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:

• limitedopportunities for professional training and career development
• poor health careinfrastructure
• low salaries
• family pressures and adesire for better living standards
• poor staff management.

The opportunity to work in a developed country's health sector hasattracted many Ghanaian health workers because of:

• large numbersof health care vacancies
• highersalaries
• bettertraining and career opportunities
• superior healthinfrastructure and resources
• proactiverecruitment by health services
• poor human resource planning, including regulationloop holes, in the destination countries.

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

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

The retention of academic certificates and transcripts by governmenttraining schools has reduced migration. However, attempts to introduce this atuniversities met with opposition. Since the beginning of 2005 internships fordoctors 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 healthworkers in 1999 followed industrial action in 1998 by doctors demanding salaryincreases. Whereas the allowance has motivated a small number of doctors tostay in Ghana, many nurses, who feel doctors have been unfairly favoured, havemigrated.

A deprived area incentive allowance was introduced in 2004 withoutadequate 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 andthe UK's National Health Service (NHS) resulted in the loss of all exchangecandidates to Jamaica and the UK. Since 1992, Ghana has had to temporarily recruitCuban health workers. There are currently 222 Cubans on two year placements inGhana and in the upper east region there are three times as many Cuban as thereare Ghanaian doctors.

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

Policy lessons include:

• Politicalcommitment and leadership are crucial for successful policies. Investmentin training would not have happened without the leadership of recentMinisters of Health.
• Thedecentralisation of health service functions, the empowerment of localstaff and the recognition of local issues are critical if retentionstrategies are to be successfully implemented and supported by healthworkers.
• All humanresources policy decisions must be informed by clear evidence and broadconsultation with all key stakeholders, including professionalassociations. The deprived area incentive scheme and the additional duty hoursallowance are well intended policies that have not been supported by professionalgroups.
• Internationalbilateral agreements for managing migration are unlikely to be effective unlessthey are backed by internationally enforceable conventions instead oflimited ethical codes of practice.