Migration of workers
Human resource management. Human Resources in the Health Sectors. Concepts of motivation. An overview of migration and its impact on healthcare. Motivation indicators, migration in the Ghana health sector. Pull and push factors. Features of methodology.
| Рубрика | Международные отношения и мировая экономика |
| Вид | дипломная работа |
| Язык | английский |
| Дата добавления | 17.06.2017 |
| Размер файла | 748,4 K |
Отправить свою хорошую работу в базу знаний просто. Используйте форму, расположенную ниже
Студенты, аспиранты, молодые ученые, использующие базу знаний в своей учебе и работе, будут вам очень благодарны.
It has been verified that majority of nurses are motivated by the need for further professional development, personal safety and quality of life as reasons to migrate overseas. According to the WHO, about $500 million are annually spent on the education of health workers from Africa who then eventually migrate. Targeted recruitment drives for health workers from resource-poor countries have become a common solution to filling vacancies in richer countries, which thereby leads to a brain drain in the poor countries (Nyonator et. al, 2005). The loss of health professionals through migration can compromise health system capacity to deliver adequate care as the more experienced workers whose expertise are needed migrate. Staff shortages increase workloads and stress levels and it subsequently leads to demotivation of the few remaining health professionals, most especially in the rural areas. While migration of health workers becomes a nightmare for most countries, some countries on the other hand intentionally export their health workers to other countries. Cuba sends their health professionals to other countries in Africa to assist in healthcare delivery and training of health practitioners. A country like the Philippines actively exports nurses to other countries and it is estimated that the Philippines receives about $800 million annually from the exportation of nurses (Chen et. al, 2008).
Health worker migration is not confined to external movement. Internal migration, from rural to urban and from public to private sector, is also creating problems with the rural areas worst affected - understaffed and the staff who are there are often under qualified (Chikanda, 2005). It must, however, be noted that the migration of health practitioners is predisposed to vary in the diverse regulatory structures that control the training, the recruitment, and distribution of the practitioners. The United Kingdom has since been one of the desired places of interest for many migrants, and the number of immigrants keeps rising. Physicians and nurses make up only a small proportion of the number of immigrants in the UK, however, the loss to source countries, especially African countries, are perilous to the provision of healthcare in the source countries. According to Ravenstein research, migration is highly age-selective where adults in the working age groups display a greater propensity to migrate. This is likely so because migration occurs mainly due to economic reasons. The working class is the target group for migration because they are those who have a majority of people in their families depending on them. Due to the high dependency ratio on the adult working groups, most especially in developing countries in Africa, the working population is more likely to migrate. This mostly happens in countries and regions that have high unemployment rates, low salaries, and bad working conditions. Some of the health workers, therefore, migrate to get better salaries overseas and send some home in the form remittances.
Chapter two. Motivation indicators and migration in the ghana health sector
2.1 Introduction
Many are the factors that contribute to high employee motivation. Most of the employees in the public sectors are satisfied with work when they find the nature and conditions of work favorable with good forms of supervision, coupled with opportunities for promotion. Most health workers in Ghana would apparently say that they are less interested in performance related pay, another important form of motivation, because they are more interested in the well-being of the sick which means that they have love for their jobs and are less influenced by financial motivation. According to a research work by Quartey et. al, 2010, there are certain basic factors which motivate health professionals to enter into the health sector in Ghana. These factors are prevalent in almost all other research works that sought to find out the basic motivating factors which propel people to join the Ghana health sector. Some of the basic pull factors were love for the nation, the predicament of the sick, prestige, among others factors. The table below shows the motivating factors which caused doctors and nurses to join the health sector in Ghana. The research surveyed 97 health professionals out of which 81 were nurses and 16 doctors.
Source: Quartey et. al, 2010
An interview that was conducted with the president of the Ghana Health Service (GHS), Dr. Kwabena Opoku-Adusei, confirms the need for health workers in Ghana to be motivated duly. As reported in 2013 in the Daily Guide, a famous Ghanaian newspaper, in an interview with the president of the Ghana Medical Association, Dr. Kwabena Opoku-Adusei, who made it clear to the government to highly motivate health practitioners so that the health practitioners would give their best on their work. Prior to the interview, there was a news report that surgeons at the Komfo Anokye Teaching Hospital - the biggest hospital in Southern Ghana - had successfully separated a three-month-old pair of Siamese twins. It is believed that the said surgical procedure to separate the twins was reported to have been deferred twice due to the serious nature of the case. Doctors, according to sources, needed to observe the situation for some time before they could perform the surgery. Speaking on Okay FM after the surgery, Dr. Opoku-Adusei stated that the nation was lucky to have experts in the medical field and as such it is the duty of consecutive governments to make it a necessity to improve upon existing infrastructure to make the work of doctors and other health workers easier. Touching on the issue of doctors' annulment of their nationwide strike in the said year, Dr. Opoku-Adusei made it clear that the strike was as a result of their belief that the meetings between their outfit and the government would yield positive results. He added that their strike was based on governments' role to be committed to them and not necessarily on `physical cash'. Dr. Opoku-Adusei climaxed his speech with a plea that the government must try its maximum best to motivate health workers as well as other workers in the various sectors of the public. The above statement made by the president of the Ghana Health Service, Dr. Kwabena Opoku-Adusei, may sound highly altruistic, however, it must be noted that behind every altruistic action there exist an egoistic intention. Prior to this speech, doctors in Ghana had gone for a long strike, which is a yearly act, and the main idea from the president of the association was to call on the government to increase the salaries of physicians so that the physicians would feel motivated to put in much effort on their jobs.
