In hospitals across Ghana, death often brings silence. Families gather, paperwork is signed, and bodies are moved to morgues with quiet resignation. The cause of death, however, is sometimes guessed rather than known. I have seen this too many times, the certificate filled, the family told a simple phrase like “heart failure” or “short illness.” Behind those words lie a truth we never confirmed.
As a doctor working within the health system, I find this silence troubling. Pathology, the branch of medicine that investigates disease and death, should be the final voice that speaks for the deceased. It should close the loop between diagnosis, treatment, and outcome. Yet in Ghana, that voice is faint, underfunded, under-resourced, and often unheard.
The missing link in our health system
Pathology is not just about death. It’s about understanding life by studying what went wrong. Autopsies help us learn from each patient we lose. They refine diagnoses, reveal hidden diseases, and expose gaps in care. Every strong health system relies on this feedback loop. Ours, unfortunately, does not.
In Ghana, the number of autopsies performed each year is alarmingly low compared to the deaths recorded. Many hospitals conduct only a handful of post-mortems monthly, and even fewer are full autopsies. Forensic autopsies, those done to investigate unnatural or suspicious deaths, are limited mostly to major teaching hospitals and the 37 Military Hospital in Accra.
Outside these few centers, the story is grim. Bodies remain unexamined due to lack of facilities, trained personnel, or legal clarity. Families often refuse consent because of cultural beliefs or mistrust. The coroner’s system, meant to guide medicolegal death investigations, is outdated and inconsistently applied. The result is a nation where too many deaths go unexplained, and too many lessons go unlearned.
A system running on goodwill
The few pathologists we have work under immense strain. They juggle diagnostic pathology, that is examining biopsies, tissues, and cancer specimens, alongside medicolegal autopsies and hospital post-mortems. Some are called from their laboratories to testify in court one day and to teach medical students the next. Ghana has fewer than forty practicing pathologists for a population of over thirty million people. Forensic pathologists, the specialists who investigate deaths for legal purposes, are even fewer.
The facilities are just as thin. Many hospital morgues function more as storage rooms than scientific workspaces. Cold storage often fails due to power cuts. Autopsy suites lack proper ventilation and safety equipment. In some district hospitals, there is no functioning morgue at all. The bodies are transferred long distances, delaying examination and worsening decomposition.
Yet, despite these odds, pathologists continue to serve. Their dedication keeps the system alive, but goodwill is not a substitute for structure. Without deliberate investment, pathology in Ghana will remain an afterthought, spoken of only in crises and forgotten in budgets.
The cost of silence
When autopsies are not done, health systems lose data. We cannot accurately track causes of death. Diseases remain underestimated or misclassified. For example, conditions like stroke, sepsis, or heart disease may appear less common than they actually are because the real cause goes unverified. Public health planning becomes guesswork.
In hospitals, the consequences are even more direct. Without autopsy feedback, medical errors go undetected, and quality assurance weakens. Doctors, nurses, and policymakers make decisions without the clarity that post-mortem data provides.
The judiciary system also pays a price. In cases of homicide or suspicious death, forensic autopsies are essential for fair trials. When they are delayed or skipped, evidence is lost, cases collapse, and justice slips away quietly. Families are left with questions that never find answers.
Beyond data and justice, there is a human cost. Families deserve to know the truth. Closure should not depend on speculation. The right to know why a loved one died is not a luxury, it is a basic part of dignity.
The cultural and legal barriers
Autopsy practice in Ghana is shaped by history, belief, and bureaucracy. Many families resist autopsies out of fear that it desecrates the body or delays burial. These beliefs are deeply rooted and deserve respect, but they can be addressed through dialogue. When people understand that autopsies can prevent future deaths, protect public health, and even prove innocence or guilt, acceptance grows.
The legal framework also needs urgent revision. The Coroner’s Act of 1960, which governs medicolegal deaths, is outdated. It leaves too much discretion, and implementation is inconsistent across regions. Some deaths that should fall under the coroner’s jurisdiction are buried without inquiry. Others are delayed for weeks because of administrative confusion or funding gaps.
