Some tips on setting up a hospital
The Healthcare industry can be lucrative, if you really understand it. It is one of the most rapidly growing industries. Nigerians are said to spend an average of 1 billion US Dollars annually on health tourism. Two hundred and fifty million dollars of that is spent on trips to India alone. Anyone who can properly position themselves to tap into that market stands to make a healthy income and profit. In Ghana the market for medical services is rapidly expanding, with new hospitals springing up regularly.
Even though there is a lot of successes and money to be made, a proper understanding is required. Before you sink your hard earned cash and that of your partners into building a health facility, there are a few things you need to bear in mind …
You are not the government.
The government can do things you as an individual cannot even dream of doing, and even if you were able to conceive of them, it would be illegal for you to attempt them.
The Government can owe people and refuse to pay
As scandalous as that sounds, it is a fact. The government can buy supplies this year and pay next year, and even in that case choose to pay a fraction of the cost. All over the country, you’ll find contractors who have executed contracts and are still yet to be paid years afterward. You will also find many people in jail who defaulted on their debts. Running a hospital requires a lot of supplies, and you have to pay your supplies promptly for obvious reasons. It will pay you a good dividend to keep that in mind.
The government can print money – you can’t.
When the government runs out of money, it can simply print some more. You are not so fortunate to have that right. A government organization was building a hospital. They were setting up several operating rooms. I tried to make contact with them to recommend an anesthesia machine to them. This particular anesthesia machine is from the United Kingdom, and has several features that make it well suited for the peculiar situation in Ghana. For one it is very compact and durable. The parts are easily serviceable. Any technician can be trained to service it. In addition it comes with a standby battery that can power the machine for up to six hours if the main electricity supply goes off. Another advantage is that it comes with a built-in oxygen concentrator. That means that it simply generates its own oxygen from room air. Since we started using this particular machine our oxygen costs went down by about 90 percent, plus we didn’t have to panic anymore whenever the electricity went off in middle of a procedure. We simply continue as if nothing happened. Despite all these features it costs less than a third the cost of the regular anesthesia machines on the market. I wasn’t recommending this machine for personal gain, or for a commission. I wanted to help. The Head of the Committee when he was informed claimed they had already completed the deal for the contractor to supply the high-end anesthesia machines which cost several times more. The sad thing is that these government owned facilities are generally constructed with huge loans which take several years to pay. The particular hospital has been completed and remains unopened for about two years now. Why was the government organization not interested in saving money? Because it’s a government owned organization. They don’t have to save money. You, on the other hand, need to consider several factors before you sink your hard earned cash into frivolous expenditure.
Also on the issue of money, the government hospitals don’t have to worry much about overhead because their workers are paid by the Central Government. Their doctors and nurses are on government payroll. That means that whether theta hospital makes any income or not, their workers will be paid by the Central Government. You don’t have that luxury. You have to run your hospital or clinic as efficiently as possible and generate enough income to continue to attract and retain the right caliber of staff and also generate enough profit to make it work your while.
The government can get away with bad customer service – you can’t.
Just pay a visit to some public hospitals and observe the testy exchanges between some of the staff and the patients. You would be wise not to try that at your private facility. For obvious reasons.
The government can and will survive any number of lawsuits – you might not
The government can simply post its workers to any of its numerous facilities and does not even have to ensure that they are well suited for the task. The government does not have to enforce the highest standards of care at its facilities. If the government gets sued, life goes on – for the government. You on the other hand, would be playing Russian roulette if you do not ensure that the highest standards of care are implemented at your facility. You must also ensure that you carry adequate professional indemnity, or what is called malpractice insurance. The other day a health worker at a public hospital was found to have killed a few people just by giving them intramuscular injections. They developed florid abscesses and died within days. It was found that the person who administered the injections was not even qualified to administer injections to start with. He was not a doctor or a nurse. It also emerged that he had simply mixed the medication into a bag of diluent and kept drawing from it to administer to the patients. He did this to save himself the trouble of having to mix the drugs as needed. It did not matter that the drugs came as single – dose vials. The case made the news for several days, and then died out as other salacious news items emerged.
You are not the Red Cross or MSF
You also need to remember that you are not the Red Cross. The Red Cross raises money by begging rich people and countries. They have been in the news recently for not managing the donations well, but the Red Cross keeps going. It hasn’t folded up, nor is it likely to. You on the other hand may not have the elaborate systems instituted for begging for money, and will have to make sure that you are adequately resourced to bear the setting up and operational costs involved. This simply means that while The Red Cross can continue to be a charity, that “business” model will largely not work for you. If your goal is to run a health care charity, it will be simpler for you to focus on raising funds so you can help pay the hospital bills of those in need. Setting up a hospital specifically for that purpose might not be a viable venture. Just for your information, you can be held professionally liable even if you are providing services for free. An aggrieved patient can sue you if they believe your free service caused them harm.