According to the 2008 and 2014 Ghana Demographic and Health Surveys, demotivation is one eminent factor that hinders the accessibility to quality healthcare in Ghana. According to the surveys, most of the doctors in Ghana have been migrating from the rustic areas to the cities to work there and hence depriving the majority of people living in the rural areas access to quality healthcare. As the majority of the health practitioners are found in the cities such as Accra in the Greater Accra Region and Kumasi in the Ashanti Region, the few who decide to stay in the villages are overburdened with the workload and due to the high doctor-patient ratio in the rural areas, quality healthcare is compromised. According to the survey, in 2007, the national doctor-patient ratio was one doctor to 10,452 patients, while each nurse took care of 1,251 patients. The situation was worse in the Upper East and Upper West Regions, where the doctor-patient ratio was one doctor to 40,502 patients in 2012 and 39,697 patients in 2014. According to the 2014 GDHS, the number of midwives reduced marginally from 4,032 to 3,863 in 2012. These reductions were due to demotivated staff and it sent a wrong signal to the general public, and those who had interest in working in the health sector were deterred from reading midwifery in the nursing colleges. This paper goes ahead to discuss some other motivation indicators in Ghana health sector;
2.2 Job Motivation
Job motivation or satisfaction is a sentimental response to various aspects of one's job. The emotions of employees can have an impact on their attitude towards work, and it is verifiable that the main causes of job satisfaction and productivity lie chiefly in the social relationships and psychological issues that go on at the workplace. Many are the reasons that cause health workers in Ghana to feel motivated and perform better on their jobs. Health workers will generally express job satisfaction if they feel effectiveness in their job input and output. Factors contributing to motivation and job satisfaction also include strong career development, an adequate compensation, and adequate working and living conditions (Deussom et. al 2012). Job satisfaction is basically an emotional response that results from an employee's perceived fulfillment of his needs and what he considers the company to have offered (Locke, 1968). This means that when an employee finds his needs met, he is believed to be satisfied with his job. Again, job satisfaction has to do with the attainment of basic psychological and physiological needs and enabling environmental circumstances that cause a person to admit his satisfaction with his job. What this means is that, when a person realizes that his basic needs have been met and as well has a very conducive environment at his workplace, he tends to be fully satisfied with his job. It must, however, be noted that since motivation is subjective, irrespective of the environmental circumstances at the workplace, the most important factor is the personal traits of the employee. The worker is the person who chooses to be influenced by what he sees, perceives or what he receives and he is the only one who can candidly say he is satisfied with his job or not.
So, how motivated are workers in the public health sector of Ghana? This can be empirically verified from their attitudes toward work which includes their actions and inactions that express their satisfaction. No matter which spectacle one looks from, almost every public health worker in Ghana will attest to the fact that he/she is satisfied with their personal achievements at the work place. An interaction with a couple of health workers in Ghana revealed that almost all of them were boastful of their achievements and how hardworking they were on their jobs. However, most of the junior female nurses in Ghana, when confidentially confronted, would reveal that they are most often than not sexually abused or socially irritated by their superiors or doctors in their respective facilities in the public hospitals. In order not for the female nurses to be sentimentally demoralized, if not all, most female nurses have matured female nurses or female doctors as their immediate supervisors - but the problem still persists. When positive relationships are maintained with coworkers, there can be an increase in motivation. It is more likely for health workers, most especially nurses, to feel more satisfied with their jobs when they have a greater autonomy in decision making with regards to patient needs. Moreover, as said early on, when there are weak human resource managements systems that fail to motivate health workers, the greater impacts are felt in the rural areas where there are few health workers who work long hours. Unlike the urban centers, rural areas have limited resources for work and health workers in rural areas feel isolated, and as a result, they tend to be demotivated. When these health workers are demotivated, they tend to either leave their jobs or migrate to the urban areas or even overseas when they have the means.
2.3 Nature of work (Organizational Satisfaction)
The nature of work constitutes a significant factor with respect to public sector motivation of employees. The term `work' can be described as the degree to which an employee's job provides him with stimulating tasks, opportunities for learning and personal growth, and the opportunity to be responsible for results. Again, a research work by Bhaskar and co. suppose that substantial influence over job satisfaction of employees seems to come from the nature of the work given to them, and they also affirm that job satisfaction can be achieved by employees if the job requires adequate variety of expertise, prudence, challenge and scope for using a person's expertise and abilities (Bhaskar and Sharma, 1991). Individuals will be more committed to perform their best on their jobs if they find their organizational objectives achievable with beneficial results (Wright, 2007).
