The nexus between migration and remittance from aboard
The case of Adembra in Ghana
At Adembra, in rural Ghana, when the only medical assistant in the village abandoned his post and left for the United States, the local health post was put under lock and key. Villagers now have to travel for 45 kilometers to the nearest health post to receive medical attention, in an area where buses are available on only market days; once a week. Sick persons who are unable to make the journey either for lack of transport, money, or fragile health die needlessly.
The medical assistant was also the chairman of the Parents Teachers Association (PTA) of the only local junior secondary school that serves Adembra and its surrounding villages. The presence of the medical assistant in the community was enough to put teachers on their toes in the discharge of their duties. Although these teachers were not professionally trained, their commitment to their duty was par excellence, and that yielded results. The children of the medical assistant were role models to other children in the village, who learned new ways of doing things from them. He paid rent and his spending in the local economy in a month was more than the average annual income in the village. But today things are different. He is gone and has left a vacuum that cannot be filled.
His remittance has not provided the chain of services – tangible and intangible – that the community benefitted from when he was there. His remittance is sent to his family in Accra, not Adembra. They might not spend it on ventures that inure to the rest of the community, but for the support of a few individuals among his kin.
Clearly, it is not only the local health post that has been affected by an indefinite closure but the local school which is supposed to be the bastion of hope for the young people in that community, too. Teachers go to school late and without preparing lesson notes; they leave school when they are supposed to be in the classroom; and worst of all, they take the children to the farm to help generate income during classes hours.
The current chairman of the Parents-Teachers Association, being a localite without the leverage the health assistant wielded looks on helplessly, unable to exert any considerable leverage on the teachers to turn the situation around for lack of diplomacy which his predecessor possessed in plenitudes and of the highest quality. If the maxim: “education is the best policy there is,” is anything to go by, then the hopes and aspirations of young people in Adembra and its surrounding communities cannot be any dimmer than it is with this situation. The departure of just one medical assistant goes beyond the health needs of the people. It affects education and other important socio-economic dynamics of the local economy with far-reaching implications for the larger economy as well.
There are many communities such as Adembra in Ghana and across the African continent, whose tax contributions fund education and buy the state-of-the-art cars for the politician, communities whose tax contributions fund the education of the sons and daughters of the politicians abroad. But all these communities need from the politician is the fashioning of policies that give them a semblance of life, hope, and inspiration to get up in the morning and continue to do what they do best to feed the nation – farming, fishing, and a host of other jobs – in the hope a better future awaits their progenies if even they do not live to see that promise land. Development is about giving hope to ordinary people that their children will live in a society that has caught up with the rest of the world. Take that hope away and the smart people will use their energies not to develop their society but to escape from it—as have a million Cubans. And we cannot end poverty when all the brains needed to move the society forward are cleaning the streets of New York, Paris, London and, recently, Beijing. Military rule and instability had been seen as the cause of the departure of professionals. Two decades of democracy has rather quickened their departure. If political failure – civil war, coups, and instability – is a reason for the most talented to leave, then economic failure would be an impetus, as well. Mobility of labor has long proved this assertion.
As part of efforts to reduce global inequality and improve lives, the UN in September 2000 initiated eight Millennium Development Goals (MDGs), three of which are health related: reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and disease. Central to effective implementation and realization of these three important goals is a robust and a responsive health care system with well-trained and adequate health human resources.
But in most developing countries, especially in Sub-Saharan Africa, the available health human resources are inadequate to prop-up the health care delivery systems. Many professionals in the health care sector and other sectors of the economy have already left. They are in London, New York, and Paris, not Adembra or Accra. When even intake into the medical schools are doubled or tripled, upon completion, the newly trained only use their credentials as a passport out of the country. This illustrates that without finding a way to halt the perennial hemorrhage of professionals, efforts to increase the number of professionals through increasing intake into training institutions is like the proverbial African housekeeper whose chicken is snatched by the hawk, he turns around looking for a quick solution, found an egg, instead of nurturing that egg to hatch as a replacement, he throws it at the flying hawk in the hope that it will bring the hawk down for him to rescue the chicken. He loses both chicken and egg. Without finding ways to entice those who have left to return home, Africa has continuously been increasing educational opportunities at the higher levels only to feed the center – a continuation of the center-periphery conundrum.
The imbalance in the distribution of health human resources between and within countries and regions is a global phenomenon. Though not peculiar to developing countries, as developed countries may have high proportions of health human resources in urban and wealthier areas, the disparities between developed and developing countries are huge.
In Ghana in 2004, some 80 per cent of physicians worked in urban regions although two-thirds of the population lived in rural regions of the country. Similar trends are observable elsewhere.
The US and other developed countries have a medical doctor-population ratio averaging 1:300, whereas Ghana’s is estimated at 1:20,000 with some regions of the country having as low as 1:50,000, far below the world health organization recommended minimum staff-population ratio of 1:5,000 and 1:700 for doctors and nurses respectively, for proper health care delivery.
