Exodus of Health Workers Gets Worse

- 12% of health workers left in 2003
- Three northern regions worst hit
Dr. Agyeman Badu Akosa, Director-General of the Ghana Health Service has said in spite of measures put in place to address the exodus of health workers in the country the problem is getting worse.

"Despite the fact that we have introduced incentives such as vehicles for health professionals, our workforce continue to suffer the effects of mass migration in an unprecedented manner," Prof. Akosa said in Accra at a meeting to commemorate the celebration of the Ghana Health Service Month.

He said the number of health personnel has reduced by nearly 12 percent thereby increasing the workload for an already overworked staff.

"These have greatly affected our performance leading to signs of stagnating and declining service performance and declining utilization of health services," he said.

"While there is a lot of good intent to deal with the issue, government for several reasons has not been able to deal with the issues as quickly as it would have wished."

Not long ago, out of probably frustration over the matter, a member of government openly accused the British government of enticing health personnel trained at the expense of the Ghanaian taxpayer with bigger salaries.

While the UK government officials in the country have denied this accusation, the exodus still continues

"The risk to the health of our staff is real," Prof. Akosa said, adding shortages were seen in all cadres but higher in the ranks of doctors and nurses."

Although he said the problem is an old one, its acceleration in recent years is due to the shortage of health personnel in other countries.

He said the problem is worse in the three northern regions which are most deprived.

There is also a severe shortage of teaching staff, facilities and equipment available to train new health professionals.

Given the current exit rate from government service, Prof. Akosa said it is becoming increasingly difficult to achieve service targets.

According to Prof. Akosa, it is possible to increase the intake of health professionals and hope that they would stay on the job, however an analysis of increases and relevant numbers to compensate for attrition will probably continue to show that it is not feasible.

"Even if it is, it would require between three to eight years before any impact can be made across the professions," he said.

An Act of Parliament established the Ghana Health Service in 1996 to implement services in government health facilities at regional, district and the district sub-levels.

It is also to implement approved national policies for health delivery and increase access to good quality health services as well as manage prudently resources available for the provision of health services.

In spite of all the problems, Prof Akosa said the Service continued with key strategies related to the expansion of services to undeserved areas through the community based health planning and Services (CHPS) approach. This approach was to allow us to place a qualified health worker in the community. This health worker lives with the community members and facilitates the health and health seeking activities of the people.

He said the passage of he national health Insurance Bill has increased the awareness of the role the GHS is required to play as a key service provider. Therefore the Service has taken steps to review its internal structures and systems to allow for a smooth takeoff.

"We have produced a strategic framework with a clear roadmap bordering on infrastructure development, staff education, revenue management, billing systems and registration.

Last year at a press briefing to commemorate the launching of the Ghana Health Service, the GHS promised that it was putting in place modalities to enable people access healthcare before paying for it.

The Deputy Director General of the Ghana Health Service Dr. Sam Adjei said the Service was also considering how to retrieve its money in case clients who have been offered services refuse to pay.

"We want to see how best we can turn the cash and carry around," he said adding people should receive service without the hindrance of cost."

He said the service would communicate the procedure to the public later on.

Dr. Adjei was speaking at a day's sensitisation workshop on the Ghana Health Service for members of the Media Network on Health in January 2003

Explaining the new role the Service would be playing Dr. Adjei said the service would remain within the public sector but its employees will no longer be part of the Civil Service and GHS managers will no longer be required to follow all Civil Service rules and procedures.

According to him, the independence of the GHS is designed primarily to ensure that staff have a greater degree of managerial flexibility to carry out their responsibilities than would be possible if they remained within the Civil Service.

He said for instance a local manager of a health facility outside Accra would have to write letters seeking permission from the Chief Director of the Ministry of Health before he or she could spend money on an epidemic in a particular area.

Decentralising and empowering local managers he said will bring about efficiency in the health delivery system.

He said although the Ministry of Health would play a supervisory role, the day to day management of the hospitals with the exception of Teaching, Private and Mission hospitals would be done by the Service.

"The Service has been mandated to set technical guidelines to achieve policy standards set by the Ministry of Health," he said

He said under the programme, health bills would be standardised.

" Every citizen of the country will know how much to pay when they visit hospitals, polyclinics or health centres."

"It would be well known just like people know the price of petrol to prevent exploitation at the various hospitals."

He said the current system of billing where people pay different sums at various places is flawed and would be changed very soon

Under the new system, health workers are expected to treat patients cordially.

The Director of Human Resource of the GHS, Dr. Ken Sagoe said as a public service, a new terms and conditions of service is under discussion which could also stem the problem of brain drain in the health sector.

He said the service is putting in place measures for the professional and academic progression of health workers.

Clinical pharmacy is now available in Ghana as well as Public Health nursing, Ophthalmology nursing among others while Paediatric nursing is also in the pipeline.

According to Dr Sagoe, the Service has so far trained 24 Clinical Pharmacists who are currently working in the country.

He said the Service under a draft policy is asking communities to help identify people who are exempted from paying health bills.

He said it is difficult for health officials to identify paupers who are not in a position to pay their bills.

On the issue of Health Insurance, Dr. Sagoe said the Service has recommended to Government to encourage local health insurance organisations than a big national insurance body with all its associated bureaucracy.

"Members of such a group if credible can access medical care and pay later," he said.

The Director of Administration and Support services Yaw Brobbey Impiani said under the GHS administration, auxiliary staff and students would be made known to patients so that a student does not use a patient for experimentation.

He said under no circumstance would a patient be used for research or be given treatment without his or her consent while aggrieved patients could seek legal redress.

It appears the promises of the GHS are being delayed because of the shortage of staff exactly one year after its launch.

But "we have made some modest gains," said Prof. Akosa.