Relating this to the Ghana public health sector, from the ranks of the doctors through to the community nurses in the various hospitals and clinics, each of the workers is charged with a specific duty to perform; surgeon performing their surgical operations and checkups, dentists, opticians, lab technicians, obstetricians, pharmacists, nurses, among others are all charged with specific responsibilities in their various fields of work. As this is done, each worker is able to bring his/her expertise to bear on his/her job. Though their responsibilities are challenging and they are also overburdened with work due to the high health worker ratios in Ghana, yet they still strive hard and at the end of the day, they pride themselves by their achievements. Despite the nature of the work which includes night shifts duties and the huge numbers of patients, if not all, most health practitioners in Ghana are satisfied with the nature of their jobs. This is the main reason why many parents yearn to have their children study health-related programs in universities and colleges, while other health workers such as nurses are highly respected by their clients - the patients.
Moreover, a research work by Landy (1989) describes a situation which will make employees satisfied with their jobs, and according to the research, job satisfaction is attained when such jobs are attractive to the employees. Taking into consideration two public institutions in Ghana; Ghana Ports and Harbor and Ghana Cocoa Board, it is believed and has actually been verified that these two public institutions are very attractive to the employees and as a result, most university graduates aspire to work there. Likewise, the health sector of Ghana and the main reason behind this motivation is that, taken aside the salaries paid to health practitioners, the workers in the Ghana health sector are highly respected in their respective societies and they pride themselves by such reverence. Research has estimated that what a person does at work, - which includes the nature of the job or fulfilled tasks - can influence his motivation towards work. In other words, it is not the particular sector per se that determines motivational patterns, but rather the content and type of the performed tasks such as routineness and job specificity.
2.4 Opportunities for Promotion (Merits and Rewards)
Some researchers believe that job satisfaction has an enormous connection with opportunities for promotion. Herry and Noon (2001) describe promotion as the lifting of an employee from his current status to a higher status in the organization's hierarchy which brings about an upgrade to the employee's level of responsibility, an increment in salary among other things. A lot of employees will experience satisfaction with their jobs when they realize that they have positive future opportunities to rise within ranks - the prospect for progression and development in their workplaces. In the various Ghanaian public sectors, though there exist bureaucracies here and there, youthful but vibrant and hardworking employees are given the opportunity to rise within ranks. Though most of the directors in the various public sectors are old, their deputies, as well as important authorities, are quite younger, and it serves as a motivation for younger employees to work harder in order for them to be promoted duly.
There are huge opportunities for promotion in all sectors of the Ghanaian public, likewise the health sector. It must, however, be noted that promotions in the health sector of Ghana have a different approach unlike what happens in the other sectors. Promotions are typically based on one's academic status and as a result, a nurse cannot be promoted to a surgeon - it doesn't work that way. The health sector is structured based on one's specialization and so a health worker can only be promoted within his own sub-sector, say a chief surgeon among surgeons or a hardworking doctor or nurse promoted to head a particular facility. Most of the time, promotions in the health sector are based on one's education level and upgrades - specialization, hard work, and attitude towards work. These attributes, qualities or qualification levels are the main factors that contribute to promotions in the Ghana public health sector. Administratively, one's ability to manage the affairs of his endeavor in the health sector can also get him promoted. For example, an assistant administrator of a public hospital stands the chance of becoming the main administrator if he/she has a high command over his job and is able to execute his tasks appropriately and effectively while he is a deputy administrator.
It is assumed that the level of job satisfaction will go down if the employees think that they have fewer opportunities in their career advancement, and also if the promotional opportunities are biased or impartial. The confidence in promotional opportunities can be appealing to employees if managers are willing to provide special opportunities for subordinates to prepare for a future position by allowing the employees to attend important conferences and represent their divisions during board meetings in order to gain necessary experiences. Again, health workers can be exposed to the overall picture of the demands of work and the expectations of the organization. Promoting employees without bias means that the employees are to be promoted based on merit through the use of a recognized criteria or standards designed for measuring employee output. When this is done, employees who exhibit good work ethics are the ones who will be promoted. When employees see their colleagues duly promoted to higher positions, it challenges them to put in more efforts so that they may also be promoted.
2.5 Supervision (Satisfaction with management)
Many research works reveal that supervision and job satisfaction have an optimistic relationship. A supervisory work is done by a qualified supervisor, and according to Noon (2001), a supervisor is a forefront manager who is responsible for the supervision of employees. Supervisors are mostly employees who are given the mandate of directing and assisting lower employees. The duty of a supervisor goes a long way to have an influence on the total work output which will in return have an effect on the organizational set targets.
Moreover, a well-supervised employee has his morale towards work boosted and he delivers his best on his job. Every supervisor has his own leadership style or supervisory ethics; some are democratic, while others exhibit paternalistic and/or autocratic qualities. According to the findings of the research undertaken by Packard and Kauppi (1999), the employees who have supervisors who show skills of a democratic management most of the time experience maximum job satisfaction in comparison with those working with supervisors who display an autocratic kind of supervision. Talking to some nurses in the public health sector of Ghana, it was realized that most of the nurses were satisfied with the nature of their supervisors. They, however, revealed to that whenever their supervisors were harsh on them or used strong words on them, they poured out their rage on the innocent patients whom they attended or rendered their services to. This shows that good supervision is fundamental since it has a direct effect on an employee's motivation and an indirect effect on work output. A supervisor who stresses on the concerns of employees in his leadership generally has more workers feeling satisfied and contented as compared to those who practice task structuring and care more for production.