The situation in most cases is due to the relentless poaching of health workers from some of the developing countries like Ghana by attractive conditions of service and higher wages in developed countries. It is estimated that more than half of Ghanaian trained medical doctors have migrated; and about 600 of them work in New York alone by 2000.
UNICEF’s latest data (2009) indicates that 99% of general maternal mortality deaths occurred in developing countries, with the vast majority in Africa and Asia. The case is no different with child mortality rates, currently 98% occurring in developing countries. This coupled with high incidents of HIV/AIDS in most of these countries, makes the case for the pressing need of health professionals in these regions and countries.
In these scenarios, there is no doubt that even before the inks that signed the MDGs dried up, the program had failed in advance especially in most of Africa including Ghana.
Let us assume that the top foreign exchange earners for the Ghanaian economy are: cocoa, gold and, recently, remittance from abroad. If the two most important - cocoa and gold - emanate from the rural areas of Ghana and with the third unable to trickle down to them, then we must rethink the new form of unequal access that is emerging in light of the first two and other social factors like health and education-related topics which are beyond the scope of this book. Over a hundred years of gold mining has not brought the needed economic relieves we all seek to the immediate mining communities. Obuasi, Ghana’s foremost mining town bears testimony.
Recent developments on the labor front in Ghana suggests that government’s attempt to stem the tide of the high hemorrhage of health professionals from the country by increasing their emoluments has triggered similar demands from the country’s graduate teachers. Incontrovertibly, this highlights the fact that when all state institutions are competing for scarce resources, individual’s education in relation to the economy (production) is an important tool for social stratification rather than the concept of how economically mobile one group is to the other.
With the current medical doctor-population ratio in Ghana, and with her three medical schools turning out about 150 doctors annually, all factors constant – including brain drain kept at bay and constant population - projections are that it will take Ghana not less than 20 years to achieve a doctor-population ratio of 1:5,000. Therefore for Ghana and other developing countries, it is a mirage to think of the 1:300 that the United States, United Kingdom and Canada have achieved through the exploitation of the health human resources of poor countries.
It is this very state of affairs that exasperated Santuah Niagia to describe the world as sick not just of medically diagnosed diseases but also of the growing tactlessness in addressing inequality by established agencies, notably of the UN system.
The NHS in Britain and similar institutions elsewhere in the United States, Canada, among others, do not employ health workers directly from abroad. Rather, they are recruited by independent international recruitment Agencies but these professionals end up working for the NHS.
There are few questions here to ask. Can the Home Office disassociate itself from the granting of work permits to these crops of professionals? Is there not biographic information on each individual applicant for work permit stating their places of origin, academic and professional history? The point is that for every health worker recruited from a foreign country, there is academic and professional record indicating they are leaving where they are most needed.
By extension, all the countries that continue to benefit from this crop of professionals relax requirements for this group of professionals and cannot in anyway disassociate themselves from the near collapse of the health care delivery systems in many of the disadvantage poor countries, especially those in Africa.
Further, if migration is an individual decision and in respond to economic incentives, do the recipient countries offer equal opportunities to both the highly skilled and the unskilled? Bandwagon of exodus, not only do the poor countries make a gift in invaluable amounts to the recipient countries, their skills and talents, mostly in demand to complement national development efforts are also lost. A chain of negative consequences like the one described earlier follow as a result.
Let us stop deluding ourselves with those figures and lay more emphasis on human development and its retention to forward the development agenda of Ghana and Africa for the benefit of the present and future generations. A problem that is not discussed is a solution postponed.
Why would countries where there are more than enough doctors will still be ready to poach from the poor third world countries? It is because their governments are very much aware of the short-term and the long-term effects of good health on their economies and other social processes and would invest whatever it takes to keep their health systems running smoothly.
With the current state of affairs on the continent especially with regards to the departure of the best brains, there is no doubt that Africa has been disenabled from making any significant contributions from within – or internally - towards her own development in the near future.
Though the proverbial stitch may look too late to save Ghana’s health care system, we should guard against despair. We should also be aware that there are no shortcuts to achieving our development goals.
In a recent speech on: “The Role of African Intellectuals in Africa’s Development,” he read at the African Development Bank (AfDB) Group’s sixteen Eminent Speakers Program in Tunis, Wole Soyinka, the Nigerian winner of the Noble Prize for literature, reiterated the need for the reversal of the brain drain.
Indeed, the nations that now serve as magnetic forces for Africans to seek economic refuge have not been built by remittances from abroad, but by the ideas and ideals of the human mind, allowed to function and fantasize at its fullest capacity. For Ghana to make any headway therefore, serious efforts must be made now on how to retain her young educated population and woo those out there back home to contribute to her development.
Keep tuned in as we head to the apogee of the series – corruption !!!
The above-title is serialized into 30 articles covering issues of politics, corruption, education, migration, the economy (Ghanaian economy), unemployment, land tenure, dearth of policy innovation, and stories from the frontlines – Cote d’Ivoire, Kenya, ECOWAS and the AU. The series are syndicated and media houses/outlets interested in enriching the national debates in Ghana for the 2012 are free to publish all the series.
By: Prosper Yao Tsikata