Migration Expectation of Trainee Health Professionals in Ghana

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Migration Expectation of Trainee Health
Professionals in Ghana

• Presented by
• Prof. John K. Anarfi
• ISSER, University of Ghana

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Outline of Presentation

• Introduction
• Overview
• Objective
• Sources of Data Methodology
• Results
• Discussion Conclusion
• Future Outlook
• Effects
• Efforts to Motivate Health Workers
• Managing Migration
• Options to Stem the Tide
• Conclusion

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Introduction

• Migration seen as labour market redistribution in
  response to market needs.
• Economic maximisation theory as demand supply
  of labour are in equilibrium in a classic
  competitive framework, wages are the main cause
  of migration.
• Increasing expansion in health care services due
  to aging population reduced entrants to health
  workforce.
• Personnel being recruited from developing
  countries instead of health staffing needs for
  new services being met from developed country
  resources.
• Developing countries lack adequate resources to
  motivate retain their health workers.

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Overview Emigration of Highly Skilled - the
Situation in Ghana

• Pre 1960s Ghana generally experienced net
  immigration (with international migration in the
  areas of Education Training, in Trading in
  Foreign Services.
• Mid 1960s/1970s emergence of international
  migration as a result of the Ghanaian economic
  downturn.
• Rising phenomenon of highly skilled
  professionals, trained at great cost to the
  Ghanaian economy. Generally believed to be linked
  to rapid advances in globalisation ICTs.
• Estimated that about 3 million Ghanaians (15 of
  the population) live abroad (Twum-Baah, 2004).
• Peil (1995) estimated that 10 - 20 of Ghanaian
  nationals were living abroad in the 1980s 1990s
  (cited in Black, 2003).
• Volume of skilled emigration from Ghana is a
  source of worry to national development.

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• About 30 of all highly educated Ghanaians lived
  abroad in 2000 (Economist, Sept 2000).
• Ghanaian emigrants (particularly to developed
  countries) are generally well educated
  (Economist, Sept 2000).
• 35.9 of Ghanaian residents in England/Wales
  (aged 16-74 years) have a higher level of
  qualification (Economist, Sept 2000).
• By 1990, 15 of Ghanaians with tertiary education
  had migrated to USA 10 lived in OECD countries
  compared with less than 1 of Ghanaians with
  secondary education in OECD countries (Black et
  al. 2003).
• Over 70 of Ghanaian migrants in USA in 1990 had
  completed tertiary education (Carrington
  Detragiache. 1999)
• Problem difficulty identifying the magnitude of
  specific skills that have migrated because most
  movements are not documented.

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Objective of the Study

• Assessing the level of migration expectation
  among trainee health workers determining some
  of the factors which have are likely to
  continue to push Ghanaian health professionals
  out of the country.
• Questions
• Is the emigration of Ghanaian health
  professionals likely to grow or decline in the
  near future?
• What causes migration of health professionals
  (individually generally)?
• Do these causes have to do with dissatisfaction
  with home country, or aspirations or
  opportunities abroad?
• What are the consequences of health professional
  migration for training other labour-related
  issues within the health sector?
• What has been done in the past to arrest the
  situation what are the policy options available
  now?
• What can be done generally to minimise the risks
  maximise the benefits involved (if any)?

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Sources of Data Methodology

• Leading medical institutions were selected in the
  three ecological zones of Ghana
• Coastal Korle-Bu Teaching Hospital, Accra
• Forest the Komfo Anokye Teaching Hospital,
  Kumasi
• Savannah the Tamale Regional Hospital
• The public nursing training colleges based in
  these medical facilities the UGMS KNUST (SMS)
  were involved in the study.
• In addition, the two newly opened private nursing
  training schools in Accra/Tema Kumasi were
  included to give some basis for comparison.
• The study aimed for a total sample of 500
  trainees (400 nurse trainees 100 doctor
  trainees). Allocation of sample based on student
  population in the selected institutions.