Without clear laws and funding mechanisms, the responsibility falls unevenly on hospitals, and individual doctors, who must improvise with little support
Learning from bright spots
Not all is bleak. The Korle Bu Teaching Hospital, Komfo Anokye Teaching Hospital and 37 Military Hospital remain a beacon of what is possible, conducting both hospital and forensic autopsies, training residents, and contributing to national data. During the COVID-19 pandemic, its pathologists conducted systematic post-mortems that helped clarify how the virus affected different organs, guiding clinical care and public health response.
These hospitals are slowly upgrading facilities and training programs. International collaborations have brought equipment, digital pathology systems, and mentorship. These examples show that with focused investment, progress is achievable.
What must change
First, Ghana needs to train and retain more pathologists. The few specialists we have are aging, and replacements are not keeping pace. Medical schools should make pathology attractive, through scholarships, postgraduate incentives, and mentorship.
Second, we must modernize infrastructure. Every regional hospital should have a functional mortuary and autopsy suite equipped with cold storage, protective gear, and basic histology and toxicology support. Electricity reliability should not determine the quality of an autopsy.
Third, legal reform is overdue. The Coroner’s Act should be reviewed to clarify reporting pathways, funding responsibilities, and timelines for medicolegal cases. Families must not have to beg for justice or wait months for results.
Fourth, public awareness must grow. The autopsy should not be seen as an act of desecration but as one of truth and service. Campaigns led by professional bodies, faith leaders, and the media can help shift perception.
Finally, we must link autopsy findings back into our health system. Death certificates should feed into a national mortality database. Patterns of preventable deaths should inform hospital audits, training, and policy. When we listen to the dead, we save the living.
A call to courage
We cannot reform our health system without reforming how we handle death. Pathology and autopsy are not side issues; they are the mirror that reflects the strengths and failures of our care. To invest in them is to invest in accountability, justice, and science.
I know this because I have seen what happens when we don’t. The missed diagnosis that repeats itself. The family that never gets an answer. The hospital that continues a flawed practice because no one traced the outcome.
Ghana has the brains, the will, and the evidence to fix this. What we lack is urgency. We must move pathology out of the shadows and into the center of health planning. Let us fund it, modernize it, and give it the respect it deserves.
The dead cannot speak, but through pathology, they can teach. If we listen, the lessons will save countless lives.
References
- Stalsberg H, Adjei EK, Owusu-Afriyie O, Isaksen V. Sustainable Development of Pathology in Sub-Saharan Africa: An Example From Ghana. Arch Pathol Lab Med. 2017;141(11):1533–1539. doi:10.5858/arpa.2016-0498-OA
- Anim JT. Autopsy Practice in Ghana—Reflections of a Pathologist. Ghana Med J. 2015;49(2):112–119. doi:10.4314/gmj.v49i2.9
- Akakpo PK, Awuku YA, Derkyi-Kwarteng L, Gyamera KA, Eliason S. Review of Errors in the Issue of Medical Certificates of Cause of Death in a Tertiary Hospital in Ghana. Ghana Med J. 2017;51(1):30–35. doi:10.4314/gmj.v51i1.6
- Asumanu E, Attoh S, Servor RX, et al. Causes of Death and Post-Mortem Testing for SARS-CoV-2 in a Tertiary Hospital During the COVID-19 Pandemic in Ghana. Afr J Lab Med. 2022;11(1):a1766. doi:10.4102/ajlm.v11i1.1766
About the author:
Dr. (Med) Kwabena Owusu Aninkora is a resident pathologist at the Komfo Anokye Teaching Hospital, currently pursuing public health studies at the Johns Hopkins School of Public Health, where he is specializing in Epidemiology and Public Health Informatics. His work centres on advancing health equity in pathology services, particularly within rural communities, through the use of digital health systems. He is dedicated to educating the public on the importance and relevance of autopsies in strengthening healthcare delivery and understanding disease patterns.
