…As ‘Pay-to-Jump-the-Queue’ system comes under fire
Serious questions are being raised over the operation of intramural services at the Korle Bu Teaching Hospital, following allegations that some patients may be gaining faster access to specialist care by paying additional fees, while others without the financial means are allegedly left to their fate, singing along to Horatio Spafford and Philip Paul Bliss’ hymn, It Is Well with My Soul.
Intramural services are additional healthcare services provided by health professionals within their own public hospital or institution, usually outside the normal public-service arrangement and often for an additional fee.
At Korle Bu, the arrangement generally refers to services provided by doctors and other specialists to patients for payment, separate from the hospital’s regular public-service pathway.
Such services can have legitimate purposes, including providing specialists with opportunities to offer additional consultations or procedures while helping public institutions retain experienced professionals.
The controversy, however, arises when intramural services allegedly give paying patients faster or preferential access to treatment that should ordinarily be available through the public system.
The issue follows a publication by The Herald on September 2, 2026, under the headline: “Health Workers Accused of Profiting from Desperate Patients Through Intramural Services.”
The allegations have since triggered wider concerns about the relationship between the hospital’s regular public services and its intramural arrangements, with patients reportedly coming forward to recount their experiences.
At the heart of the controversy is a question that goes beyond individual health workers or departments: Is Korle Bu operating one healthcare system, or are two systems gradually emerging within the same public hospital?
The question is particularly significant because Korle Bu is Ghana’s premier public referral hospital, serving thousands of patients every year, many of whom have little or no capacity to pay additional fees for medical attention.
The concern arises when access to a paid service creates an advantage over patients relying on the ordinary public system.
If a patient can be seen more quickly, obtain earlier specialist attention or secure access to a procedure simply because he or she can pay more, the principle of equitable access to public healthcare comes under serious pressure.
Healthcare is fundamentally different from most commercial services. A patient seeking treatment is often vulnerable, anxious, and dependent on the professional judgment of those responsible for his or her care. In many cases, the patient cannot afford to wait indefinitely or negotiate from a position of strength.
This makes the allegations particularly troubling.
If patients begin to believe that the fastest route to a specialist, an operation, or another critical intervention is through an additional payment, confidence in the public healthcare system could quickly deteriorate.
The issue, therefore, is not simply about money. It concerns fairness, professional ethics, and equal access to care.
The concerns are likely to attract particular attention in specialties such as Surgery, Anaesthesia, Plastic Surgery and Orthopaedics, where patients may present with painful, debilitating or potentially life-changing conditions.
Patients attending the Neurosurgical Department are also reportedly among those affected by the practice, with concerns over what they describe as substantial intramural charges.
An invoice sighted by The Herald showed intramural fees exceeding GH¢30,000.
According to patients attending the clinic, such charges can have a significant impact on their ability to access clinical care, with some claiming that their conditions deteriorate as they struggle to meet the costs associated with the service.
For patients with serious or debilitating conditions, delays can carry significant consequences.
A public hospital must therefore be able to demonstrate that clinical need, rather than financial capacity, is the principal consideration in determining access to treatment.
The mere perception that paying privately can move a patient ahead of others is enough to raise legitimate questions about the integrity of the system.
It is important, however, that the allegations are not treated as established facts. Health professionals must be given the opportunity to respond, while patients who raise concerns must also be heard.
What is required is not a rush to judgment but a credible process capable of establishing what is actually happening.
The controversy also places the spotlight on hospital management.
Questions are being raised about the safeguards in place to prevent conflicts of interest, how hospital equipment and facilities are used during intramural services, and the mechanisms for independently investigating complaints of preferential treatment.
These questions are important because the issue extends beyond individual transactions. It concerns the governance of public resources and the confidence Ghanaians place in one of the country’s most important healthcare institutions.
There is a legitimate argument for allowing specialists to undertake properly regulated intramural work.
However, there must be a clear boundary between legitimate additional services and arrangements that could undermine the ordinary public healthcare system.
Public hospitals are funded and supported by the Ghanaian taxpayer. Their infrastructure, equipment, and institutional capacity exist primarily to serve the public.
The ability to pay for an additional service should therefore never become an unofficial requirement for obtaining timely, high-quality care.
If intramural services are to continue, they must be governed by transparent rules that protect public patients and prevent conflicts of interest.
There must be clarity on scheduling, fees, the use of public resources, specialist availability, and the separation of public and private interests.
The emerging concerns provide sufficient grounds for the Ministry of Health to take a closer look at how intramural services are operating at Korle Bu.
An independent review could examine patient waiting times, appointment systems, theatre and bed allocation, specialist scheduling, financial arrangements, and the use of hospital facilities and equipment.
Parliament may also have a role to play in seeking answers on the broader policy and governance implications.
Such an investigation should not be viewed as an attack on Korle Bu or its health professionals.
On the contrary, transparency could protect the institution and its professionals from allegations that may ultimately prove unfounded.
If the allegations are false, evidence should establish that clearly. If weaknesses exist, they should be corrected, and if wrongdoing is found, those responsible should be held accountable.
For a hospital as important as Korle Bu, public confidence is an asset that cannot be taken for granted.
The institution represents hope for patients from every part of Ghana. It is where complicated cases are referred and where families turn when they need some of the country’s most specialized medical expertise.
That responsibility comes with an equally important obligation: a patient’s ability to pay must never determine the patient’s worth.
Intramural services may have a legitimate place within Ghana’s public healthcare system. But they must not become a mechanism through which public healthcare is gradually divided between those who can pay more and those who cannot.
The ultimate test is straightforward: Can a Ghanaian who cannot afford to pay extra still receive timely, dignified and quality care at Korle Bu?
If the answer is yes, the institution must be able to demonstrate it through transparent systems and evidence.
If the answer is uncertain, then the time for an honest examination of the system is now.
Korle Bu belongs to the public. Its doors must remain open to every patient, not only to those who can afford to pay for a faster passage through them.
