The last man dies when the last Doctor Leaves

Wed, 17 Aug 2005 Source: Tsikata, P. Y.

Readers may be wondering why the choice of this apocalyptic heading for this commentary. Some will recollect that in the 1980s Ghana embarked on a vigorous campaign to increase her stock of trees to check the fast depletion of trees and the forest to protect the land from going bare. This campaign with the slogan ?The last man dies when the last tree dies?, sent the message right across with the dividends there for us all to see today.
This time it is not about trees, it is about human health and life.
More than half of Ghana?s health professionals have immigrated to the countries which already have more than enough medical professionals and should be helping Ghana and other poor countries to increase theirs?.
This has left Ghana?s health sector in complete disarray as health professionals who remain to hold the fort watch babies and patients die needlessly for lack of health professionals to diagnose and dispense health care.
For a country like Ghana, it reinforces rural poverty, inequity and sets in motion a chain of negative consequences for the rural poor.
A local woman in a rural area in Ghana, where I did field work last year intimated to me that ?when the only Medical Assistant in her village abandoned his post, the local health post was put under lock and key. We now have to travel for over 45 kilometres to the nearest health post to receive medical attention in an area where buses are available mostly on market days; once in a week. Some who are not able to cover the distance either for lack of transport, money or fragile health give up the ghost needlessly?.
She further explained that the Medical Assistant was the chairman of the Parents-Teachers Association of the local Junior Secondary School in the Community, and his presence in the community was enough to put teachers on their toes in the discharge of their duties. His children 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 week equalled what she earns in more than a quarter of a year or so. But today things are different. He is gone and has left a vacuum that cannot be filled.
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 in the community is also in complete disarray. 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 local chap looks on helplessly and not able 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, in the words of the British Prime Minister, Tony Blair, ?education is the best policy there is? then the departure of just one Medical Assistant goes beyond the health needs of the people. It also affects education and other important socio-economic dynamics of the local economy with far-reaching implications for the larger economy as well.
According to 2001 figures from Ghana?s Ministry of Health, whilst Greater Accra Region with a population of 2 984 181, being about 15% of Ghana?s population, could boast of 969 Medical Doctors which translated into 1:3 079 (figures are high due to double counting of those who operate both in the public and the private sectors, and those in the medical school), the Northern Region with a population of 1 869, 968, being 10% of the population had only 36 medical doctors which translated into 1:51 943.
Whilst nationally Ghana falls far behind the minimum number of doctors required for health delivery according to World Health Organization standards, which is actually pegged at 1:5 000, the rural areas, especially the three Northern Regions-Northern Region, Upper East and the Upper West-are the most deprived.
It is acknowledged that Ghana?s doctor population ratio currently stands at 1:20 000 and her three medical schools turn out approximately 150 doctors per annum.
With all things being equal (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's 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 angered 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 (Chronicle August 8 2005, Accra, Ghana).
But the World Bank?s Chief Economist, John Page, says they are working ways to minimize the adverse impact of brain drain on the continent. In his estimation, ?migration is an individual decision and because people respond to economic incentives, most of us would agree that it?s very hard to control it directly?.
It is when we begin to work from assumptions such as his that we will never have any reasonable solution to confront the issue. In one of my articles to Ghana Web, I stated clearly that the NHS in Britain does not employ health workers directly from abroad. 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?
Right, Professor Agyeman-Bedu Akosa?s findings are applicable here. Visa requirements for these crop of professionals are dispensed to make migration easier for them due to the economic advantage they offer the recipient countries.
By extension, all the countries that continue to benefit from this crop of professionals relax requirements for these crop of professionals and cannot in anyway disassociate themselves from the collapse the health care delivery systems in many of the loosing 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?
Other equally dangerous positions work on the premise that the volume of remittance from Ghanaians abroad has jumped from 517 million dollars in 1993 to over 1.4 billon dollars a decade later with the whole continent attracting a total of 32 billion dollars in remittance from relatives abroad (IMF).
We should have no doubts in our minds that when these highly qualified professionals join the bandwagon of exodus, not only do the loosing countries make a gift of $184,000 to the recipient countries, their talents which is in most demand to complement national development efforts are also lost. A chain of negative consequences like the one described in the leading paragraphs follow as a result.
Let?s stop deluding ourselves with those figures and lay more emphasise on human development and its retention to forward the development agenda of Ghana and Africa for the benefit of the present and future generations.
Can we stop for a minute to consider why countries where there are more than enough doctors will still be prepared 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, I have no doubts in my mind that Africa has been disenabled from making any significant contributions from within (internally) towards her own development and world development now and in the next generation that will help save her people.
Though the proverbial stitch may look too late to save Ghana?s health care system, we don't have to throw our arms in despair believing that it is too late to act. We also don't have to think that there are any ?short cuts? by which we can achieve our development goals.
As part of initiatives to reverse the trend, South Africa?s Health Minister, Dr. Manto Tshabalala-Msimang, in a BBC report intimated there is the need to encourage health professionals to return home.
Will Ghana and other African countries take the chance now and present a united front or remittance from abroad to a section of our population is more important than the health of the entire population?
As the world body prepares to meet in September, let?s remind ourselves and our leaders of the fact that our voices can only be heard when we are healthy and able, not when we are sick and bedridden. Therefore, the time for them to act is now. Remember when the last doctor leaves, the last man will be too sick to let his voice be heard.