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 .
What are intramural services?
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 .
Two systems within one hospital?
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 .
At the heart of the controversy is a fundamental question: Is Korle Bu operating one healthcare system, or are two systems gradually emerging within the same public hospital? .
This 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 cost of waiting
For patients attending the hospital’s Outpatient Department, waiting times can be extensive. A study published in BMC Health Services Research found that waiting times at KBTH ranged from 41 minutes to 185 minutes, with a median waiting time of 93 minutes .
The study revealed that 56.4 percent of patients experienced long waiting times of 120 minutes or more . Patients without formal education were found to be 2.67 times more likely to experience long waiting times compared to those with tertiary education, while female patients were 1.78 times more likely to experience extended waits .
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 they can pay more, the principle of equitable access to public healthcare comes under serious pressure .
Specialties under scrutiny
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 .
The ‘no bed’ paradox
Ghanaians are painfully familiar with the phrase “there is no bed.” Families move from facility to facility searching for space. Emergency patients wait anxiously. Elective procedures are postponed because beds, theatres, staff, or other resources are said to be unavailable .
Yet concerns arise when patients and families observe that services appear more accessible through special or intramural arrangements. This raises an uncomfortable public-interest question: if resources are genuinely insufficient for the ordinary patient, how are those same resources being allocated for additional fee-paying services? .
The perception of “no bed for the poor but a pathway for the paying patient” is corrosive to the moral foundation of public healthcare .
Hospital management responds
Dr Yakubu Seidu Adam, Chief Executive of KBTH, has previously outlined significant improvements at the hospital during the 2025 review period, including stabilised oxygen supply through an underground pipeline, new digital X-ray units, and a refurbished Ear, Nose and Throat Department equipped with advanced endoscopic systems valued at GH¢11.3 million .
Infrastructure improvements have included installation of new power generators, re-roofing of the Paediatric Intensive Care Unit, expansion of water storage capacity by 150,000 litres, and replacement of elevators in key departments .
On operational efficiency, Dr Adam said the hospital had introduced measures to improve patient flow, including expansion of emergency care spaces to address the “no bed syndrome” .
However, public perception remains influenced by long waiting times, perceived overbilling, and poor emergency care, according to Professor Titus Beyuo, Board Chairman of KBTH, who urged staff to improve systems, attitudes, and service delivery .
Recent emergency unit controversy
In March 2026, a viral video purportedly showing patients lying on the floor of the hospital’s emergency unit sparked public outrage . The video captured several patients, some visibly frail and in need of urgent care, sleeping on the bare hospital floors .
Dr Adam dismissed claims that patients were left on the floor, stating: “We have increasing numbers, and at a point, some patients had to sit on chairs, but at no time was any patient put on the floor” .
He explained that following the circulation of the video, hospital authorities conducted an assessment of the accident and emergency unit and created new wards to decongest the unit . He noted that 80 to 90 percent of patients who come in are medical cases, and bed capacity in the medical department has been increased .
Previous investigations
The Ministry of Health has previously investigated allegations of unethical practices at Korle Bu. In March 2026, an investigative committee submitted findings on the “medical kalabule” scandal, which involved alleged extortion schemes at the Greater Accra Regional Hospital and Korle Bu Teaching Hospital .
The committee found that a medical officer violated the Ghana Health Service Code of Conduct by directly accepting money from a patient for a surgical item required for an amputation. The report also cited an improper payment in US dollars to a supplier, which breached Bank of Ghana regulations .
However, after examining the evidence presented, the committee concluded that allegations of deliberate collusion between doctors and suppliers could not be substantiated .
The broader debate
The controversy has also placed 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 .
A concerned health worker, in a letter to The Herald, urged the government to ensure that intramural services, where permitted, did not become a mechanism through which patients could purchase priority in institutions built and sustained with public resources .
“Public hospitals belong to the people,” the concerned worker concluded. “Their beds, theatres, equipment and human resources must first serve the public interest because, in the end, life must always come before personal financial gain” .
Looking ahead
What is required is not a rush to judgment but a credible process capable of establishing what is actually happening . 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 .
Health Minister Kwabena Mintah Akandoh has announced nationwide reforms aimed at improving coordination and efficiency across the emergency healthcare system, including the development of an IT-powered command centre to streamline emergency response .
For a crucial institution like Korle Bu, maintaining public confidence is vital. As Ghana’s premier teaching hospital, it represents hope for millions across the country needing specialised medical expertise. This responsibility comes with an obligation: a patient’s ability to pay must never dictate their worthiness for care .
