There is No Future Here - Migrating health workers

"There is no future here, I have been a nurse for the past 22 years, I have not seen any change in my life, I will not come back. May be, I will when I retire," says a Ghanaian nurse now resident abroad.

According to Dr. Delanyo Dovlo, a Public Health and Human Resource System Consultant, most of the Ghanaian health workers, such as doctors and nurses, who are resident and working in advanced countries, share these sentiments.

Dr. Dovlo who presented some experiences from Ghana's Health Workers at the 2nd International meeting of the Joint Learning Initiative Working Group on Africa in Accra said the issue is a rather serious one that needs attention from government and all other stakeholders.

In an interview with Public Agenda, he explained that the meeting was to bring together ideas from different countries to find solution to the problem of migration, which is affecting the Health systems of African countries and also lay down principles for countries to follow in dealing and managing the problem.

"This is not for the countries that are affected only but those who pull these health workers away as well," he said adding, "The meeting is also to create advocacy for people to look at the issue critically."

Dr. Dovlo pointed out that Ghana seems to be one of the worst affected countries and indicated that about 60 percent of the graduates of the Medical Schools leave the country.

A study conducted by the Joint Learning Initiative Working Group on Africa on the problem in six countries namely, Cameroun, Ghana, Senegal, South Africa, Uganda and Zimbabwe showed that most of the health workers in these countries had the intention to migrate.

Most of them said that the reasons for migration to the advanced countries were for better conditions of service, better remuneration and the ability to embark on further studies.

From the study, 61 percent of Ghanaian doctors indicated their intention to migrate. The total Health Workforce for Ghana is estimated at around 43,000.

According to the State of Ghanaian Economy Report 2002 a total of 3,157 health professionals left the country between 1993-2002, representing over 31 percent of health personnel trained in Ghana during the period.

The report said out of 871 medical officers trained between 1993-2002, 604 (96.3 percent) left the country, leaving 267 for the entire nation. The situation has put health delivery beyond the reach of the common man, besides widening the doctor-patient ratio to approximately 1-67,416.

Out of 944 pharmacists trained from 1995-2002, a total of 410 had left the country by the end of 2002. The same goes for medical laboratory technologists and technicians. Out of 432 trained within the period, 87 are currently outside the country.

The number of nurses and midwives abandoning post for foreign countries is the highest and still rising. Of the 10,145 trained between 1995 and 2002, 1,996 had left the country at the end of December 2002. This leaves many hospitals, especially those in the rural areas with no qualified nurses and midwives.

Last year alone 200 nurses and 20 medical officers were reported to have turned their backs on the country.

At the 2nd International meeting, the Minister of Health, Dr. Kwaku Afriyie noted that indeed the migration and brain drain of the country's health staff has reached an alarming rate and threatens the very fabric of healthcare service delivery.

"As you are aware, healthcare system in Africa and for that matter Ghana are labour intensive and the successful development and implementation of health programmes is largely dependent on the quantity and quality of human resources" he explained.

He said in the light of this, the Government, has over the years spent a high percentage of its budget not only on emoluments of health professionals but also on their training and capacity development.

He said faced with huge rise in the emigration of health workers, intake into the various training institutions in Ghana has been doubled to ensure that sufficient numbers of professionals are produced.

Dr. Afriyie said government has also instituted several measures that have stretched its thin resources to mitigate the problem by instituting the Additional Duty Hours Allowances (ADHA) which has significantly increased the take home income of health professionals especially doctors.

The procuring and distribution of means of transport for key health professionals, and in addition, improvement in the opportunities for local post-basic and specialist training within the country and abroad attest to this.

"However these measures have not helped much, those who graduate from our training institutions continue to leave for other countries in high numbers, but the irony of this situation is that it is the countries who are well endowed with resources which rather pull our health professionals to their country", he stressed.

He however admitted that the financial rewards and conditions of service in the countries' Ghanaian health professionals drift to are much more attractive than what Ghana could afford.

"We as a government have tried to do our best within the constraints of our economy and have prioritised the sector's human resources problems, we are committed to addressing them by improving the work environment, enhancing professional development and improving remuneration through various financial mechanism among others", he noted.

He said while government continues to pursue programmes and policies in a bid to retain health professionals in the country, "it is in the interest of all of us - development partners, non-governmental organisations, civil society, professional groups, labour unions, academic and researchers to assist government and health services to find workable solutions."

He noted there is the need to move beyond mere academic recommendation to evidence-based actions with clear implementation strategies and success factors.

Dr. Afriyie also said there was a need to look at issues of funding in the training of health workers to ensure the development agenda and investments into health infrastructure and services expansion are linked clearly to human resources requirements including their motivation and retention.

Dr Ken Sagoe, Director of Human Resource Development, Ghana Health Service (GHS) cautioned that if the trend continues, the country would not be able to achieve the Millennium Development Goals or attain the targets set for the nation in the Medium Term Health Strategic Framework.

Prof. Gilles Dussault of the World Bank said there is shortage of health professional in sub-Saharan Africa and there is the need for about a million doctors to be at par with the developed countries.