Focus on the 20 percent
You have probably heard of the 80/20 principle. It may actually be 90/10 or 95/5 or 99/1 or 75/25 – it doesn’t make any difference. The point is that most of your income in any business comes from the minority of your range of services, or goods, and from the minority of your clients and customers. Your goal as a business owner or entrepreneur is to identify the niche that will bring you the highest yield, and leave the rest of the services to the government to provide. After all, you’re not going to be up for re-election. Right on the other end, you are up for a different kind of election on a day to day basis. Your customers are always voting on you and your hospital. That is why you have to make sure it counts for something. Why expend so much energy and resources providing low – yield services when you can instead focus on areas that will bring you better returns?
As simple as this is, this is the point where many enthusiastic businessmen, companies, and professionals meet their death. They acquire a piece of land, put up a building with dozens of patient rooms, and simply wait for the business to flow in. They soon find out that is a dumb business plan. If you were thinking along similar lines, you need to think again. No matter how many patient beds you have available, no well person will come and pay you to simply lie in them. Barring some epidemic, you’d be thankful if you had a thirty percent bed occupancy. And, if there’s an epidemic, chances are your beds are going to be occupied by people for FREE. You cannot eject an EBOLA patient from your hospital because they cannot pay their bills.
Sometime ago the owner of a big health facility was negotiating a partnership agreement with some investors. It increasingly became apparent that the said facility was in dire straits. The owner had sunk a lot of money – borrowed money – into putting up a humongous structure. He ended up utilizing just about a quarter of the structure. Because of all the cash he had sunk into the building itself, he did not have the requisite funds to properly equip the facility, or to attract the requisite skilled labor to serve the patients. The banks were hot on his heels. In addition he couldn’t get his pricing right. He had started off setting his prices, only to quickly backtrack when a few of his initial patients complained. He thought he could attract more patients by reducing his prices. It didn’t work. His lower prices simply made things impossible for him. You need to understand that pricing in the health care industry is not exactly the same as pricing of commodities. You can attract more people to your grocery shop by adjusting your prices. Your market for the groceries is potentially all living and breathing human beings in your catchment area. The healthcare industry is not so. No matter how low your prices are, the only people who will come to your facility are people who need the services you offer. If you don’t position yourself properly in the eyes of the market, you will simply suffer by attracting the wrong kind of customers, and end up not being able to meet your overhead.
When our facility was being set up, I realized from the beginning that we had to pay particular attention to our pricing. More important we had to position ourselves properly. It takes as much work to sell to a “rich man” as it does to sell to a “poor” person. The problem with the latter group is that no matter how hard you work, the person who cannot afford your services simply cannot afford them. In addition, let’s say you are running a Maternal Health facility. You can make your services as cheap as sand, and it won’t make much difference because only a finite number of women are pregnant at a particular point in time. A cheap maternity service cannot attract men to come to your facility, nor will it attract non-pregnant females. Remember also that you cannot beat the government in a price war. The government can offer, or pretend to offer, free health care at will. I recall when Ghana introduced “free” maternity services for pregnant women. It was simply done by an announcement in the media. No change in the number of doctors or nurses, no increase in infrastructure or logistics. Just a cold press release. You see why you can’t compete with government when it comes to pricing? It is far better for you to zero in on the many untapped niches available in the health sector.