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• A self-administered questionnaire was the main
  survey instrument for data collection in-depth
  interviews were conducted among officials of GHS,
  MoH, MDC, NMC training institutions.
• More questionnaires were given out the coverage
  rate exceeded the target 541 respondents
  consisting of 94 medical students 447 nurse
  trainees (112).
• Distribution of the students by institution
• Medical School (17.6)
• Public Nursing Training College -Diploma (71.5)
• Private Nursing Training College -Diploma (5.0)
• Public Graduate School of Nursing (5.9)
• Regional distribution GAR (50), AR (36) NR
  (14)
• Sample largely made up of females (78.1)
  relative to males (21.9). (Figure 3.1) and
  trainee nurses (82) relative to medical
  students (18).

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Figure 3.1 Distribution of Respondents by Sex
Type of Institution
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• The analysis of the respondents showed little
  variation in age (with the exception of the
  graduate student nurses). Mean ages were as
  follows
• Medical students (22.8 years)
• Diploma nursing students (21.7 years)
• Graduate nursing students (25.7 years)
• Almost all the students had never married (96.9)
  as opposed to married (3).
• Region of Birth
• Over 60 of students in the medical profession
  were born in the Greater Accra Ashanti regions
  with the remaining 8 regions sharing about 38 of
  the students.
• Under 6 of the students were born in the
  Northern Region
• Most students who enter the medical profession
  are born in urban areas (75). 64 36 of their
  fathers mothers respectively had tertiary
  education.

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• Opinions on the Admission Process
• Analysis shows that repeated attempts were not
  made to secure admission to a nursing training or
  medical school. For example, only in 9 of the
  students tried more than once to secure
  admission.
• 57 of the students felt that securing admission
  to these training institutions is not difficult.
  In contrast, 10 of them felt it was very
  difficult while 33 agreed it is difficult.
• Unsuccessful applicants may have different
  stories to tell about difficulties related to
  admission. It is possible that most applicants do
  not get a second chance.

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• Initial Aspirations of Students
• 82 of the students aspired to become either
  doctors or nurses. 5 wanted to become other
  health-related workers.
• The major reason for changing their aspirations
  cited by those who initially did not aspire to be
  health workers was the interest they developed in
  health work. The next important reason cited was
  an encouragement or advice by someone or a family
  member.
• No interviewee chose to go into the medical
  profession as a gateway to emigrate for greener
  pastures.
• Interviewees who eventually enrol for training to
  become nurses or doctors have parents (especially
  fathers) with higher education Fig. 3.2.
• Parents of medical students were more highly
  educated than those of nursing students.

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Fig 3.2 Family Background
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• 51 of the students had a close relative working
  in the medical profession.
• 58 of those with close relatives in the medical
  profession indicated to have been influenced by
  these relatives, as opposed to 42 who were not
  influenced by these relatives.
• Majority of relatives in the medical profession
  were reported as working in Ghana (62.4). 28.4
  worked outside Ghana 9.2 of these relatives
  were reported to be deceased.
• Similarly, 49 of the students indicated that
  they had friends working in the medical
  profession, but further analysis shows that just
  about a quarter of them had been influenced by
  these friends to enrol in health-related training
  institutions.

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Motive for Becoming a Nurse or Doctor ()
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Views on the Medical Profession in Ghana

• The assessment by the respondents on the medical
  profession in Ghana reveals negative views.
• To 71 of the students, the profession as
  practised in Ghana is frustrating, stressful or
  hectic.
• On the other hand, over 25 thought the medical
  profession in Ghana is prestigious.

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Migration Experience

• Migration expectation is relatively high among
  trainee medical personnel.
• 300 trainees (55.4) had ever decided to
  emigrate.
• In relative terms, more males (61.3) had ever
  decided to emigrate than females (53.4), ranging
  from 60 of medical students to 55.5 among
  trainee nurses.
• Regional analysis NR (63), GAR (58) AR
  (50).
• Reasons for not having emigrated
• Waiting to complete their training (88)
• Inability to secure visa (5)
• Financial difficulties (4)
• Wanted to work for sometime (2)
• Marriage (1).