Supervision in the Ghana health sector is structured in such a way that every facility has a number of supervisors who have a number of junior staff members or new health practitioners under them. More often than not, employee-centered supervisors will show interest in the employees by listening to what the employees have to say which in the long run will result in an increase in the number of satisfied employees. When a supervisor is very friendly towards his subordinates, the employees feel more motivated than those who work under strict and hostile supervisors. Accordingly, a tolerant supervision will cut down red tape and empower employees to put in much effort on their jobs. Due to bad supervision, health workers' attitude to their clients - the patients - are very poor and their motivation to work is very low (Karima Saleh, 2013).
2.6 Performance Related Pay
Many researchers have done a lot of research regarding the motivation of employees and the influence of performance pay on job satisfaction. Among such researchers is Luthans (2006) who claims that though it is worth it when human basic needs are met, but it is also important if employers pay good salaries to their employees to help the employees cater for their higher level needs. What this means is that employers must be willing to pay their respective employees `huge' salaries that will make the lives of the employees better off. For example, a good pay will increase the purchasing power of an employee and he can live a comfortable life because he can afford higher needs like a car, a house, and comfortably cater for his/her family needs. When an employee finds himself enjoying such a comfort, it influences his attitude towards work and it goes a long way to increasing organizational output. Normally, an employee will feel much satisfied with his job if he compares his/her pay with that of other employees in other sectors and finds out that he is on a good pay system. According to a research work by Cavalcanti in 2009, workers in the Ghana health sector receive the highest base salary across different public sectors in Ghana. Satisfaction is expected to be achieved if the payment appears to be evenhanded, equivalent with job demands, individual skill levels, and community payment standards. However, job satisfaction, in cases where we have altruistic workers, is less likely to be associated with the payment and benefits the employees accrue.
However, although performance related pay may have a certain positive relationship with public sector motivation, it may also diminish the altruistic intentions of some public sector employees. Moreover, it is not certain if an inconsistent pay diminishes the motivation of employees in the public service, however, based on the findings of the `crowding theory', there could be a decrease in public service employees' motivation due to PRP (Moynihan, 2007; 2008). It is advised to rather encourage performance bonuses rather than PRP. Yet, it is obvious that the public sector is often incapable of providing such benefits - most importantly countries in Africa which Ghana is inclusive. Consequently, it will be quite appropriate if incentive systems in the public sector are restructured to promote intrinsic motivation, especially public service motivation, rather than extrinsic motivation and variable pay, which is traditionally geared towards satisfying the altruistic intentions of the employees. Ghana's economy is not strong enough to practice performance related pay in all sectors of the public including the health sector. For this reason, doctors and all workers in the health sector all have a fixed pay and the health practitioners can only receive extra bonuses for performance. Such instances occur when a doctor is able to perform a critical surgery on a patient and in which instance he is given a token as a form of appreciation or praise for the good work done. Most of the time, employees in the public sector of Ghana simply receive a warm handshake or public praise and rarely extra pay for a good work done.
Most health workers in Ghana will proclaim that they are less influenced by money or pay and claim that what motivates them the most are the availability of essential resources or incentives, good conditions in the work places as well as quality supervision. However, if the doctors and the other health workers are less influenced by `physical cash', as they claim, why do we always see them going on strike at least once every year in Ghana? They may argue that they do so because of the poor conditions of service, burnouts, and lack of some working incentives that must be available to facilitate their work, however, it is believed that among all the other means of job motivation, pay increments drive workers in the Ghana health sector to put in their maximum best on their jobs than any other factor. As a result of that, it will be in the interest of all Ghanaians if successive governments resort to pay increments to motivate doctors and all other health workers to help save lives. Moreover, it is important that workers in the public health sector of Ghana are well motivated because when they are well motivated, it has a direct effect on the customers - the patients. It must be noted that a higher share of the health sector budget in Ghana is spent on salaries paid to health professionals.
As part of the millennium development goals, universal access to good and quality health care and optimal patient safety are as well the goals of health systems and governments all over the world. Developed countries have made significant achievements towards the attainment of these goals, however, developing countries in Africa still lag behind due to financial, material and human resource constraints. It must also be noted that there exists a significant relation between health worker motivation and quality healthcare provision. Kenneth J. Arrow (2001) describes medical care as a fundamental commodity which the product and the activity of production are identical, and in which case the customer cannot test the product before consuming it, and this shows that there is an inherent element of trust in the relation. For this reason, this research suggests that it is imperative that successive governments of Ghana make it a chief priority to see to it that they restructure their policies to motivate workers in the public health sector so that effective and quality health care will be accessible to all Ghanaians.
2.7 An evaluation of health worker migration in ghana based on the theories of e. g. ravenstein and everett lee
The first attempt to establish the laws of migration was made by E. G. Ravenstein in 1885. Using the birthplace data, Ravenstein identified a set of generalizations, which he entitled laws of migration which was basically about inter-county migration in Britain in the nineteenth century. Many of Ravenstein's generalizations still hold in today's migration related issues. According to Ravenstein, the natives of rural areas are more mobile than their counterparts in the urban areas, and the major direction of migration is from agricultural areas to the centers of industry and commerce.