From the inception of our hospital, we began to experience the push from various people, some well-meaning, to slash our prices. What they didn’t understand was that a lot of thought went into determining our prices. We knew what it would take to deliver the quality of service we wanted to give our patients. We also knew what would be required to meet our overhead. We stood our ground, and it worked. Which is easier – to sell one pricy item or to sell a hundred cheap item? Unless you are Walmart or Amazon, the former is easier. Within two short years we have had patients come in to see us from across Africa: Mali, Cote D’Ivoire, Togo, Liberia, Nigeria, as well as the United Kingdom, the United States and the Middle East. We serve a growing number of people from the expatriate community. During the same period we have seen other new facilities spring up and do quite well, old ones struggle to the brink of collapse, and some stuck perpetually in the “construction” phase. I recall meeting a certain gentleman who represents a certain global investment group. They had planned to build a multi-specialty facility. They even went as far as recruiting some top-notch doctors from Europe and paid for them to relocate to Ghana. It’s been a few years now, and not a single brick has been laid. The doctors they recruited are drawing salaries while volunteering their services elsewhere. Someone must have taken a special class in how to complicate simple projects. First they were going to put up a new structure in the heart of town. Then they abandoned that plan and went to try to acquire a certain facility. They drafted a plan of redesigning that facility. They must have hired an architect and several engineers. I visited that facility a couple of times and was granted a tour. It had enough rooms to be used for the purposes. There was no need for any redesigning. The project still hasn’t taken off, as at the time of this writing. Hopefully they’ll get it right one day. From all indications they have the money. How else would they have successfully recruited those doctors who are drawing salaries and yet volunteering their services elsewhere? The money isn’t their problem. The lack of relevant common sense is. They could have had a multimillion-dollar business running already if they only knew how to.
Whatever you do, do not copy the government model. When you pass by a hospital that looks busy with lots of patients queued up, don’t be too easily impressed. They could have lots of patients queued up because they operate a poor system which hinders patient flow, or they simply don’t have enough doctors to see the patients. I recall one such facility. They were the first hospital in that community. There was no government hospital nearby. The residents quickly took to the place. They had good patronage. At some point they had about three doctors running the outpatients department in the mornings. One of the doctors died. Then another became too sick to work. They didn’t replace either of them. They were down to one doctor. Then a new hospital opened up nearby. They had excellent customer service. Guess what happened to all the people who used to queue up at the other place. If the first facility were a government hospital however they would not have had much of a problem. After all the National Health Insurance Scheme would have kept them well patronized. People would have continued to go there and queue because they didn’t have to pay out of pocket for many services. Even if the facility wasn’t being patronized the government would still continue to take care of their payroll and other expenditure so they wouldn’t have much to worry about. There would be no investors or venture capitalists breathing down their necks demanding some good returns on their investments.
Keep it simple – sir! (Or Madam)
Don’t set out to set up a big hospital initially. Identify a niche (or a few niches) and focus on that. Focus on services that have a high gross margin. I’ll give just one example in this document. The field of Assisted Reproductive Technology is one rapidly expanding and profitable niche in Ghana. It is recommended that countries maintain a ratio of 1500 IVF cycles per million people. That would mean about 42 000 cycles for a country of 28 million people. Ghana is far from achieving this target. The average IVF center in Ghana conducts about 200 to 400 cycles a year. An IVF suit would cost about 500,000 USD to set up. That is assuming you are setting up ONLY an IVF center without supporting facilities. To maximize that niche, an extra 1million USD should be budgeted for the provision of a properly equipped laboratory and Gynecology units. Most IVF centers in the United States and other countries are well supported by such units, which greatly enhances their success rates. If you don’t include such services, you’ll soon have to outsource those services, thereby missing out on a significant stream of income. Most IVF facilities in Ghana do not spend anything close to this amount for their initial setup. Of course it’s an open market, and you can get a good bargain on your purchases. Right on the other hand, it can simply be a sign of cutting corners, which can be a reason why some centers have lower success rates compared with international standards. If your goal is to set up a lasting business enterprise, you need to be ready to invest properly. Sometimes all it’ll take is for you to shift your business model from a large sprawling edifice to a simpler more compact model. A well designed two – floor structure with a dozen rooms is usually adequate to provide a full range of gynecologic services, and a fully functional IVF center.
IVF services have a very healthy gross margin. A cycle of IVF can cost the patient anywhere up to 10 000 USD. The gross margin can be in the region of 80 percent or even higher. Most centers insist on upfront payment. If you set up and maintain the requisite standards, you are looking at a potential gold mine. If this is potentially so lucrative, why aren’t many more people venturing into it? The answer is that it is simple if you know what you are doing, plus if you have the required funds to invest. Some people know what to do, but they don’t have the funding. Others have the funding but lack understanding of how to do it. This is why the quality of the team is important. I visited a major quasi-government health center. It had just been completed but was yet to be open to the public. It was top notch, with several units and departments. I asked the CEO, “where is your IVF center?” “It’s going to be part of the second phase,” he said. What about your dialysis unit? Phase 2. What about laparoscopic surgery? Phase 2. Cardiac catheterization? Phase 2. It was obvious this facility was soon going to run into problems. They had a large outpatient department, and huge wards for admission. Just to give you an idea, you can keep a patient for 24 hours on a ward and charge them 100 USD. You can carry out a surgical procedure on a patient and charge many times more. Depending on the procedure and other factors they can go home three hours later. Which would you rather be focused on?
