ghana’s Public Financial Management Act (PFM ACT 921). It is also at odds with the country’s Payment System and Service Act, 2019 (act 987). 

The Hospital Fees Act, 1971 (Act 387) mandates that official receipts are issued for all payments made at health facilities. Specifically, the Act requires hospital revenue officers to issue receipts after payments are made. Among the core values of the Ghana Health Service includes integrity.

The practice of not issuing receipt covering payments at health facilities appears not to be a new game, except that the actors develop new strategies with the passage of time.

On October 30, 2017, the then Director General of the Ghana Health Service, Dr Anthony Nsiah Asare, issued a written warning to health facilities against illegal charges and non-issuance of receipts covering hospital fees.

Anti-corruption bodies express worry. 

The practice of not giving out receipts to patients, got anti-graft bodies worried. Sharing a perspective on the matter is the Ghana Integrity initiative (GII), an anti-corruption organization. The GII is encouraging clients to report to relevant authorities when they are not issued receipt at the facility level. Its fund-raising manager, Micheal K. Boadi, in an interview noted that state institutions are not everywhere to identify some of these practices and thus urged health service seekers to report to the relevant authorities. For him, the state institutions are not being proactive. “We have left the fight to a few institutions, but they are not everywhere, so they have institutional limitations,” he said. 

He wants actions taken beyond news reporting. 

The Ghana Collation of NGOs in Health, another anti-corruption body also expressed worry over non-issuance of receipts for payments made at  health facilities. Its National Vice Chairman –Kwasi Darku Alazar Ninsau in an interview noted that the act of not issuing receipt to patients was news to his organization. 

Authorities wade in. 

At the centre of this practice, comes in one of the main regulators, the Ghana Health Service. (GHS). ‘‘That is against the law, all statutory payments are supposed to be issued  receipt. So, it is something that is news to us. Auditors will make sure that management knows what is happening’’. Head of the public relations unit at the ministry of Health, Tony Goodman was responding to findings of the undercover investigations that unearthed practices where patients are not issued with receipts when they visit public health facilities for medical attention upon payments.

we came across one Edward Adeti, a middle-aged man, based in the Upper East Region who is unhappy that staff of a public hospital in the Bawku Municipality of the Upper East Region, last year failed to issue him a receipt after he paid the charged amount. He told our undercover team that he got infuriated that he was left with no option than to confront the staff. ‘‘I was shocked as to why I was not issued a receipt after I paid. I was compelled to confront the staff. Unfortunately, the receipt was still not issued to me after the complaint’’.

Edward Adeti is not alone. Another middle-aged man, a resident of Akorabourkrom in the Atwima Mponua district who did not want his name mentioned, recalled how a public health facility, in the district he visited with his son for health care few months ago did not issue him a receipt. Interestingly, he told our team that he was unaware that obtaining receipts was necessary. 

At the Tweapease health centre of the Amansie Central district of the Ashanti region, an out-patient told the team that recipt are mostly issued upon request. ‘‘if you request for a recipt, they will issue you’’. She spoke to the team in Twi. 

On December 15 and 16, 2025, we pitched camp at the Bekwai District Hospital to monitor if patients are issued recipt. All patients we spoke with were giving recipt. The practice of not giving out recipt appears to be minimal at the district hospital, but not same at the CHPS.

How much is the state losing with regard to these practices? 

“We have internal auditors that really do their work. At the district level, at the regional level that supervises some of these activities to make sure they are okay. So we need to look into it to find out what really happened,” Jacab Andoh, public relations officer of the Ghana Health Service.

Ghana has always made enough space for healthcare delivery in its annual budgets. In the 2025 budget, an amount of GH₵17.82 billion. More than 1.5 million dollars was allocated to the country’s health ministry as captured on the budget presented by the finance minister Dr. Cassiel Ato Forson on Mrch 11, 2025 on the floor of Parliament. This figure represents 6.32% of the national budget, surpassing the World Health Organisation (WHO) recommendation.

The Ministry was fourth after that of the road, housing and energy ministries in terms of amounts allocated to each sector in the budget presentation. 

Aboaso Health Centre, Kwabere East District

As of August 2022, Ghana had 7,745 (seven thousand, seven hundred and forty-five) public health facilities, with the Ashanti region having the highest number of facilities being 1,709 (one thousand seven hundred and nine). The nation’s capital, Greater Accra, followed with 1,299 (one thousand two hundred and ninety nine).

Joshua Kewura, head of staff at the St Peter’s Health Centre says he would want the matter properly looked at.

On June 12, 2025, as the team made another visit to engage patients in some public health facilities, we came across Veronica, who visited the Nkromah CHPS compound with her dauther. She told the team that she was unaware that requesting for receipts was necessary. 

“I have never been issued receipt in all the hospitals I have attended,” she told our undercover team as she walks out of the Nkroma Community-Based Health Planning and Services (CHPS) compound where she sought an out-patient medical attention. 

Weeks after our first visit to the said facility, just like Veronica, Yaw Dam was not issued recipt too. 

At the Nyinahin Government hospital, patients showed receipts upon discharge. 

At the Konfo Anokye Teaching Hospital (KATH), one of the premier referral Centres in Kumasi, patients showed receipts to the team. ‘’I have being frequenting this place for the past one-year. I have always being issued with receipts upon every visit’’. A patient told the team.

For the management of the Ghana Health Service, frustrated victims including Adeti are assured that appropriate measures will be put in place for appropriate state institutions to make sure the right things are done. Jacob Acquah Andoh assured.

A response to a Right to Information request [RTI] sent to the Ashanti regional health directorate, seeking for number of patients who visited public primary health care institutions indicates that 304122 patients attentented public Community-based Health Planning Services [CHPS] and  Health Centers between April and June 2025.  

When contacted via phone, the Ashanti regional director of health services, Dr. Fred Adomako Boateng says he is unaware of the practice in the region. ‘’I am unaware. You are telling me. I will follow up. We work with intelligence, I will have to follow up and confirm’’. He said.