In Ghana, it is more likely to find health workers migrating from northern parts of the country to the southern and eastern parts of the country because of the prevailing environmental conditions in such areas of the country. The eastern and most importantly southern parts of the country have better working conditions, urbane and with modern infrastructure which makes it enjoyable to live in such areas of the country. The northern parts of the country are massively rustic with little or no social amenities, poor roads, and bad weather conditions. Such areas are typically marked with agricultural activities and the standards of living in such areas of Ghana are highly disheartening. What normally happens is that most health practitioners abhor being stationed in the rural areas of the country because of the poor nature of the societies in the northern parts of Ghana. While their counterparts in the southern parts of Ghana have better work schedules, the situation is the opposite in the northern and certain parts of the country because there are few health practitioners in such areas and the health workers there are overburdened with work. According to a research by the Greater Accra Health Directorate in 2015, the director, Dr. Linda Van Otoo, said that it was realized that in the Western region of Ghana there were instances where some hospitals had only one doctor and in such instances, it didn't matter the background of the doctor, whether the doctor was a specialist or a general doctor, every treatment in the hospital had to be done by that doctor. This suggests that the doctor had the duty of caring for adults, children, doing surgeries in the theater, performing cesarean sessions among other duties. This is how bad the situation is in some part of the country while in other parts of the country, we have numerous doctors at post who run shifts from time to time.
According to the 2008 and 2014 Ghana Demographic and Health Surveys, the three northern regions in Ghana have the highest and devastating share of doctor-patient ratios. According to 2014 GDHS, the Upper East and Upper West Regions have the least proportion of doctors, and recorded the worse doctor-patient ratio of one doctor to 39, 697 people in 2011, and one doctor to 40, 502 patients in 2012, and a nurse-patient ratio of 1, 601 (GDHS, 2014). It must be borne in mind that the three northern regions are the most hit with diseases and infections, snake bites among others due to poor hygiene and lack of education. Moreover, natives in the three northern regions in Ghana are drawn by tribalism, and since provocation is deemed as one of the big factors for internal migration, people from western and southern parts of Ghana who get posted in the northern regions of Ghana, in most cases, cannot cope with the traditional ways of life of the northern natives and they often get provoked by the culture and traditions of the northern indigenes, and hence their urgent decisions to migrate from such areas of the country. According to Ravenstein's theory, females are more mobile than males in their country of birth, but males are likely to migrate beyond the borders of their country of birth. This is probably based on the ability and strength of males to withstand the pressures of living in a totally new environment, as per the high male adaptability to changing environments. According to a research work in 2005 by Nyonator et. al., nurses in Ghana prefer to be stationed in the Ashanti, Greater Accra, Western and Central regions of Ghana (Nyonator et. al, 2005). Those nurses who find themselves in other parts of the country are always tending in their documents to move from the rural areas to the urban centers in the aforementioned regions. Most often than not, newly married female health workers tend to migrate from their stations of work to other parts of the country where their spouses work - in cases where their husbands work in different parts of the country other than where the female health workers work. Male health practitioners, on the other hand, have a high tendency to migrate overseas in pursuit of a better working environment. Most of the physicians are males and they always have the desire and have as a matter of fact been migrating to the USA and UK. According to the national statistics, experienced male physicians are bound to vacate their post in pursuit of better working conditions and salaries overseas than female physicians and nurses.
2.7.1 Pull and Push Factors
Internal and international migration of health workers has plagued quality healthcare in Ghana. As a result, service outputs in public and private health centers have declined due to lack of trained staff. The loss of skilled labor from poorer countries to richer countries has raised global concern and has been labeled brain drain (Nyonator et. al, 2005). Why do health practitioners in Ghana migrate? It must be noted that there is no objective reason for migration because the desire to migrate is chiefly a personal one and as a result decision to migrate is subject to change per inherent personal circumstances. These personal decisions are informed based on the social and economic circumstances in the respective regions where the health practitioners are stationed. Though the decision to migrate may be personal, yet there are certain patterns that run through the various personal decisions. Some of the social and economic situations may be related to tribalism, social unrest, lack of amenities for work, deprivation of any sort, provocation, poor working conditions, high living standards in the region, high doctor - patient and nurse-patient ratios, among other factors. A research by World Health Organization shows some of the reasons that influence or affect the decision by health professionals in five African countries to migrate overseas. According to the research, majority of health professionals who migrate from Ghana to different countries normally go to the United Kingdom and the United States of America. According to the research, there were certain major reasons or prominent factors that cause health professionals from Africa to migrate to Europe and America. Ghana was among the captured countries in the survey and the research shows that the desire to work in a better-managed health system, the desire to continue education or training, better salaries and good working environments are among the driving factors that cause health workers in Ghana to emigrate to certain countries in Europe and America. The graph below shows the basic influential factors by health practitioners in five African countries including Ghana in their quest to migrate.
Source: Bulletin of the World Health Organization - August 2004
According to the research works by Ravenstein and Lee in 1885 and 1966 respectively, there are certain pull and push factors that cause people to migrate. Higher wages and salaries, the demand for labor, political and religious freedom are some of the pull factors that attract migrants into a particular country. On the other hand, push factors that cause people to move from their countries of origin to other countries include poverty due to lack of jobs, civil and political unrest, religious persecution, environmental problems among other factors. The migration of health professionals in Ghana is in three forms; internal migration of health professionals from one area or region of the country to another, international migration of health professionals and finally, the migration of health professionals from the public health sector to the private health sector and vice versa. There are also instances where health professionals quite working in the health sector to work in a totally different sector such as the mining or education sector.