Avoid second hand equipment if you can
The issue with second equipment is that they break down. People generally buy these equipment on the flea market, without any form of service agreement. A health facility in Accra went and bought a CT scan machine. The machine was quite old but was still functional. The hospital thought they were getting a good deal. They had it installed. A few months later they needed to carry out minor repairs. The bill they got could have bought another one of those old machines. Both payments could have bought them a brand new CT scan, or at least a certified used one with manufacturer’s warranty. There are payment plans available for new buyers, and it is common sense to properly research into them and get yourself a good deal. The medical equipment market is like the aircraft industry. Airline companies have bought older airplanes at very low prices, only to be forced out of business because they could not pay for the servicing of the aircraft. Another fact to bear in mind is to remember that the older the equipment, the higher the chances that the manufacturer would have stopped making parts to support that particular model.
You need reliable energy
A certain health facility pays about five thousand USD as electricity bill to the Electricity Company of Ghana every month. The sad thing is they hardly make that much in a month? How is that possible? They have a huge structure. Elephants drink a lot of water and consume a lot of food. Big buildings cost a lot to maintain and consume a lot of electricity. It’s that simple. This bill was at a time when there was erratic power supply in the country (the famous “Dumsor”). They had to spend a similar amount powering their generators. The fact is with proper planning that entire building could have been solar powered. Plus they needed a much smaller building than the one they had.
Central air conditioning is nice and fancy, but you must be cautious. Your operating room suite should have central air conditioning, but everywhere else can do with split units. It’s easier to manage the consumption that way. You can switch off the individual units in offices that are unoccupied and save on your bills. At last check the Electricity Company of Ghana was selling power at $0.2 per kWh. You can easily rack up bills in the tens of thousands if you don’t plan effectively.
Standby generators are a must. In Ghana energy is something you can’t have too much of.
You’ll need to have voltage regulators in place, and you’ll have to have UPS batteries in place for some of your equipment. That goes without saying.
You’ll need water
It will be a good idea to sink a borehole to supplement the water supply from the Ghana Water Company. You’ll need a water purification system as well, for desalination and purification. A well installed reverse osmosis system will go a long way to help you. For the first few years of our operations we relied solely on our borehole system for water. You cannot have a health facility without running water. To maintain the right level of cleanliness you need water. You need water to sterilize your equipment.
By all means you should carry malpractice insurance. Government facilities can survive several lawsuits. You can’t, without adequate insurance cover. There is a private health facility which has faced several lawsuits over the years. They have survived. They have good malpractice insurance. A public hospital was sued for amputating the wrong leg of a young man. They survived it without any insurance cover. They are a public hospital. The government will bail them out if it has to. A good rule of thumb when it comes to estimating how much cover you need is this: multiply whatever you think you’ll be sued for by ten. That should be the minimum total value of the cover you need. I got a call from a friend of mine recently alleging that one of his babies had been stolen at a private facility. He and his wife had undergone antenatal care at the facility for the entire period of the pregnancy. They had done numerous scans, and had been examined by the obstetrician during each antenatal visit. They were told they were carrying twins. He said the sonographer always showed them the two babies. Their obstetrician never took issue with any of the scans. He planned a mode of delivery. An elective cesarean section was planned. The husband was not allowed into the operating room. The twins became a single baby. He is angry and distraught. He’s planning on suing.
Assets all risk insurance
I assume you will take an assets all risk insurance for your buildings and equipment. That goes without saying. You need to properly insure all your buildings and equipment. Medical equipment can be expensive, and the least you can do is properly insure all your assets.
You’ll need to hire the right staff
Attracting the right caliber of staff is key to the success of your enterprise. Medicine is more than simply prescribing treatment. You must connect with your patients. These are the things that patients and their families remember long after the ailments are cured. If you are deliberate about it, you will attract workers who are not only skilled but compassionate as well. This is the key to the success of your practice. In fact, your caliber of staff will even determine whether or not you’ll get sued, to a large extent. Studies have proven that patients hardly ever sue doctors they like. There is an art to hiring. For certain key positions, I actually go incognito to the candidates’ place of work and observe their interactions with patients and their colleagues. I want to see them in their natural state, not in their “interview state.”
Part of the hiring decision is the salary you are prepared to pay. You don’t have to break the bank, but you have to be prepared to pay proper wages in order to attract the right caliber of staff. The right workers will pay you back many times over by increasing your patient satisfaction, recommendations and as a result your profitability. The wrong kind of workers will bleed you dry.
