Establishment of Academic Medical Centers in Ghana

Traditionally, the basic components of an Academic Medical Centre (AMC) are a Medical School, within a university setup, and a health facility which may or may not be university-owned. There may be additional components, including schools for other health professions (dentistry, nursing, pharmacy, allied health professions) and other clinical entities. In situations where the health facilities are not owned by the university, there may be varying levels of affiliations/partnerships for training and research purposes.

Variants of Academic Medical Centres exist all over the world, with different names, including Academic Health Science Centre (AHSC) and Academic Health Science Network (AHSN), Academic Health Science Systems (AHSS) and Academic Health Science Partnership, and Academic Healthcare Organization. Due to their complexity and varied organizational structure, there is no universally agreed definition of an Academic Medical Centre.

Often described as ‘citadels of curiosity and cutting-edge’, Academic Medical Centres have a three-fold mission: provision of education and training, conduction of research, and delivery of patient care. Training is accomplished at both undergraduate and postgraduate levels, including opportunities for sub-specialization in various clinical specialties. Research activity at Academic Medical Centres may either be cutting-edge basic medical science and clinical research or research leading to the development of latest innovative medical diagnostic and treatment technologies.  Research from bench to bedside, referred to as translational research, aims at translating results in basic research into innovations in clinical practice that directly benefit humans. It guarantees that patients at Academic Medical Centres receive the highest quality of care. With highly skilled physicians, nurses, researchers, and teachers all working in unison, patients have better access to the latest medical breakthroughs and clinical trials that aren’t available at other hospitals.

The first health training institution to fulfill the tripartite mission of an Academic Medical Centre was the University of Michigan in 1869. It commenced with a Medical School, a 20-bed hospital and a research facility. This concept later spread to the rest of the US and then globally. The spread to the UK was in the form of Academic Health Science Centre (AHSC) partnerships between a university with a medical school, and a number of National Health Service (NHS) organisations. Here, the first to be established in 2007 was Imperial College Healthcare comprising the Faculty of Medicine at Imperial College, London,  and the Hammersmith Hospital and St Mary’s NHS trusts. Subsequently, seven others were established between 2009 and 2013. In the West African sub-region, the first AMC to be established was at the University of Ibadan in 1957. The first attempt at establishing a university-owned academic medical center in Ghana was mooted by University of Ghana at the commencement of its medical school in the sixties but this remained on the drawing board for decades due to lack of funding. The aspiration of the University then was to establish a ‘Medical Village’ (academic medical center) of excellence on Legon campus for the training of all categories of health professionals for the country, delivery of high-quality clinical service as well as the conduction of cutting-edge medical research.  The Noguchi Memorial Institute for Medical Research therefore came on board in 1979 as the research wing of the Medical Village. The establishment of the University of Ghana Medical Centre in 2018 completed the third component of the Academic Medical Centre.  

The governance of AMCs is a complex and unique enterprise, given the varied nature of their structure and their tripartite mission. There are two basic types of academic medical center governance models: single leadership and multiple leadership. Single leadership AMCs typically have one fiduciary board and one team of executive leaders, all governed by a university’s own governance structures, with the university hospital and physician groups falling under the leadership of the university. In contrast, the multiple leadership model is characterized by the university and the hospital or health system each having separate fiduciary boards and separate executive leadership teams that report separately. Like governance, funding of AMCs is complex but historically, their triple mission has been funded ‘through cross-subsidies from patient care revenues, tuition, research grants and contracts, gifts, and endowments.

The purpose of this inaugural lecture is to consider a historical development of Academic Medical Centres globally, attempts by Ghana to create its own Academic Medical Centres and the challenges encountered. It also looks at what the future holds for such Academic Medical Centres to provide quaternary-level training, research and service delivery.