Interview with the President of the Ghana Medical Association, Dr. Jacob Plange-Rhule

Doctors, nurses and other health professionals are leaving Ghana in droves to seek greener pastures in countries that pay good money for their services. The State of the Ghanaian Economy Report for 2002 notes that 68.2 per cent of medical officers trained between 1993-2000 have left the country. The situation is no different with other health workers such as nurses, pharmacists and laboratory technicians. IRIN interviewed the President of the Ghana Medical Association, Dr. Jacob Plange-Rhule to get a deeper insight into this precarious situation. Q. How would you describe the current exodus of medical professionals from Ghana? A. Health professionals have been leaving Ghana over the last decade. But now, it has become really frightening. About 15 years ago, we had about 20,000 nurses in this country. Now, we have something in the region of 10,500, which means we have lost close to 60% of our nursing staff, even though nursing schools all over the country train about 600 nurses a year. In some hospitals, a ward built for 40 patients, which should have 6 or 7 nurses for night duty, is manned by a nurse and a nurse aid, who is a non-professional. The doctor population in Ghana 20 years ago was about 1,500 when the population was about 10 million. Today, we have the same number of doctors despite the fact that the population today is close to 20 million, even though the two medical schools in Ghana churn out about 150 doctors annually. Ghana's Upper West Region has no more than 10 Ghanaian doctors. The Upper East Region used to have about 24 doctors. In both regions, we are looking at a doctor-patient ratio of 1:66,000. There are a number of districts in this country where there is no doctor at all, so a nurse provides health care. We have a problem that gets worse by the day. Q. So where are Ghanaian Health Professionals going? A. We know that there are more than 600 Ghanaian Doctors in the New York area alone. There are large numbers in other parts of the United States, the United Kingdom, South Africa and Europe. That is where the bulk is. Q. Should the trend continue for the next decade, what will the impact be like? A. Already we are beginning to see the effect of the exodus on the quality of healthcare delivery. We may have to close down some health institutions if the situation continues at this rate because we cannot assure safety. Imagine a ward of about 40 patients with only one nurse to look after everybody. We are at a point where single doctors are seeing patients in excess of 200 a day. Doctors are human beings. If they are overworked, their level of efficiency keeps falling and mistakes are made. That can be dangerous. Q. What should Government do? A. We believe that this is the time for government to take bold steps, really bold decisions to try to stop the exodus. This should not be done only for doctors and nurses, but for all manner of health professionals. Large numbers are leaving to other non-health areas within the country since the financial returns are better and future security is assured. Q. What bold steps should government take? A. We have acted in a pro-active way to try and ginger up government to improve on the conditions of service for health professionals. In 1999, the Ghana Medical Association worked with the theme, "Arresting the brain drain in the Health sector". We did a survey asking our members why they were leaving. First, we found out that doctors are leaving for professional advancement. At that time, plans that had been on paper to put up a National Postgraduate Health College were really not moving anywhere and our people were leaving to ensure that in the next five years, they come out as specialists. Of course, after they get the new qualifications they realise that life out there is so rosy that they do not want to come back. We started championing the need for a local postgraduate training college for doctors many years ago. Happily, the college will be inaugurated on December 8, 2003. This is an example of government's reaction to the noise that we have made all over the years. Secondly, doctors are also leaving due to poor conditions of service. The current situation does not allow them to make adequate savings and really it does not assure any future security. So people are leaving to earn adequate monies to put some away into proper pension schemes, to put up a roof over their heads, to ensure proper education for their kids. Q. Would you say that government is making very serious attempts to tackle these problems? A. In 1988, the GMA got the government to recognise that doctors and other health professionals do not work the normal 40-hour a week schedule. A doctor, working alone in a district hospital, will do something in the region of 300 hours in a month. Since December 1999, government has been paying additional duty hour (ADH) allowance for extra hours that health professionals do beyond the normal 160 hours per month. So although something has happened along these lines, basic salaries are still abysmally low. Other incentives to induce them to stay and work in Ghana are non-existent. If you work as a Doctor in Ghana for 25-30 years you retire on a national social security pension scheme at best worth 400,000 Ghanaian Cedis (US$ 50) a month. A lot of our senior colleagues, who are retiring are finding this rather belatedly in their career. They retire without putting up a house and no nest of savings to fall on. Within no time, that individual falls into depression and dies soon after retirement because life has become unbearable. I know of retired prominent specialists who are living in single rooms in a house in their village. That cannot be something that anybody would want to experience. And that is good enough incentive, if you would ask me, for any doctor to leave Ghana for a greener pasture when he is strong and young enough to work and make reasonable savings. Q. How much does it cost to train a Doctor in Ghana? A. It takes about six years to train a doctor. It would cost a minimum of about 16 million cedis (US$ 1,800) a year. These basically are inputs into teachers, equipment for training et cetera. This does not take care of accommodation, stipends and a lot more. Q. There are currently some newly built hospitals all over the country such as the Brong Ahafo Regional Hospital, which appear to be abandoned due to the lack of adequate health professionals to staff them. A. Yes, Ghanaians are making a lot of noise about the new hospitals such as the Brong Ahafo Regional Hospital, because they are new and so much money has gone into building them. These big facilities in the Brong Ahafo, Volta and Central Regions (in central Ghana) have become white elephants. They have been built with huge sums of money from international donor agencies without the health authorities going the extra mile to ensure that professionals who are going to run the facility remain in the country. The Volta Regional Hospital, which is similar to that at Brong Ahafo, has not been able to attract 25 percent of required health professionals needed to run it. That facility currently depends on some retired physicians and surgeons, some of whom travel every now and then from Accra to offer some service. The Brong Ahafo Hospital just opened recently because there was virtually nobody to man the facility. Now, let us forget about these facilities and let me tell you something. If you go beyond Kumasi (Ghana's second biggest city) towards the northern part of Ghana, there is no paediatrician. There are only three surgeons beyond Kumasi. These are at Sunyani, Wa and in the Upper East Region. One is retired, the other is close to retirement and the third is relatively young. If you go beyond Kumasi, there is no dermatologist, there are not more than five dentists and there is only one obstetric gynaecologist at Tamale. Q. What about the proposed US $5 million revolving fund to assist health professionals in the country? Is it functioning? A. The Ghana Medical Association asked for simple things like government giving cars to doctors to go about their work. Over the past five years, 368 cars were given out to health professionals. I also know there has been some allocation of monies meant to be up to $5m to set up a revolving fund. That fund currently has at least $3 m and it is yet to start functioning. We need to expedite action on it. Q. What do you think about suggestions that because Ghanaian medical personnel are in hot demand worldwide, government should consider training more personnel for export and demand compensation from the foreign countries that recruit them? A. Yes, there is talk about recompensing the Ghanaian government for health professionals that are recruited out of the country. I disagree with that notion. Peoples’ health is not assured by money. Experienced health professionals, who will deliver the service, assure it. I have worked here for 19 years. Should I decide to leave overnight, the 19 years of experience will be lost to Ghana. That is one more doctor gone. That is one more health facility without a health professional. That is sad. [ENDS]