There are some things you can compromise on, but others you can’t, or rather shouldn’t. Do not cut corners when it comes to staffing. It is true that you can decide to do the barest minimum required by the regulatory agencies, but you’ll soon find out that that will not help your practice in the long term. Most patients would rather pay and receive quality service than take a chance with their health. Adverse outcomes have occurred in even the best equipped and staffed centers in the world, but there are simple steps you can take to minimize their occurrence.
You’ll need supplies
Medical supplies and consumables are a necessary part of your operations. Public hospitals run out of supplies routinely. There are public hospitals which send out their patients’ relatives to go and buy gloves to be used on the patients. The government can get away with such nonsense. You can’t. Make sure you properly research the medical supplies market, and obtain several sources for each consumable. It is shameful to run out of gloves, gauze and cotton wool. With a little bit of imagination and common sense, you can actually produce some of these supplies on your premises. There are huge rolls of gauze you can buy and cut and sterilize for use at your facility.
If your goal is to become known as a center of excellence, you need to set the tone right from the start. Encourage your practitioners to join international bodies of repute. Membership of such professional bodies helps inculcate a culture of excellence and conformity to certain industry standards. As much as possible, you need to discourage the use of discretion in the management of patients. It is much better and safer to use properly developed and time tested guidelines. For most medical conditions there are management algorithms developed by reputable bodies that have been formulated. The benefits of using such guidelines and checklists include standardization of care within and across facilities. Whereas the finer details of care can vary from doctor to doctor and hospital to hospital, the principles undergirding the proper diagnosis and management of diseases should not vary greatly. It is commonplace to see wildly varying standards and quality of care even within the same facility. Such variability is unacceptable. Take the airline industry for example. The principles of aviation are the same no much which airline you travel with. Aviation is the safest means of travel, and has remained that way for decades. This didn’t just happen fortuitously. It was the result of deliberate effort on the part of the airline industry. When the Boeing B17 prototype crashed shortly after takeoff in 1935, killing the pilots, an extensive investigation was conducted, revealing that the crash was due to the failure of the crew to disengage the gust lock before takeoff. Boeing instituted checklists for pilots, and the entire aviation industry came on board. No commercial pilot is expected to rely on memory, experience or sheer skill to fly a plane. This is why despite a few mishaps here and there, air travel has quickly evolved to become the safest means of travel. If you learn to introduce the use of standard guidelines and checklists into your facility right from the beginning, your practice will quickly acquire a reputation for excellence. Patients can come in expecting to receive the same high standard of care consistently. You can walk into a MacDonalds anywhere in the world and the burger will taste the same. Franchisees make sure they maintain the same standards of cleanliness in the washrooms, else their license would be at risk of being revoked. It is the same standardization that makes every single bottle of Coca Cola taste the same. When you walk into your favorite hairdresser’s salon, you expect the same great service each time. If the service is variable or unpredictable, you will soon begin to look for a new hairdresser. That is the same thing that happens to health facilities. A doctor of average intelligence who uses checklists will have better outcomes than a super intelligent doctor who routinely relies on his discretion and “intuition.” Let me give you one example of how a simple checklist can save lives. In order to prevent the situation where during surgery the wrong operation is carried out, or the wrong site is operated upon, or the wrong patient is operated on, the Joint Commission, an international accreditation body, came out with the Universal Protocol in 2004, which includes the following three steps:
- A preoperative verification process
- Marking the procedure site
- A Time Out performed immediately before starting the procedure. (The Time Out is a simple pause immediately prior to starting the procedure where the surgical team confirm the identity of the patient, the nature of the procedure and where necessary the site, and also mention any important issues that need to be considered by the team. There are a few other details, but essentially the Time Out lasts less than a minute in most cases.
This simple three – item list has been proven to drastically reduce the incidence of adverse outcomes in hospitals. A public hospital was in the news some time ago for amputating the good leg of a young man. It was not an emergence surgery. Proper implementation of the Universal Protocol would have avoided that situation. If you want to do well and be known as a center for excellence, SOPPs are obligatory. Always be on the lookout for the best available guidelines and protocols and implement them. By doing that you will be able to eliminate discretion to a large extent from your facility, and offer consistently reproducible high quality service which your patients will grow to trust. Treatment will not vary greatly from patient to patient, doctor to doctor or from day to day, even though it will be individualized. Laboratory investigations will not be “forgotten” where they should have been done, and your incidence of misdiagnoses will go down.
