Presentation on GHS Code of Conduct and Disciplinary Procedures

1. Presentation on GHS Code of Conduct and Disciplinary Procedures DOMIE GODSWILL:- chPA, CMC, MBA, BSc HSA, PgCcert- Mgt & Leadership,WU-USA; PgCert- Governance& Leadership; Pentecost University, Ghana. MPH student- CUCG DEPUTY DIRECTOR ADMINISTRATION-GHS WNR

2. GHS CODE OF CONDUCT & DISCIPLINARY PROCEDURES • The code is primarily meant to guide the conduct of all managers and employees of the Service in their normal dealings and relations with patients, clients, fellow employees and the general public. • It draws lessons from available laws, rules, regulations, relevant codes of all health professionals and the Patients’ Charter

3. OBJECT OF THE SERVICE GHS exist basically to • Implement approved national policies for health delivery • Increase access to improved health services • Prudently manage resources available for health service provision

4. SCOPE OF THE CODE • All GHS employees • Personnel on contract or secondment to the GHS • Personnel on leave of absence with or without pay • Any other person(s) working with the GHS under approved terms

5. DEFINITION OF DISCIPLINE & INDISCIPLINE • Discipline – Orderly behaviour of employees in the Service and obedience to the existing rules and regulations • Indiscipline – Any act of omission or commission contrary to the above definition

6. GUIDING PRINCIPLES • Delivering quality health service in a humane and equitable manner within the resources of the country • Upholding the dignity and interest of patients / clients, staff and service providers • Adhering to the provisions of the patient’s charter • Exhibiting high levels of professionalism • Promoting the corporate image of the Service • Exhibiting competence and effective leadership at all times Guiding principle

7. GUIDING PRINCIPLES • Avoiding discrimination against patients, clients and employees on the grounds of - the nature of illness - political affiliation - occupation - disability - culture, ethnicity, language, religion, etc

8. CONSTITUTIONAL & CIVIL RESPONSIBILITY • Be accountable to the President and Parliament through sector Minister • Be accountable to the public* • Be accountable to the immediate superiors and the Governing Council of the Service • Not openly engage in party political activities whilst in the Service • Not put oneself in a position where personal interest conflicts with legitimate duties

9. DISCIPLINARY AUTHORITY IN THE GHS • Ultimate Disciplinary Authority rest with the President of the Republic, with respect to members of the GHS Council and Category A1 staff of the Service • Delegated Authority, which is in accordance with the structure of the Service

10. DISCIPLINARY AUTHORITIES AT THE VARIOUS LEVELS OF THE SERVICE • National level – the GHS Council, the DG, the DDG & Divisional directors • Regional Health Directorate – the RDHS • District level – the DDHS • Institutional Level – the Head of institution e.g. Med. Supts. • Note that this function can be delegated to others

11. DISCIPLINARY PROCEEDINGS Reporting the incidence (within 3 working days) Preliminary investigations, which may take the form of • interview(s) • Inspection of documents etc • letter of enquiry

12. DISCIPLINARY PROCEEDINGS • Where the results of the preliminary investigation point to a conclusively minor offence or misconduct, the officer i/c shall apply the appropriate sanctions within 3 working days • On the other hand if the results point to a major offence, the in-charge shall proceed with formal disciplinary proceedings and take any of the ff actions – interdiction, issuance of query or setting up a Committee of Inquiry

13. INTERDICTION • This refers to the suspension or exclusion from duty of an employee who is alleged to be involved in a case of major misconduct • The immediate supervisor has the responsibility of interdicting staff under him/her and is required to submit a report within 5 working days to the higher disciplinary authority

14. CIRCUMSTANCES FOR INTERDICTION • Where the employee concerned is likely to interfere with the formal proceedings • Where criminal proceedings are being instituted against employee • Where the employee is being investigated on grounds of professional incompetence or malpractice

15. CONDITIONS OF INTERDICTION • It shall remain in force until an inquiry has been concluded and the decision of the disciplinary authority conveyed to the employee • An employee on interdiction shall receive 2/3 of his gross monthly salary (no allowances shall be paid during the period • Where the employee on interdiction has not been found guilty his salary and appropriate allowances withheld shall be restored to him in full

16. CONDITIONS OF INTERDICTION • An employee on interdiction shall make himself available to his immediate supervisor and the investigating authority when requested to do so • An employee on interdiction shall not travel outside the country without express permission from the DG

17. OFFENCES • These are omissions and commissions by staffs that are considered as the code of conduct of GHS. Offences are in two forms • Minor offences • Major offences

