Uncontrolled migration threatens Ghana’s routine immunization
Ghana could run the risk of achieving its immunisation goals as a result of the rising emigration of the country’s health workforce. Advocates worry the problem will pose dire consequence to prevent needless suffering from preventable diseases and premature deaths.
Exodus for greener pastures
Richard Attandoh worked in Ghana for six months as a nurse and traveled to the UK to work for six years. He attributes the cause of health workers’ immigration to the foreign exchange rate. According to him, “Nurses in Ghana prefer to work in the UK because the value of a pound is higher than that of a cedi.”
Mr. Attandoh added that unlike Ghana, the UK has structures to address shortfalls. “Compared to other professions, UK nurses are not paid well that is why they are unable to keep them and often rely on nurses from developing countries. Immediately a nurse leaves, someone is employed but in Ghana, it takes years to replace medical staff,” he said.
Meanwhile, another Ghanaian nurse in the UK, Antoinette Ametefe stated that, there are better remuneration and opportunities to work extra hours for extra cash. “Salaries are paid on time because our bills must be paid. Instruments and gadgets to work with are available and we don’t need to improvise,” she said.
Additionally, a Ghanaian nurse in the USA, Yaw Nyarko said, “Working conditions here are much better as compared to Ghana. There are continuous efforts to improve on the welfare of nurses.”
Just like anyone has the right to freedom of movement, nurses have this privilege too and foreign countries; Canada, USA, UK, Australia and Germany have now become the land full of boundless opportunities for healthcare providers coming from Ghana which ultimately affects service delivery to Ghanaians.
Unemployed graduate nurses
Arguably, people perceive that the shortfall of health workers is not unforeseen since the various training schools churn out thousands of nurses yearly. The actual reality; it takes more than three years for trainees to be employed, whiles waiting, some give up and switch to other sectors of the economy.
In an interview with the International Women’s Media Foundation (IWMF), the Public Relations Officer of the 2019 Referral batch of the Graduate Unemployed Nurses and Midwives Association, Georgina Kwakye said after series of protests to demand financial clearance and employment from the government of Ghana, over 8,000 of them still remain jobless, the trained nurses now survive on small businesses.
“We feel pity to be called nurses in the sense that after all these kinds of training unless we go and do house-to-house homecare, fetch water for concrete works at construction sites and sell sachet water in traffic. Last year, our leaders told us that the rate at which nurses were leaving the country was too much. They asked that we stay and work in Ghana. We were told that in 2021 more than 3,000 nurses left Ghana, their places are now vacant why can’t we be employed? When the opportunity comes, I will leave Ghana to work elsewhere,” she said.
Recently, in the World Health Organization (WHO) Health Workforce Support and Safeguards List 2023, globally, Ghana was among 55 countries facing the most pressing health workforce challenges related to universal health coverage. The report identified “the disruptions caused to health services by the COVID-19 pandemic, and the effects on health worker mobility and migration” as major reasons.
Furthermore, the WHO in 2014 projected 6.1 million shortage of health workers in Africa by 2030, a 45 per cent increase from 2013. The WHO Regional Director for Africa, Dr. Matshidiso Moeti, said, “The severe shortage of health workers in Africa has daunting implications.”
The success of any immunisation programme depends on the availability of a skilled workforce, thus, qualified medical practitioners who understand; the importance of vaccines, vaccine storage, vaccine inoculation, complication management and public health education. In Ghana, majority of these roles are performed by preventive health workers; community health nurses, public health nurses and disease control officers.
Meanwhile, the Technical Officer in charge of immunisation at the WHO Ghana Country Office, Fred Osei-Sarpong in an interview with IWMF said, “Looking at our population and the number of our health workforce, I wouldn’t say we have enough. Specifically, there are public health physician specialists whose primary responsibility is to support the development of strategies and health activities at the regional and national levels however, some districts in Ghana do not have them.”
Currently, Ghana has over 120,000 nurses and midwives yet on daily basis, the health sector faces unchecked emigration of professionals. Medical personnel abandon their post, travel out of their homeland country in search of fortunes.
The Ghana Registered Nurses’ and Midwives’ Association confirmed that within a period of two years over 6,000 Ghanaian nurses have migrated to other countries while 14,000 nurses have also applied for financial clearance with the intention to leave their posts. In 2019, the Association alerted the government on the dangers associated with the increasing migration on health services but, till date, their recommendations are yet to be reacted to.
Migration implications on immunisation
Even though Ghana has made some progress in routine immunisation, in instances where experienced health human resources are absent, people suffer from diseases. A former Medical Director of the Greater Accra Regional Hospital, Dr. Thomas Winsum Anabah believes unimpeded exodus of health professionals will negatively impact Ghana’s immunisation goals.
“Migration will definitely cause a reduction in the number of people who will be vaccinated and decrease the quality of an on-going immunisation programme. It is not all who can handle vaccines, those who work around it know how to store them. When there is a problem with it, they know how to put it back into the fridge and dispose-off. Furthermore, they encourage mothers to accept vaccines even though sometimes it is painful to the kids and advise them on ways to handle complications like high temperature, swollen legs etc. Losing specialists like this will reduce the rate at which kids get vaccinated and this will then cause an outbreak of preventable diseases,” he said.
