File photo: Casket of the dead, with flowers from family and acquittances on the cover, laid to final rest on the ground during burial ceremony. Selective focus.
When Kofi Mensah, a respondent of a new study, lost his mother at a regional hospital in Accra, he thought the worst was over. But the grief of her passing was soon compounded by another unexpected demand — he was asked to pay GH¢150 for the Medical Certificate of Cause of Death (MCCD), a legal document required to register her death and release the body for burial.
“I was still in shock,” he recalls. “The nurse told me without the certificate, I couldn’t bury my own mother. And to get it, I needed to pay. It didn’t make sense. It felt like being punished for mourning.”
Kofi’s experience reflects a widespread but poorly understood practice in Ghana. A recent study, To charge or not to charge: ethics of charging fees for the issuance of Medical Certificate of Cause of Death in Ghana, exposes the inconsistencies, legal gaps, and ethical concerns surrounding the issuance of MCCDs — documents central to death registration and burial arrangements.
A Certificate with a Price Tag
The MCCD is the official record of how a person died. It is essential for the legal registration of death, obtaining a burial permit, and in some cases, accessing insurance or pension benefits. Despite its importance, the study reveals that there is no national guideline regulating whether, when, or how much families should be charged for it.
The study reveals that across public and private health facilities, the practice varies widely. Some hospitals provide the certificate for free; others charge fees ranging from GH¢50 to GH¢200, sometimes unofficially. The study, led by Ghanaian public health and ethics experts, draws on interviews with clinicians, public health officers, mortuary staff, and bereaved family members in several regions.
Ethical Tensions and Professional Justifications
The study indicates that many clinicians view the issuance of MCCDs as a duty — part of their professional and moral obligation to patients and families. But others say the work involved, particularly for deaths occurring outside health facilities, requires time and investigation, justifying a fee.
In some cases, doctors are expected to inspect bodies or verify circumstances of death. For medico-legal cases or situations involving police, the paperwork and accountability are even more complex.
“We’re asked to go and inspect a body, sometimes late at night, and still provide documentation,” one doctor noted. “That effort is not always officially recognised, so people find ways to ‘recover’ the cost.”
Mortuary staff and health facility administrators also told researchers that the lack of a formal policy opens the door for individual discretion — and, sometimes, exploitation. In extreme cases, grieving families are forced to pay bribes or “facilitation fees” before certificates are issued or bodies released.
A Burden on the Bereaved
The impact on families can be both emotional and financial. The study details cases where delays in accessing the MCCD — often due to inability to pay — led to postponed funerals, extended mortuary charges, and increased psychological distress.
“When someone dies, it should not become a commercial transaction,” said one of the lead researchers. “We’re seeing a silent erosion of dignity at one of the most vulnerable points in a person’s life.”
The research notes that the situation also threatens Ghana’s death registration system. Some families, especially in rural areas, forgo formal death registration altogether to avoid costs — a trend that contributes to inaccurate national mortality data and hampers health planning.
What Can Be Done?
The study makes recommendations including the following.
The Ministry of Health and Ghana Health Service should develop and enforce a national policy on the issuance of MCCDs, clarifying whether it should be a free public service.
Training for health workers on the ethical and legal responsibilities of death certification is essential to ensure fairness and consistency.
Public education is needed so that citizens know their rights — and can challenge exploitative practices where they occur.
The researchers argue that, as a vital component of end-of-life care, issuing an MCCD should be considered a public health obligation, not a revenue-generating opportunity.
A Matter of Dignity
The question the study ultimately raises is one of dignity and justice: should a family be made to pay — in money and in stress — to prove that someone they love is gone?
For Kofi Mensah, the answer is clear. “We do everything to honour the dead,” he said. “Why must the state or a hospital make money off their death?”
As Ghana continues to modernise its health and civil registration systems, this simple yet profound question demands an answer — not only from policymakers but from society at large.