To begin with, there are certain factors that pull people into the Ghana public health sector. One of the most important pull factors has to do with the social recognition and reverence for health workers. In Ghana, health professionals are deemed important figures in every society and parents desire to enroll their children in health-related programs in the tertiary institutions. Because of this social recognition, a lot of people prefer to study health-related programs and they end up in the health sector of Ghana. Another pull factor is the conditions of work with regards to work schedule and salaries. Health practitioners in Ghana have undoubtedly good working conditions than most workers in the other sectors in the country. According to a research work by Cavalcanti in 2009, workers in the Ghana health sector receive the highest base salary across different public sectors in Ghana.
Source: Cavalcanti, 2009.
Note: CEPS = Ghana Customs, Excise, and Preventive Service; CSIR = Council for Scientific and Industrial Research; GAF = Ghana Armed Forces; IRS = Internal Revenue Services; PPPSARS = Public Policy, Planning, Services, Administration and Related Services; VAT = Value Added Tax.
In the city centers, most hospitals have many nurses and physicians who work in shifts thereby making the work schedule conducive for the health professionals. There are better salaries and wages for all health workers in Ghana and majority of health professionals in Ghana have good housing, cars and they enjoy better standards of living. These things tend to lure people into the health sector and there are instances where trained teachers quit their jobs and enroll in nursing training colleges so that they can also enjoy better standards of living. The government of Ghana under the leadership of president Nana Addo Danquah Akuffo-Addo has recently designed a policy to reinstate allowances for all students in nursing training colleges across Ghana. According to the budget read in the Parliament of Ghana by Hon. Ken Ofori-Attah, the Minister of Finance, on March 2, 2017, the president of the Republic of Ghana had decided to reinstate allowances to all trainees in the nursing training colleges as a means of motivating the students. These allowances, which were hitherto abolished by the previous government, are sums of money paid to the nursing trainees while they undergo training. This token is to motivate the students and to attract other people to enroll in nursing courses in order to boost the workforce in the Ghana health service. Another factor that pulls health practitioners to enter the rural and urban areas is the occurrence of marriage and other family-related issues. In most cases, irrespective of the station of a health practitioner, whether in the rural or urban centers, marriage and family demands tend to push and pull certain health practitioners from either the rural areas to the urban areas or vice versa. There are also some altruistic health professionals who willingly decide to migrate from the urban centers to the rural areas because they feel called to duty when the need arises to join forces with the few health workers in the rural areas in making quality healthcare accessible to the rural populations.
Push factors, on the other hand, cause a majority of health professionals to flee from the Ghana health service to other sectors of the public or overseas for an anticipated better standards of living. It must be noted that there is little or no incidence of forced health worker migration in Ghana because the decision to migrate is mostly voluntary. Several factors push people from the Ghana public health sector and these factors are made known by the health professionals themselves through their actions and inactions, interviews on television and radio, written memoranda, among others. One of the major factors that cause health professionals especially nurses to migrate overseas is the poor living conditions they are faced with. Nurses in Ghana are not treated like how other physicians are treated and the living conditions of most nurses in Ghana are detrimental. The salaries of nurses compared with other health workers in Ghana are nothing positive to write home about - lack of equity. A study of 400 trainee nurses at 7 training institutions (5 public and 2 private) saw that 55.5% of nursing trainees intended on emigrating (Kumar, 2007). Unlike doctors who ride in fancy cars and are provided with many free gallons of fuel for their cars each month, nurses are left out of this privilege. Nurses in Ghana health service are more active on the field of work yet they are marginalized when it comes to such privileges. Moreover, nurses are burdened with unfavorable work schedules and the nurses tend to make good use of any opportunity to either migrate overseas or from one particular hospital to the other or from the public health sector to the private health sector and vice versa (ibid.). It is indisputable that the health workers in the Ghana health service are overburdened with the workload and their performance is below average when compared with other countries in Africa. The workloads deter others from joining the workforce and those who are already in the field always desire to emigrate overseas.
Moreover, due to the staff shortages, the majority of health workers in Ghana are overburdened with the workload. The health worker ratios are very high and this causes many of the health workers to resort to migration - either rural-urban migration or emigration. There are night schedules for almost all health practitioners in Ghana and these continuous night shifts come with burnouts or fatigue and health issues due to lack of rest. According to the data from the integrated personnel payroll from the GHS Human Resource Department, as cited in a research work by Appiah-Denkyira et. al, 2012, shows that Ghana is not doing well regarding health worker ratios.
Source: Appiah-Denkyira et. al, 2012
Marital problems are also inevitable because these health professionals have their own families to cater for and spouses to spend time with. One serious negative externality of these night schedules is broken homes. According to a research work by the World Health Organization, health professionals tend to migrate overseas because of poor wages and they migrate overseas to enjoy better remunerations. Low salaries have been the major cause of strike actions by health professionals in Ghana and these health professionals go on strike at least once every year. Mostly, family wealth also informs health practitioners to migrate when they are dissatisfied with their salaries. Most health professionals from poor families, in most cases, endeavor to migrate overseas in order to earn better remuneration overseas and send some home in the form of remittances to help poor family members. According to Nyonator et. al, 2005, the flow of remittances into Ghana have been increasing and they serve as a stable source of external finance for most families.