18. EXAMPLES OF MINOR OFFENCES • Mgmt. or pre-empting clinical and other decisions • Disclosure of Providing false info. or withholding vital info. with the intent of misleading official information to unauthorized persons • Sexual harassment • Use of abusive language • Occasional intoxication or drunkenness whilst on duty • Non-compliance of official dress code

19. EXAMPLES OF MINOR OFFENCES • Failure to submit queries within stipulated time • Failure to submit requisite data & reports • Illegal or unauthorized collection of fees from clients

20. PENALTIES FOR MINOR OFFENCES • Verbal warning in the first instance • Warning in writing • Suspension from duty without pay and allowance for not more than two weeks • Cancellation of leave in cases of excessive unauthorized leave • Temporary change of work schedule • Refund of illegal / unauthorized money from clients

21. MAJOR OFFENCES • Theft, embezzlement, fraud • Rape and sexual harassment of coworkers, patients/clients or their relations • Aggravated assault and battery of coworkers, supervisors, patients etc • Persistent/habitual intoxication while on duty • Trafficking in and use of narcotic drugs • Improper demand or collection of unauthorized fees • Falsification of official records • Criminal conviction by a court of competent jurisdiction

22. MAJOR OFFENCES • Divulging of confidential info without lawful authority • Persistent / habitual absence from duty without permission or reasonable excuse • Vacation of post, refusal to go on posting and desertion of post or station • Impersonation • Professional misconduct, malpractice, negligence or incompetence

23. Major Offences- contd • Breaching of financial policies and procedures • Willful destruction of official documents or property • Seduction of patient/client while under the care of the institution • Refusal to handover • Failure to comply with disciplinary penalties or awards

24. PENALTIES FOR MAJOR OFFENCES • Suspension of salary immediately the disciplinary report is received • Deferment of promotion for 1 to 3 years according to the gravity of the offence • Dismissal and subsequent forfeiture of end of service benefits with exception of social security contributions • Removal from office (termination of engagement without loss of end of service benefits • Change of work schedule • Postponement or cancellation of training and any award

25. GRIEVANCES, PETITIONS & QUERRIES • A grievance is a formal challenge by an employee to a specific disciplinary action, policy or practice of an employer • It may arise from administrative omission or commission or disciplinary action (unfair treatment) • A petition is a request or an application by an employee to an authority seeking to draw attention to a decision or an indecision that the employee perceives to have adversely affected him or another person

26. COMMON CAUSES OF GRIEVANCES • Delayed promotion, processing of salaries, allowances etc • Posting • Perceived victimization • Favouritism / discrimination • Poor work environment • Occupational health & safety concerns • Poor remuneration / incentive

27. GENERAL PRINCIPLES OF GRIEVANCE REDRESSING • Good corporate governance is a pre-requisite • Authorities must demonstrate a just cause before or have ample evidence before disciplinary action is meted out to employees • Demonstration of equity and impartiality • Disciplinary action must reflect the gravity of offence and consistent with provisions in the Code

28. PROCEDURES FOR PETITIONING • Establish an act of omission or commission • Submission of a formal petition (in writing) to immediate authority • A colleague may represent a group of persons having a common grievance • The recipient higher authority shall immediately appoint a Committee or Inquiry Officer to investigate the matter and take needed action

29. FORMAT OF REPORT ON FORMAL DISCIPLIANRY INQUIRY BACKGROUND • Events leading to the decision to set up inquiry • Summary of charges • Rights/privileges accorded the accused METHODOLOGY • Venue of sittings, • number of sittings, • number of witnesses, • documents received, • oral evidence obtained

30. FORMAT OF REPORT ON FORMAL DISCIPLIANRY INQUIRY FINDINGS • Facts and inferences in support of conclusions in respect of each charge • Observations / comments on general conduct of accused • Summary of evidence RECOMMENDATIONS • Provide recommendations based on findings and in line with provisions in the GHS Code of Conduct & Disciplinary Procedures, type of offence / penalty

31. FORMAT OF REPORT ON FORMAL DISCIPLIANRY INQUIRY ACKNOWLEDGEMENTS • Give a brief statement of acknowledgement of contributions by witnesses and committee members • N/B Provide relevant appendices mentioned or referred to in the report

32. MEDICAL ETHICS AND MEDICO LEGAL ISSUES • Medical law and ethics is an area of law that regulates the relationship between patients and medical staffs pursuant to legal norms and other medical activities • Medical law basically deals with the mediation between bioethical dilemmas generated by human life. Some of these dilemmas has to do with issues of confidentiality, TREATMENT OF HIV/AIDS, vasectomy, abortion and surrogate motherhood among others.

