4.2 Data Description

The data for this study comes from an organized field survey, and the software used for the drafting of the questionnaire was Google forms while the dissemination of the questionnaire was done via social networks. The sampling method used was snowball sampling. The survey was carried out to find out information on motivation, satisfaction, and migration in the Ghana health sector. At the end of the survey, 203 responses were collected out of which 54.2% were females and 45.8% males.

4.3.1 Demographic characteristics of the respondents

Source: Field survey, 2017

The research looked at one of the major indicators in the public health sector; job motivation. Job motivation is the foundation for an employee to base on and candidly say he/she is satisfied with his/her job. The research questionnaire aimed at measuring the overall job motivation of the health practitioners who took part in the survey. According to the outcome of the survey, the majority of health practitioners in Ghana have reasonable levels of motivation and 84 respondents representing 41.4% said they neither agree nor disagree with the fact that they feel motivated on their jobs. Also, 56 respondents representing 27.6% said they have a good job motivation while 43 respondents (21.2%) disagree that they feel motivated to work. Moreover, 5.4% said they strongly disagree that they feel motivated to work, while 9 respondents representing 4.4% said they, on the other hand, feel that they have a very strong motivation to work.

4.3.3 Job Safety

The research questionnaire measured the safety of the health workers on their job, and the item used to measure job safety was; employees are protected on their job.

Source: Field survey, 2017

To ensure that health workers are healthy to provide services to the sick, it is imperative to ensure the safety of the health workers on their job. When there are good health policies, safety precautionary mechanisms, and a healthy body, a health worker will feel motivated to extend a helping hand to others who need medical attention. The survey sought to find out how workers in the Ghana health sector are protected from health hazards on their job. According to the survey, 79 respondents representing 38.9% said they are somehow protected from health hazards on their job.66 respondents representing 32.5% said they have average protection, 14.8% said they were fully protected on their job. On the other hand, 13.8% said they lack protection from health hazards on their job.

4.3.4 Job Satisfaction

The table below gives the summary of the levels of satisfaction by the workers in the Ghana health sector.

Source: Field survey, 2017

According to the survey, a majority of 42.9% said they had average job satisfaction - neither favorable nor unfavorable to them.33.5% said they had favorable job satisfaction, while 23.6% on the other hand said that they experience unfavorable job satisfaction. To find out how satisfied Ghana health workers are with the management of the various hospitals and clinics in the country, respondents were asked to rate their satisfaction with management of the healthcare system on a 5 Likert scale. According to the survey, 42.9% said they have had an average satisfaction with the management of the healthcare system.39.9% said they were dissatisfied with the management of the healthcare system, while 17.3% said they were satisfied with the management.

Moreover, the respondents to the research questionnaire were made to rate their satisfaction with their salaries and according to the survey, as seen from the table above, 46.3% said they were neither satisfied nor dissatisfied with their salaries.31.5% said they were dissatisfied with their salaries, which justifies why health workers in Ghana always go on strike, at least once every year over salary increments and unpaid allowances. On the contrary, according to the survey, 22.1% said they were satisfied with their salaries. It must be noted that most health workers in Ghana have good standards of living and this may be a justification of their satisfaction with salaries.

The table below shows the measured indicators on merit-rewards systems.

Source: Field survey, 2017

Table 5 is used to show merit reward systems and merit-based promotions in the Ghana health sector. The first part of the table evaluates the tendency of health workers in Ghana to get pay increments over good performances. According to the survey, 63.1% said they do not get pay increments for good performances while 11.8% said they get some pay increments for good performances. Moreover, 25.1% said they neither agree nor disagree with whether they get pay increments for good performances or not.

The second part of the table evaluates the genuineness or biasedness of awards and promotions in the Ghana health service. Out of the total number of respondents surveyed, 49.3% said awards and promotions in the Ghana health service are neither characterized by favoritisms nor legitimacy. This could be as a result of the fact that majority of the health workers are not familiar with the procedures involved in the promotions and bestowing of awards.26.6% said awards and promotions were genuine and given to legitimate people, while 24.1% said awards and promotions were biased and hence given to favorites or illegitimate workers.

The research questionnaire measured resource sufficiency in the Ghana health sector, and the item used to measure resource sufficiency was; You have sufficient resources such as people, materials, budget etc.

Source: Field survey, 2017

Resource sufficiency, human and material resources, helps employees to fully function appropriately on their jobs. Lack of sufficient human and material resources lead to low input and poor output. When there are sufficient resources for employees to work with, they feel motivated and they make good use of the resources available. According to the survey, 91 respondents representing 44.8% said they neither agree nor disagree that they have sufficient resources at their disposal.76 respondents representing 37.4% said sufficient resources such as materials, people and budget were at their disposal to aid them with their work, while 36 respondents representing 17.8% said they lacked resources to aid them with work.

The table below shows other measured indicators such as cooperation on the job and workload.