Another push factor according to WHO data on Ghana is the lack of experience and professional development. Most physicians and nurses migrate overseas in order to continue their education and gain more experience outside Ghana. In-service training for physicians and nurses are mandatory because new drugs and equipment are manufactured year after year, and most of the things that the physicians and nurses study in medical schools and nursing colleges respectively are obsolete at graduation. Ghana doesn't have most of the newly improved equipment and as a result, physicians and nurses with inquiring minds tend to migrate overseas in order to abreast themselves with new technological advancements in modern healthcare systems. The migration of these physicians and nurses leave a loophole in the health sector and it causes problems when it comes to the access to and provision of quality healthcare in the country because the number of health professionals keeps decreasing and the doctor-patient and nurse-patient ratios keep doubling up. It must be noted that these push factors do no only cause the health professionals to migrate overseas or from one city to the other, but also they push future health workers from pursuing health related courses and programs in the tertiary institutions.
2.7.2 Motivating Ghana Health Workers and Curbing Migration in Ghana Health Sector
For Ghana to effectively manage the outflows of health professionals from the country, successive governments must design strategic policies to curb the menace. There should be policies that will seek to motivate health workers and ensure better working conditions for all health workers, retain the workers and also provide certain tantalizing allowances to influence the health workers to perform better on your jobs, and also to pull other people to join the workforce in the health sector. It is undoubtedly true the statistics from the ministry of health that majority of their spending is on the salaries of the health workers, however, it is advised that the government, through the ministry of health, increases the allowances and salaries of the health workers if there are the means of funding. In the western world, salaries and pay increments have been identified as least extrinsic motivation incentives, however, the case is different is Africa - nothing cajoles or motivates public workers in Ghana better than a good payment system.
Moreover, other local and international organizations such as the World Health Organization can also come in with strategies that will help boost the material resources in the Ghana health sector which will indirectly help to regulate migration in the Ghana Health Service. The migration policies by ECOWAS member states must be regulated and member countries must also design their individual migration policies to counter migration-related issues. Hitherto, Ghana had no migration policy until recently. Though the maiden migration policies by Ghana are in the right order, however the country and its policy makers must try as much as possible to design and implement certain migration policies that will discourage health practitioners from emigrating and rather pull other people to join the workforce in the health sector which will in the long run ensure the provision and access to quality healthcare in Ghana. According to a research work by Hagopian et al. 2004, the UK government issued a code in 2001 which stipulated that the UK National Health Service must not merely recruit health workers from developing countries unless there was a government-to-government agreement between the UK government and the governments in the developing countries such as Ghana from whence health practitioners emigrate from into the UK health service. This code by the UK government seems to be in the right order in helping to curb the menace of health workers' emigration from a poor country like Ghana, however, the number of verified nurses in the UK from Ghana after the introduction of the code far outnumber the levels of health workers who emigrated to UK in 1988 (Hagopian et. al., 2004). A report in one popular newspaper in Ghana, The Ghanaian Times, on March 23, 2002, showed that an estimated number of 1800 Ghanaian doctors were working outside Ghana which was more than the estimated number of 1600 doctors we had working in Ghana in 2001. This is a significant number and it goes on to affirm the strength of the push factors over pull factors. I believe that if the government of Ghana implements good policies to attract and retain health practitioners in Ghana, the number of health professionals who intend to migrate will reduce. Policy makers must factor things such as good pension schemes for health workers, and design strategies to increase the salaries of all health practitioners. The recent decision by the current government of Ghana under the leadership of President Nana Addo Danquah Akuffo-Addo has recently reinstated allowances paid to nursing trainees in all nursing training colleges in Ghana. This is a positive endeavor to help motivate the future health workers, and also lure new people to enroll in the various nursing training colleges in Ghana in order to boost the workforce in the health sector. The various departments in the Ghana public health sector must also ensure constant in-service training for all health professionals concerning new improvements in health care provision, while the government also imports newly manufactured equipment to aid the health professionals to ensure professionalism and creativity in healthcare delivery in Ghana. When such pragmatic approaches are employed, the health practitioners will be motivated to perform well on their jobs, and there will be a reduction in health worker migration and the creation of a peaceful atmosphere in the health sector will be ensured. In the end, access to and provision of quality healthcare in Ghana will be ensured.
Chapter three. Methodology
3.1 Introduction
This chapter is fundamentally about the methodology that was applied in distributing and fetching the responses of the research questionnaire, the review, and analysis of the questionnaire. This chapter has four main sub-chapters; data collection, sampling size and sampling method, analysis of the collected data and an evaluation and interpretation of the collected data. First and foremost, the methodology can be said to be a process or procedure of an inquiry. In research work, methodology focuses on how a researcher finds information, and his interpretation of the gathered information.
3.2 Data Collection Method and Procedure
This research comprises a study survey of the motivation, satisfaction, and migration of health professionals in the Ghana Health Service. As a desire to attain an unbiased and a clear indication of what the whole idea and strategy of motivation in the public health sector of Ghana, this research electronically disseminated the research questionnaire to the health practitioners to verify from them what really motivates them as health practitioners and how the process or means of motivation is carried out in the public health sector of Ghana. There were other questions on migration which sought to find out from the health practitioners the driving factors that cause them to migrate. As said earlier, the data collection was done by a survey medium using a questionnaire that was administered online through the various social media.