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Intention to Emigrate

• 58 of the selected trainees intended to emigrate
  after graduation with higher proportion for
  medics (63) than nurses (57).
• More males (62) intended to leave the country
  than females (56).
• About 70 do not intend to work beyond their
  third year of graduation (next slide).
• The proportion ranged from 66 among medical
  students to 50 for trainee nurses

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Prospective Emigrants by Period Training
Programme
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Reasons for Emigration
21
Preferred Destination
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Discussion Conclusion

• Some writers blame globalisation.
• Demographic trends mean that immigration is an
  increasingly important option for addressing
  changing labour force composition needs in
  developed countries.
• Push-Pull factors of migration include
• Relative availability of job opportunities
• wage rates
• educational opportunities
• demographic socio-economic characteristics.
• Migration seen as a reaction to stress arising
  from individuals own unique physical, economic,
  social cultural environment.
• UNPD (2000) predicts that the levels of migration
  required to offset the aging population in
  developed countries are extremely large may in
  some cases require higher immigration than in the
  past.

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Efforts to motivate health workers

• Institution of ADHA for health workers since
  1998. Forms 200 -300 of doctors monthly
  salaries.
• Housing scheme being developed to enable them
  acquire houses on hire purchase.
• Allocation of HIPC funds for Deprived Area
  Incentive Allowance (DAIA) to attract health
  professionals to rural deprived communities.
• Allocation to doctors of cars on hire purchase.
• Establishment of WA College of Surgeons to
  provide local postgraduate training.
• Study leave with pay is offered to qualified
  staff at all levels to upgrade their skills.

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Effects of Migration

• A crippled health care delivery system GRNA
  membership fell from 25 between 1998 2003
  (Dovlo Nyanator, 2004)
• In 1998 the GHS had vacancies for doctors (43)
  nurses (26). By 2002, this rose to 57 47
  respectively.
• Two medical schools in Ghana trained 2,856
  doctors but only 1,778 trained doctors (38.2)
  are in active service.
• Inappropriate skill mix for effective health care
  delivery
• Unmanned facilities in some communities
• Excessive workload, stress burnout leading to
  increased errors among health workers
• Poor quality health care for the population
• Loss of investment in education, training
  future productivity.

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Projected Health Professionals Required by Ghana
in 2006
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Managing Emigration

• There is a need for a rights-based multilateral
  framework to address emigration of the highly
  skilled labour.
• Promote mobility policies to facilitate
  circulation of talent in order to ensure return
  of skilled personnel. Encourage temporal rather
  than permanent return of professionals in
  Diaspora
• Need to achieve a balance between individual
  state in order to protect the welfare of the
  people.
• Options to Stem the Tide
• Enforced mandatory 3-year housemanship for
  doctors.
• Bond all professionals trained with tax payers
  money. Provide fee paying (full cost recovery) as
  an alternative for not more than 10 of those
  admitted each year in public training
  institutions.
• Increase enrolment in all training institutions
  through private sector participation. Strengthen
  regulatory bodies (NMC, MDC, Pharmacy Council,
  etc to ensure acceptable standard of training
• Improve working conditions environment in
  Ghana.

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• Conclusions
• Balancing rights of the individual skilled worker
  to emigrate the need for a country to protect
  the integrity of its education/ health care
  system
• Supporting governments in improving their
  planning mechanisms to manage migration through
  compensation the introduction of codes of
  practice.
• The ILO stresses the need for a rights-based
  multilateral framework to address the migration
  of skilled labour, noting that market forces will
  prevail in the supply demand of labour.
• Representatives of governments, employers
  workers should be involved in consultations to
  attract retain workers.
• Mobility policies promoting circulation of talent
  to encourage return.
• Timing the training of doctors nurses outside
  (staff development) to ensure that health care
  system is not adversely affected.

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• Conclusions cont.
• The most important factors influencing the
  retention of health workers in deprived areas
  include (DfID 2000)
• staff accommodation, water sanitation,
  electricity, access to good schools qualified
  teachers for children, transport for work, road
  access (good transport links to from the
  district), availability of working materials
  equipment.
• Pay is important but is not the main factor.
• The GHS must work closely with the district
  assemblies local communities on many of these
  issues.
• The high intention of the medical nursing
  students to migrate observed in this study should
  serve as a challenge to all stakeholders if the
  future trend is to be reduced drastically.

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• END
• THANK YOU