Ghana’s health care system is one of the most hit in Africa with regards to rates of attrition of professionals.

Each month, de-motivated health care professionals of all categories leave the country to seek better working conditions elsewhere, especially in Europe and America.

The attrition rate among health professionals has been estimated at 3.7% for doctors, 0.07% of pharmacists and 4.2% for professional nurses and midwives.

According to Twum-Baah, 60% of trained Ghanaian doctors work outside the country.

Nyonator et al report that of the estimated 43,000 health workers that Ghana requires to meet the health needs of its population about 18 million in the year 2000, only 21,262 (2,211 doctors and 19,051 nurses) were available in the year 2000. That is a shortfall of 49%

A report in the Ghanaian Times of March 23, 2002 also indicated that it is believed that more Ghanaian doctors numbering 1,850 were working outside the country than the 1,600 at home in the year 2001 - and that was a reduction of the year 2000 figure by 611.

And recent developments in the health front in the country do not make the situation any better. There are agitations among and between professionals such as doctors, pharmacists, nurses, medical assistants, health care assistants and other professionals within the system. This is creating a situation that can be mirrored in the saying, ‘when elephants fight, it is the grass that suffers.’

If the agitations are allowed to continue, it is the helpless Ghanaian that would suffer from a poorly staffed and managed health care delivery system, and this calls for concern.

Indeed, Ghanaians should not only be concerned but, should call for pragmatic approaches to resolving the crises once and for all. Because a resolution would create a peaceful atmosphere in the health sector and the greater majority of Ghanaians, whose good health is essential for national development would benefit.

For instance an Institute of Statistical, Social and Economic Research (ISSER) report put the cost of medical education to Ghana at an estimated US$9 million per year.

The same report put the calculated cost of health professionals leaving the country in adverse terms, for instance, increase in under-5 mortality, stagnating maternal mortality rate as well as low improvement in the Expanded Programme of Immunization (EPI), and general weakening of health care systems.

The job of the health care professional which is to provide and deliver quality and efficient health care to citizens cannot be underrated. Health care professionals are a key component in the health system. And as a matter of fact a well motivated health worker is an asset to every nation.

Fact is, for every country to meet its set goal and objectives of providing high quality health care to its citizens, professionals in the system must be so encouraged and equipped to play their roles effectively.

In any case, health policies of countries all over the world cannot succeed without the full co-operation and involvement of highly motivated and dedicated health care professionals.

Necessarily, health care professionals such as physicians or medical doctors, dentists, pharmacists, nurses, midwives, and other auxiliary make a health system function.

But personnel alone do not make healthcare systems efficient, and therefore, increasing their number, without the necessary conducive atmosphere, schemes to motivate them and the equipment to work with would not yield positive returns for the health system.

The conditions under which professionals work are important if they must achieve the main objectives of health institutions - that is provide efficient and effective health needs of their clients or patients.

M. Malek, an academician with interest in motivation for healthcare professionals argues that, “Inefficiency in the system and inadequate motivating systems could lead to the system’s inability to deliver healthcare effectively, and under such circumstances healthcare professionals may emigrate or concentrate in urban areas or in areas of affluence which provide them financial security and scope for promotion.”

The reality of motivation for the health worker cannot be over emphasized, but the question has always been what kind of motivation scheme is appropriate and adequate enough to encourage the healthcare professional to stay, work and offer the best?

In most cases, arguments and agitations for motivation seems to center around financial incentives. Not long ago, the strike action embarked on by the Health Workers Group and the response of the Ghana Medical Association to a document purported to contain details of a plan to cut down their salaries in order to improve that of their counterparts in the system were all about financial rewards.

Notwithstanding the fact that financial incentives serve as a motivating factor to retaining health care professionals in the system, a more comprehensive incentive package, including schemes that meet the other needs of professionals including their financial and material needs is a necessary condition for retaining personnel and motivating them to attain the goals of the institutions they work for.

The Korle-bu Teaching Hospital as an example

	Nurses at a function at Korle-bu.

For instance, the Korle-bu Teaching Hospital, Ghana’s foremost Tertiary institution has gone through different regimes and styles of leadership in the over 75 years of its existence. Until recently, the institution has been managed at the executive position by non-medical professional administrators.

The first medical professional to head the institution was Dr. Holdbrook-Smith. Indeed, his assumption of office was seen as a breakthrough by many for several reasons. And one of the many reasons is the fact that the medical system is a complex one and to have a medical officer play the role of a manager in the system would lessen the ever increasing tension within the system.

Fact is that, managers of healthcare institutions have to face a growing difficulty in managing health systems because of the complexity of the system, with its different occupations and occupational groupings represented in the same system.

For example, a mental health facility may employ psychologists at both masters and doctoral levels of training, psychiatrists, medical doctors, nurses, social workers, psychiatric technicians and counselors, to mention a few.

A question confronting the managers of health institutions is the issue of how to manage, control, motivate and reward the professionals who have strong ties with the institution as well as those who are not.

There also appears to be some group of professionals within the system who are more committed to their professional groups rather than the health institution they work for. The task, therefore, is daunting for managers of health institutions.

In Korle-bu for instance, there are about 1,200 nurses, while other health care professionals including medical doctors make a total of about 350. But the medical doctors have a stronger representation and a much stronger influence on major decisions for staff welfare than the nurses who form the majority in the facility do. This situation in itself further exacerbates the complexity within the system.

All over the world, however, incentive packages set up to motivate health care professionals include training programmes to improve capacity, financial packages, cars, accommodation, provision of and the upgrading of equipment to improve efficiency and delivery.

There is the need to maintain peace in the health system so that health care professionals can deliver, because for many Ghanaians, ‘Health is wealth’. A healthy person can work to fend for him or herself and accumulate wealth.

The peace and stability required in the system can be attained to a very large extent when clearly defined and established incentive schemes are instituted to motivate all categories of health care professionals to make them stay in the country and work to keep all Ghanaians healthy.

Authored by Emmanuel K. Dogbevi