Accounts and Taxes
The Ghana Revenue Authority will pay you a visit at some point during your operations, unless you are running your facility inside the core of the earth without any visible entry or exit. It is better that you initiate the first encounter with the GRA. Simply go over to the nearest office and complete the required forms. Shortly after that process is complete they’ll visit you at your premises, but that visit is much more pleasant than if you stayed in hiding till they came and found you.
Good bookkeeping is important. You can hire a good Accounts Officer, then get a chartered accountant on retainer to supervise the person. Engage the services of an auditor early, so that your books are ready by the due dates for filing your audited accounts.
Good bookkeeping also helps your track your revenue and expenditure, so you can fine tune your finances and attain maximum profitability.
Get these workers on retainer
Plumbers and electricians and biomedical technicians are crucial to the running of any health facility. I suggest you invest in employing an electrician and biomedical technician full time. A good technician will save you lots of money. It can be quite frustrating when you can’t work because some minor fuse needs replacing and you are looking for an electrician to get it done. Plumbing problems can create a mess and drive your patients away. Such issues need to be addressed promptly. Regular maintenance is key. If you have a water purification system installed it needs regular maintenance, and having a plumber on retainer can save your system from collapse. Simple tasks like switching oxygen and gas cylinders and making sure they are filled requires dedicated personnel.
Cleaners, bathrooms, etc
You need to invest in cleaners and cleaning. Your washrooms must be kept spanking clean. That is usually the first place many of your patients head to when they visit your facility. Make sure you have many bathrooms. Having people queuing up to take a leak does not leave a good impression. Have as many bathrooms as possible. There should be bathrooms on each wing and in each office. Bathrooms should be easily accessible to patients and visitors to your facility. The moment someone enters the bathroom and comes out, a member of your staff should quickly go in there and make sure the place is clean and tidy for the next person to use.
Don’t be too eager to offer “24 hour” outpatient or “emergency” services
It sounds nice, but if you’re not careful you’ll simply be increasing your overhead costs unnecessarily. There is no need to open your facility for 24 hours each day. Of course if you have patients on admission you’ll have staff present to attend to them, but don’t simply keep the place open offering outpatient services round the clock. Your electricity consumption will go up. Your water consumption will go up. Wear and tear of your facility will increase. Your wage bill will increase. And you will not be doing enough business at night to cover those expenses. If you are overly concerned about what would happen to “all” the people who might need your services at 1am if you’re not open for business, there is a simple solution. You can site your clinic or hospital close to a government facility that provides 24 hour services. Most poly clinics offer 24 hour services. In addition, make sure that you have your ambulance and ambulance driver ready at all times. It is mandatory for private health facilities to have at least one operational ambulance. This model is not cast is stone, and can be adjusted to meet your peculiar needs. For example, if you run a cardiac catheterization lab, you’ll need to make it more accessible to patients who might require the services. A little nugget here: most imaging centers in Accra do not operate round the clock. You can attract a lot of healthy patronage just by having a CT scan that operates at night, between 6pm and 6am. I do not advise running the same CT scanner round the clock continually. There are ways to go around this, which I will discuss at another time.
Maximize the use of your equipment
You can run plain CT scans at 100 USD apiece, or you can run CT scans with contrast at five times that amount apiece with minimal increase in direct cost. If you add interventional procedures, you will quickly multiply your revenue. It all depends on your mindset and readiness to invest. You could go on the flea market and procure some run down ultrasound machine, and be charging ten dollars per scan, or you can invest in the right ultrasound machines, get a good radiologist and add other services such as ultrasound guided biopsies that could fetch hundreds of dollars per procedure.
Private Health Facilities fall under the jurisdiction of the Health Facilities Regulatory Agency is the body that is in charge of licensing and regulating private health facilities in the country. You cannot operate a health facility in Ghana without the relevant certification. The registration process at HEFRA itself is pretty straightforward, even though it may take some time to complete because of the documents you’ll need to submit. You can visit their website http://hefra.gov.gh/ for more information.
The doctors who work at your facility are required to be licensed and be in good standing with the Ghana Medical and Dental Council. This goes for foreign doctors who come in to practice as well. This is one area where some people cut corners. You may get by with it until you get into trouble, and then it could quickly get complicated.
The Pharmacy Council is in charge of licensing pharmacists, and the Nurses and Midwifery Council is in charge of all nurses and midwives. Make sure all your professional workers are duly licensed.
This is worth repeating: don’t cut corners, as much as possible. You can consult if you are not sure. A good consultant will save you money.