Stopping the migration of Ghana’s health workers

Ghana’s health sector has lost many health care workers, including those migrating to other countries. Strategies aimed at keeping personnel have had varied results.

Health workers have left Ghana’s health sector because of:

• limited opportunities for professional training and career development
• poor health care infrastructure
• low salaries
• family pressures and a desire for better living standards
• poor staff management.

The opportunity to work in a developed country’s health sector has attracted many Ghanaian health workers because of:

• large numbers of health care vacancies
• higher salaries
• better training and career opportunities
• superior health infrastructure and resources
• proactive recruitment by health services
• poor human resource planning, including regulation loop holes, in the destination countries.

To address the loss of health workers from Ghana a number of strategies were developed and implemented with mixed results.

US$ 2 million from the World Bank has been invested in expanding health training. In the past six years, the numbers of newly trained health workers has increased significantly from 550 to 1,500 in 2004.

The retention of academic certificates and transcripts by government training schools has reduced migration. However, attempts to introduce this at universities met with opposition. Since the beginning of 2005 internships for doctors have increased from one to two years to retain newly qualified doctors. Junior doctors are unhappy and have threatened industrial unrest.

The introduction of the additional daily hours allowance for all health workers in 1999 followed industrial action in 1998 by doctors demanding salary increases. Whereas the allowance has motivated a small number of doctors to stay in Ghana, many nurses, who feel doctors have been unfairly favoured, have migrated.

A deprived area incentive allowance was introduced in 2004 without adequate consultation to encourage health workers to stay in deprived areas. The allowance is worth an additional 30 percent of a health worker’s salary, but many feel it is too low.

A bilateral exchange arrangement with Jamaica’s Ministry of Health and the UK’s National Health Service (NHS) resulted in the loss of all exchange candidates to Jamaica and the UK. Since 1992, Ghana has had to temporarily recruit Cuban health workers. There are currently 222 Cubans on two year placements in Ghana and in the upper east region there are three times as many Cuban as there are Ghanaian doctors.

Some policies may have inadvertently aggravated the migration problem, such as the additional duty hours allowance and the subsequent emigration of nurses. Policy responses must be coordinated to deal with this complex problem.

Policy lessons include:

• Political commitment and leadership are crucial for successful policies. Investment in training would not have happened without the leadership of recent Ministers of Health.
• The decentralisation of health service functions, the empowerment of local staff and the recognition of local issues are critical if retention strategies are to be successfully implemented and supported by health workers.
• All human resources policy decisions must be informed by clear evidence and broad consultation with all key stakeholders, including professional associations. The deprived area incentive scheme and the additional duty hours allowance are well intended policies that have not been supported by professional groups.
• International bilateral agreements for managing migration are unlikely to be effective unless they are backed by internationally enforceable conventions instead of limited ethical codes of practice.

Ken Sagoe
Human Resources Development Division
Ghana Health Service
P.M.B. Ministries
Accra
Ghana
kensagoe@yahoo.co.uk

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