33. BIOETHICS AND MEDICAL LAW • The subject bioethics as a discipline deals with the study of ethical issues and health care law as a legal discipline, as well as medical activity in general and results in the awareness of health professionals of human rights. • This is because the performance of activities of health workers is almost always linked to the question of life and death so lack of knowledge of basic legal acts would not be justified at all.

34. BIOETHICS AND MEDICAL LAW • Bioethics goes beyond the so called classical medical ethics, such as abortion, euthanasia, medical secrecy, relationship with the patient, to encompass issues such as cloning, organ transplantation, treatment of patients with AIDS, contemporary issues like disthanasia (the process of purposeless extending of life), artificial insemination, surrogate motherhood, manipulation of the human genome, genetically modified foods, and religious as well as ethical issues on respect of rights for example of the members of Jehovah's Witnesses in case of blood transfusion and hence the need to control medical practice with ethics and law.

35. BIOETHICS AND MEDICAL LAW • Generally, lack of knowledge and non-compliance with the ethical principles and medical law when put together can only harm the health care worker • Ignorantiajurisnocet (ignorance of the law harms). • Medical law and ethics are inseparable and indisputably medical ethics is the source of medical law • Although Medical ethics is closely related to law, both are not identical. Ethics offers higher standard of behavior than laws. Laws are country specific but ethics are universal and transcend national and international boundaries.

36. Ethical Responsibilities of Healthcare Professionals • The health worker must respect the trust given to him and in his work to be guided only by the interests of patients; • The health worker must provide accurate and reliable information to those who create health policy. In this way the health worker participates in making decisions which are important for the organization of health services and the distribution of health dinars; • The health worker, as well as all the others, has an obligation to work for justice and social interest; • The health worker must take into account the prescribed legal and regulated rules and regulations in order to reduce medical costs. Thus, the desire of patients and assessment of doctors are correlated with socio-economic needs; • The health worker is assumed to be primarily a morally responsible individual

37. Critical ethical/legal dimensions of healthcare provision • Duty of care to the patient/client • Consent • Confidentiality/Privacy • CONFIDENTIALITY IN HEALTHCARE PRACTICE • Confidentiality is at the heart of healthcare practice. It forms the basis for which patients would confide in healthcare practitioners. Confidentiality in healthcare practice is both a legal and an ethical issue. Under ethical and legal clauses that impinges on healthcare practice, healthcare professionals are by law and ethics under the obligation to keep all what transpired between them and their clients- the patient as confidential and must not transmit same or disclose same to any third party without the consent of the patient or as may be prescribed by law.

38. Critical ethical/legal dimensions of healthcare provision • Confidentiality in healthcare practice is protected under Article 18 (2) of the constitution and also under sub-section 1 of section 103 of the Evidence Act, 1975 (NRCD 323) which state inter alia “every communication that transpired between the patient and the healthcare practitioner in the cause of diagnosis and treatment should be kept confidential” • Confidentiality also extends to people who are treated for mental and psychological disorders and even those who are dead. For example, you cannot just go a morgue and begin to take pictures or videos of dead bodies for purposes of further transmissions to third parties without the consent of the personal or legal representatives of the deceased or the hospital authorities. Also any information in the deceased person’s folder cannot be disclosed/ transmitted /given to any third party without lawful authority. You cannot also give the medical cause of death of a deceased to a third party other than the personal or the legal representative of that deceased

39. Critical ethical/legal dimensions of healthcare provision • The Mental Health Act 2012 (Act 846) also have provisions on confidentiality. In fact section 60 sub section 1&2 dealt with issues of confidentiality of mental patients • The GHS patients charter (paragraph 7) also deal with the confidentiality of patients when under diagnosis, treatment or for the purposes of using their medical records or history for research and teaching

40. Critical ethical/legal dimensions of healthcare provision • The case of Georgina Ahamefulevrs Imperial Medical Center and Dr Alex Molokwu in Nigeria served as a clear example of how healthcare Practioners can be held liable for breach of confidentiality of their clients in the course of exercising their duties

41. EXCEPTIONS TO CONFIDENTIALITY • When a person is committed by law to a mental institution for the purposes of ascertaining the mental status of that person • When in a criminal trial, a suspect id referred to a mental health institution for evaluation • When appearing before a commission of enquiry to testify or give evidence • When summoned to appear before parliament to testify or give evidence • When a patient is suspected to have committed a crime his/her confidentiality can be breached by alerting the security agencies to arrest such a person. This is guaranteed under section 25 of the Criminal and other Offences Act, 1960 ( Act 29) • When a person voluntarily elected to waive confidentiality

42. THANK YOU FOR YOUR ATTENTION