Source: Field survey, 2017

The table above captures the measurement of three important variables. According to the survey, 58.2% agreed to the fact that their colleagues at work always cooperated to get their work done while 3.4% said their colleagues at work do not cooperate at the workplace. Moreover, 69.9% of the respondents said they are always given real opportunities to improve their skills on the job while 6.4% said they lack such real opportunities to improve their skills. The majority of them said they were given real opportunities to improve their skills basically because the health workers are overburdened with the workload and each person has more tasks to accomplish at a given time which explains why they said they are given real opportunities to improve their skills. Again, according to the survey, 50.7% of the respondents said they were heavily overburdened with the workload which is in keeping with the Ghana national statistics according to GDHS which stipulates that doctor-patient and nurse-patient ratios in Ghana are relatively higher than WHO average.

The table below shows inter-sector migration of health workers in Ghana.

Source: Field survey, 2017

The table above shows the health sector to which the respondents belonged. It always measures the inter-sector migration among workers in the private and public health sectors. According to the survey, 80.3% of the respondents were workers in the public health sector while 19.7% belonged to the private health sector. Moreover, according to the survey, 66.0% said they preferred to stay and work in the public health sector while 12.8% said they desire or have made plans to move from the public health sector to the private health sector.11.3% percent said they have also made plans or desire to move from the private health sector to the public health sector, while 9.9% said they prefer to stay in the private health sector.

The table below shows the rural-urban migration of workers in the Ghana health sector.

Source: Field survey, 2017

The table above measures the rural-urban migration and vice versa in the Ghana health sector. According to this research, 53.2% of the respondents were working in the urban area at the time of the survey while 46.8% were working in the rural area.18.2% said they were previously working in the urban area which shows the migration from the urban area to rural area.27.1% said they were previously working in the rural area which shows a massive displacement of health workers from the rural areas to urban centers. Moreover, 54.7% said they have been working in their current station/area - rural or urban area. Again, the table shows the plans of the surveyed health workers with regards to rural-urban migration. A majority of 45.3% said they prefer to stay in the urban area where they currently work while only a minority of 19.7% said they would stay in the rural area where they currently work. The second majority of 26.6% said they have made plans to move from the rural area to the urban area to work which will, of course, see a reduction in the workforce in the rural area and hence the lack of accessibility to quality healthcare in the rural areas. Only 8.4% said they would like to move from the urban area to the rural area to work which explains the conditions of work in the rural areas.

Also, the table above captures the reasons for engaging in rural-urban migration by the health workers who took part in the research survey. According to the survey, marriage or marital issues is the major reason why most of the health workers in Ghana engage in rural-urban migration (59.1%).81 respondents, representing 39.9% said they desire to migrate to the urban areas due to the better conditions of work in the urban areas, while 34.0% said they want to engage in rural-urban migration due to the poor conditions of work in the rural areas. Moreover, 36.0% said they would like to engage in rural-urban migration because of different personal reasons. It must be noted that none of the respondents said they wanted to engage in rural-urban migration either because of poor conditions of work in the urban areas or because of better conditions of work in the rural areas. This is in keeping with the opposite working conditions in the rural areas and urban areas. It could be inferred from this that the conditions of work in the rural areas are very poor while the opposite is realized in the urban areas.

The table below measures the extent of emigration of workers in the Ghana health sector. The reasons for the intent are also captured below.

Source: Field survey, 2017

A question was asked to measure the tendency of health workers in Ghana to emigrate overseas and a follow-up question was asked to find out the reasons why the health workers would like to move abroad. The table above shows that 138 representing 68% of the surveyed health workers had plans to move outside Ghana to other countries to work which is very detrimental to quality healthcare accessibility in Ghana. Only 32% said they had no plans for international migration. The huge percentage of health workers in Ghana who desire to emigrate overseas could be as a result of their fantasies about huge salaries and how `excellent' working conditions in the developed world such as in the UK and USA are. Though this survey could not capture many respondents, it can, however, be used to prove, if not unanimously generalize, the huge numbers of health workers who are currently working outside Ghana and those in Ghana who yearn to emigrate overseas.

Moreover, a follow-up question was asked to fish out the reasons for this intent of mass emigration, and according to the research survey, 44.3% said they wanted to move to a different country because of their desire for a more conducive working environment unlike what they experience in Ghana.42.4% said the reason for their desire to migrate overseas is due to their quest for a better salary while 38.4% said their desire to migrate overseas is borne out of their desire to be exposed to modern healthcare systems.25.1% said they wanted to continue their education overseas, and only a minimum of 9.4% opted for other personal reasons for their desire to move outside Ghana to work.

The research questionnaire targeted the tendencies of turnovers in the Ghana health sector. The item which measured prospective turnovers was; Do you wish to quit/stop working in the health sector in the near future?

Source: Field survey, 2017

After several questions that sought to measure motivation, satisfaction, and migration in the Ghana health service, a single question was asked to evaluate the extent of future turnovers in the Ghana health sector. If one's occupation or job does not meet most of one's expectations or desires, the best option is to opt out and find a different work that is much better, fulfilling and satisfying. A final question was asked to find out if the surveyed health workers in this research wish to quit working in the health sector. According to the research survey, only 21 respondents representing 10.3% said they would like to quit working in the health sector while 182 people which represent 89.7% said they will forever be active workers in the Ghana health sector. This could be due to their love for the job - patients, love for the country, maximized job satisfaction, positive conditions of work in the health sector or some personal achievements or reasons that come as a result of their working in the health sector.

4.4 Multivariate analysis

4.4.1 Job Motivation