To:      Honourable Minister, Ministry of Health, Ghana

From:  Dr. James Duah, Epidemiologist & Medical Superintendent, King’s Medical Centre, Kumbungu

Subject: Open the Flood Gates for Ghanaian Doctors: the Resurgence of “Brain Drain”

Date:   April 12, 2015

More than anytime in the history of this country there are many Medical Officers who are unemployed. Similarly, there are many newly qualified Doctors waiting to be posted to start House Job but have not been posted for close to eight months. The temporary period of idleness and the apparent frustration of these doctors are avenues for exit from the country. Prompt posting of these doctors and House Officers will not only help the district hospitals, but also will avoid the re-emergence of the “brain drain" a situation that will spell untold consequences for Ghana.

Background

About ten to twelve years ago, the exodus of Ghanaian doctors to other countries particularly the US and UK was very common. Many a medical student would dream, complete medical school and seek for “greener pastures”. Gratefully, as destiny would have it, policies came that made doctors stay in this country. And so for the past eight to ten years or so, the brain drain appears to have stopped. Among the policies that held the Ghanaian doctor locally is the establishment of the Ghana College that has made specialist training available and easy. Also, the salary review from the GUSS to HSS in 2004/2005 contributed in no small way, to curbing the situation. Additionally, the introduction of the import duty tax waiver for health staff, a policy that allowed Doctors and Nurses to clear cars free of import duty tax, also played a key role in reducing the brain drain. The two-years house job training, with one year mandatory district rotation requirement for postgraduate training, contributed to the solution. The two year policy also helped the district hospitals to get doctors both in the short term and long term.

 Sir, I am afraid we are reverting to the situation of mass exodus of doctors from Ghana again. Currently, there are many doctors who have completed the two years house job and are not absorbed by the Ministry of Health. Their names have been deleted from the government payroll and are awaiting endlessly to be posted. The worse aspect of this is that they do not know when this posting will come. Another group of Doctors who completed Medical School close to eight months ago, are still waiting to start house job. They seem frustrated and not sure of the way forward. The doctors make their own assumptions as the MOH keeps silent. Many of these doctors have begun leaving for Namibia, Uganda and Tanzania where the health systems need doctors. Over the past one month, I have seen over 5 doctors who have left for Namibia and Uganda. A number of foreign trained doctors from China, Ukraine, Russia, etc., who wrote and passed the Ghana Medical and Dental Council exams in 2014 and 2015 are also staying idle.

In all these, the district hospitals and the tertiary hospitals are suffering the consequence. There are many of these doctors who want to be posted to districts but are not. Some of these district hospitals, particularly in the Northern region, lack doctors and this would have been an opportune time to solve a long standing problem of lack of doctors. The King’s Medical Centre in the Kumbungu district where I work, has been struggling to get a second Medical Officer over many years but without success. Since November last year, 3 Medical Officers have expressed interest in joining the facility but cannot be absorbed because the government is not recruiting them. Some departments in the Tamale Teaching Hospital lack Medical Officers while there are a number of Medical Officers in the house waiting to be appointed.

Implications for not appointing the Medical Officers timely

• There will be mass exodus of Medical Doctors to countries that need them, a situation that will take us back to the old problem of “brain drain”. When this happens, it will be a waste of taxpayers money used in training most of the doctors since the foreign countries will not pay any compensation to the Ghana government for training the doctors.

• The Teaching Hospitals, GHS and CHAG will lack doctors and will lead to long patient wait times at the Out Patient Departments (OPDs). Many doctors, particularly the new ones, will move into private practice since the government is slow in recruiting them.

• District Hospitals will lack doctors. Doctors who spend 3-5 years will leave for residency programs but there will be no replacements. Many doctors will not wish to be in the village since replacement will be extremely difficult. The patients are the ones that will suffer.  

• Parents who take pains and money to train their wards outside Ghana will no longer show interest in them coming back to serve this country. The frustration of getting absorbed into the system is just unbearable.

Having achieved success in curbing brain drain with many years of efforts, it will be most unfortunate to allow the sector revert to the situation, posterity will not forgive us.

Recommendations for action

In the light of the aforementioned reasons, I hereby recommend the following actions for your office to take:

• Promptly post Medical Officers to district hospitals even if they do not have financial clearance. It is easier for hospitals to support doctors until they are mechanized onto the government payroll

• Plan for Medical students and House Officers so that house job is coordinated smoothly without a break. After one rotation, House Officers should know and move smoothly to the next. Likewise after Medical School graduation, doctors should know where they are to start their house job just as it used to be in recent past.

• If the reason for non-posting is economic, I suggest you allow the hospitals bear 20%, District Assemblies 20% and GoG 60% of the wage of the doctors.