Govt gets tough on brain drain

To coincide with the 60th anniversary of Britain's National Health Service, the BBC looks at healthcare around the world. The BBC's Will Ross reports from Ghana where the ""brain drain"" has left hospitals struggling.

If you want to train in Ghana as a nurse and then disappear in search of greener pastures abroad, you better have deep pockets.

That is the message from the government as it attempts to stem the so called ""brain drain"" of health workers.

Nurses face a fine if they want to work abroad before serving in a Ghanaian hospital for five years.

""We have looked at the cost of training a nurse and if you default for the whole five years then you will be paying around 12,000 Ghanaian cedis, ($11,000, £5,500),"" says James Antwi, the Health Ministry's deputy director of human resources.

In theory a nurse wishing to work abroad would have to produce a certificate as proof of qualification and so until any fine has been paid, the Health Ministry can withhold the certificate.

The Ghanaian government says the threat of a fine has helped although the accountants have not exactly been inundated. Since the scheme was implemented three years ago just four people have paid fines of between $2,000 (£1,000) and $6,000 (£3,000).

In 2004, 700 nurses notified the ministry before going to work in Britain. But that has dropped massively to just six nurses leaving to work in the UK last year, according to the government.

This is, however, partly due to the fact that nowadays doctors and nurses from other parts of the European Union would be in front of Ghanaians in the queue for jobs in the British health system. It is also not clear how many have slipped under the government's radar.

There is no practical way of preventing a nurse from quitting the profession altogether and with low morale amongst health workers, retaining staff is a major challenge for the government.

------Back-to-back shifts

In the psychiatric hospital in the capital, Accra, young listless patients are watching music videos on television. A health worker is asleep, her head on a table. It is early afternoon. Other staff who have stayed awake are frustrated.

""I started in February and I still haven't been paid. And when you complain it is like it is the norm. You are told, 'It will come it will come,'"" says nurse Joanna Poku who trained in the UK before returning home.

""But at the end of the day there are bills to be paid. So I can see why nobody wants to stay here – it is very frustrating.""

A nurse in Ghana earns between $300 (£150) and $400 (£200) a month after tax but with rising transport and food costs, many are forced to take on a second job in private health and then to work back-to-back shifts.

So when the Health Ministry states amongst its visions and goals a desire to retain and increase productivity of health workers, why can it not pay all its workers on time?

""This problem has been with us for years and until we get decentralized human resource management and payroll management this problem may have to stay. But we are working hard to get a decentralized system sorted out,"" says Antwi.

The salary problem seems to be worst for newly enrolled health workers, as testified by the fact that junior doctors went on strike in Accra earlier this week. They were fed up waiting for their first salaries. They had started work back in October.

Apart from salary delays for new recruits, things are apparently improving for doctors (once they are on the payroll) and the exodus is slowing down.

""There are more opportunities for further training and we no longer have a situation at the end of the month where people are uncertain whether they are to be paid or not,"" says Dr. Sodzi Sodzi-Tettey, the general secretary of Ghana's Medical Association, before adding that there are still a few concerns about the conditions under which people are working.

------Ambitious

He believes that instead of focusing on stopping the brain drain, Ghana should consider training more health workers than it needs and then, under agreement with other countries, exporting the surplus whilst reinvesting some of the money earned.

""If it is really the case that Ghanaian doctors and nurses are that professional and well qualified, is there something to be gained by training say 5,000 a year and sending out 3,000?"" Dr. Sodzi-Tettey asks, pointing to Cuba for comparison.

Cuba has around 70,000 doctors. Ghana's population is twice the size of Cuba's but has just 2,300 doctors.

This plan, at least for now, seems a little ambitious when there is a morale problem amongst many Ghanaian health workers.

Living in her parent's home in Accra's Asylum Down suburb, 24-year-old nurse Francisca says she had to wait a whole year for her first salary.

""I will still stay in the medical profession, but I doubt I will stay working as a nurse because I believe nurses are being looked down upon in Ghana.""

Ms. Poku who came back home from the UK just four years ago is already thinking of calling the travel agent.

""If circumstances were good in our own country, who would want to leave? Home is home. It is peaceful. Why would you want to go to another country and stress out?

""It's because we are not comfortable,"" she says after crossing town for the second shift of the day.