...Подобные документы
The history of Human Rights Watch - the non-governmental organization that monitors, investigating and documenting human rights violations. Supportive of a diverse and vibrant international human rights movement and mutually beneficial partnerships.
презентация [1,6 M], добавлен 12.03.2015Natural gas is one of the most important energy resources. His role in an international trade sector. The main obstacle for extending the global gas trading. The primary factors for its developing. The problem of "The curse of natural resources".
эссе [11,4 K], добавлен 12.06.2012Human Rights Watch як одна із ведучих правозахисних неурядових організацій. Боротьба організації проти гострих соціальних проблем. Оцінка ситуації з прав людини в Україні. Роль Human Rights Watch у міжнародному співтоваристві, ефективність її діяльності.
статья [14,1 K], добавлен 01.06.2014The essence of an environmental problem. Features of global problems. Family, poverty, war and peace problems. Culture and moral crisis. Global problems is invitation to the human mind. Moral and philosophical priorities in relationship with the nature.
реферат [41,3 K], добавлен 25.04.2014Причины и проблемы, побудившие основать организацию, цели ее создания, влияние на демографическую и экономическую ситуации в мире. Мероприятия, проводимые в рамках организации, формирование бюджета и его распределение. Порядок вступления в организацию.
реферат [207,8 K], добавлен 06.03.2010Місце Англії за рейтингом "Global competitivness index", "Human Development Index", "Corruption Perceptions Index". Порівняльний аналіз обсягу та динаміки ВВП країни із середнім по Європейського Союзу. Аналіз ВВП на душу населення країни та у відсотках.
курсовая работа [4,4 M], добавлен 05.03.2013Organisation of the Islamic. Committee of Permanent Representatives. Conference International Islamic Court of Justice. Independent Permanent Commission on Human Rights. Cooperation with Islamic and other Organizations. Peaceful Settlement of Disputes.
реферат [22,2 K], добавлен 21.03.2013The reasons of the beginning of armed conflict in Yugoslavia. Investments into the destroyed economy. Updating of arms. Features NATO war against Yugoslavia. Diplomatic and political features. Technology of the ultimatum. Conclusions for the reasons.
реферат [35,1 K], добавлен 11.05.2014История фондовых индексов и методы их расчета. Международные фондовые индексы: Morgan Stanley Capital International (MSCI); Dow Jones Global Indexes; FTSE All – World Index Series; FTSE Global Stock Market Sectors. Фондовые индексы США и России.
курсовая работа [37,1 K], добавлен 31.05.2009Presence of nominal rigidity as an important part of macroeconomic theory since. Definition of debt rigidity; its impact on crediting. The causes of the Japanese economic crisis; way out of it. Banking problems in United States and euro area countries.
статья [87,9 K], добавлен 02.09.2014The value of cultural behavior for a favorable business environment at the international level. Proper negotiations between the companies. Short-term or Long-term the Attitude. Formal or Informal. Direct or Indirect. Punctuality, stages of negotiation.
реферат [12,2 K], добавлен 24.02.2016Mission, aims and potential of company. Analysis of the opportunities and threats of international business. Description of the factors that characterize the business opportunities in Finland. The business plan of the penetration to market of Finland.
курсовая работа [128,3 K], добавлен 04.06.2013Legal regulation of the activities of foreign commercial banks. Features of the Russian financial market. The role and place of foreign banks in the credit and stock market. Services of foreign banks in the financial market on the example of Raiffeisen.
дипломная работа [2,5 M], добавлен 27.10.2015The Human Capital Theory. External Migration in Kazakhstan. The major causes of out-migration in Germany. Migration in Kazakhstan during 2004-2010. Internal Migration in Kazakhstan. The major factors determining the nature of the migration to Russia.
реферат [2,2 M], добавлен 14.04.2012The Nature of Management. The evolution of management thought. Planning and decision making. Organizing is an important managerial function. Strategic management. Staffing and human resource management. Communicating and motivation in management.
методичка [104,2 K], добавлен 16.12.2010Women predominate among graduates in the fields of health, education and society and culture. The K. Betts-Robert Birrell bunch's anti-migration version of the "new class" theory. Racism is not innate in "human nature". Why Betts and company can't win.
эссе [78,5 K], добавлен 24.06.2010The study of human populations. Demographic prognoses. The contemplation about future social developments. The population increase. Life expectancy. The international migration. The return migration of highly skilled workers to their home countries.
реферат [20,6 K], добавлен 24.07.2014The nature and content of the concept of "migration". The main causes and consequences of migration processes in the modern world. Countries to which most people are emigrating from around the world. TThe conditions for obtaining the status of "migrant".
презентация [4,8 M], добавлен 22.03.2015The history of the public health system in Kazakhstan. Human resources, the capacity of organizations and reform of the health system. Pharmaceutical market in the country. Priority sectors of the medical equipment market. Medical education and science.
презентация [987,7 K], добавлен 04.02.2015Migration policies: The legal framework. The evolution of migration flows. Percentage of Portuguese emigration by district. Key migrant characteristics. Characteristics of legal migrants. Return migration. Portuguese emigration by destination, 1950-1988.
реферат [65,6 K], добавлен 25.06.2010