Shortage of childhood vaccines
The Ghana Coalition of NGOs in Health, a registered umbrella body for all civil society organisations operating in the health sector frequently holds medical outreach in rural communities across the country. The Executive Director of the Rural Project Support Network, Ghana Coalition of NGOs in Health, Felicia Sosu said, “When it comes to immunisation, we have enough nurses who are always ready to assist us. We were overwhelmed by the number of nurses who graced our recent outreach held at Afadjato in the Volta region of Ghana. The only problem is inadequate vaccines, at times, when we visit the field, there will be no syringes and vaccines. Our beneficiaries get disappointed whenever it happens, so, we apologize to them, postpone the exercise and wait till we are supplied with vaccines.”
Poor conditions of service
The Professional Association for all categories of nurses; the Ghana Registered Nurses’ and Midwives’ Association (GRNMA) is the mouthpiece for nurses and midwives in issues affecting the profession. The association with over 93,000 members continually speaks against the poor working conditions of its members. The General Secretary of GRNMA, Dr. David Tenkorang-Twum in an interview bitterly lamented that nurses do not have access to free medical care. “They use their own monies to pay for health services even within the hospitals they work,” he said.
According to Dr. Tenkorang-Twum, “nurses and midwives do not receive any allowances, they solely live on their basic salaries which is nothing to write home about,” Also, since 2013, a component of their salaries; market premium was cut off.
Apart from the meagre monthly wages amidst the high cost of living, it takes between three to twelve months for a newly employed nurse to earn a pay. A nurse at the Cape Coast Metropolitan hospital said, “The backbone of the health fraternity is nurses but we are the ones suffering the most, being a nurse in Ghana is worthless.”
Nurses in public hospitals are forced to improvise due to constraints on resources. “In this country, limited logistics make the work of nurses stressful,” a Nursing Officer in the capital city of Accra said.
Inadequate funds & opportunities
Ghana’s leading biomedical research facility, Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, Legon, conducts innovative research into communicable and non-communicable diseases. When the COVID-19 pandemic for instance broke out, NMIMR did series of study including a comparative assessment of immunology responses to different COVID-19 vaccines. Moreover, the Institute played a significant role in testing of samples from various health institutions in the country and sub-region. An anonymous source at the Institute hinted that researchers battle fund and logistic difficulties.
“We have inadequate laboratory equipment and accessing grants for projects is a big problem, they are too competitive. Personally, we have to search for training and mentorship opportunities funded by external agencies. Obviously, there is absolutely no motivation for research in this country”, the source said.
UK red list health workers’ recruitment
On the other hand, in the UK’s revised code of practice for international recruitment of health and social care personnel, Ghana was red listed for medical workers ‘recruitment in the UK. According to, Dr. Tenkorang-Twum, the ban has less impact on solving Ghana’s health workforce mobility. “People are not actively recruiting nurses to the UK, the nurses are rather leaving by themselves and nobody can stop them,” he said.
Authorities cannot continue to turn a blind eye to migration implications on immunisation. Dr. Anabah said, “There must be bilateral agreements between the developed countries and Ghana so that even if we have to export staff to them, it must be accepted on the principles of barter trade whereby, if we are giving you staff, give us resources to train more people. Just like what Cuba has done, you can’t just go to Cuba to get a doctor out of the country. There is some kind of agreement between the Government of Cuba and the country which is taking the doctors.
Likewise, “we can increase salaries but we can’t challenge the developed countries in conditions of service. The government should therefore improve on living conditions and infrastructure,” he said.
Similarly, GRNMA wants government to be intentional in addressing the poor working conditions of nurses and as a matter of urgency institute insurance policies for them. Dr. Tenkorang-Twum said, “I see no reason why if I work in the hospital, myself and my family must pay for medical services.”
Speaking on effective staff retention policies, the former Technical Director of the USAID Human Resources for Health in 2030 (HRH2030) Program, Rachel Deussom said, “There are four recommendations on ways to retain health workers; educating them appropriately, establishing effective working regulations, providing financial incentives and professional support. When working conditions are good for the satisfaction of the health worker, it shows how effective they are on the job.”
In addition to this, the Director of Advocacy and Outreach, Vaccine Acceptance and Demand of the Sabin Vaccine, Vince Blaser suggested that while implementing long-term support for healthcare workers, the creation of an interim two-way feedback loop will contribute significantly to bridging the gap between medical professionals and policy-makers.
It appears Ghana is not the only country experiencing an increased migration of health workers. The Frontline Health Workers Coalition an alliance organisation of IntraHealth International, stated that nurses in East Africa; Uganda, Tanzania and Kenya also travel abroad to work. The Senior Advocacy and Policy Advisor, David Bryden said investing in Ghana’s health workforce to achieve immunisation goals demands fostering stronger partnerships with relevant organisations to address critical needs of healthcare workers.
On March 2, 2023, the Ministry of Health in a virtual event, launched a five-year Public Health Workforce Strategic Plan. The document presents a roadmap that guides restructuring of the human resource of the public health workforce and ensures that the Universal Health Coverage target is fully achieved, using the One Health Concept by 2030. The Deputy Minister of Health, Tina Gifty Mensah said, “The document would support in addressing some weaknesses in the health workforce, particularly recruitment, workforce distribution, staff development, employee motivation and employee migration.”
This reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunization in Africa.