Effects of Health Labour Migration on low and mid-level health personnel for infectious disease control at the periphery in Ghana

Purpose: A situational analysis of midlevel health cadres in the service delivery in the Volta Region of Ghana.

Objective: To conduct a situational analysis on cadres involved in the control and prevention of infectious diseases in a region of Ghana in order to inform policy on the production, deployment and retention in the health sector.

Methods: Qualitative and quantitative data on human resources at national, regional and district levels were gathered (2000-2005). Documents reviewed, key informant questionnaires administered, analyzed and key informant interviews were conducted to validate data.

Results: The Region lost 8% of its midlevel cadre workforce in the six years under review. Transfers and study leave accounted for 42% of all attrition. Retirement accounted for 8%, death 3%, vacation of post 2%, while sick leave and end of contract accounted for 1%. Among the various mid-level staff, community health nurses (50%), technical officers (45%) and enrolled nurses (41%) were the most likely to go on study leave. Analysis of results show an ever increasing ageing midlevel cadre workforce with a mean age of 44yrs. The implication is that not only is the Region loosing its trained health professionals but also the midlevel cadres to different forms of attrition. Validation of the task list revealed midlevel cadres often have to perform and take on additional tasks outside their areas of training. Midlevel cadres are often left out in favour of professional workers and only 8% benefited from deprived area incentives.

Policy implications: Policy response to address the inadequate numbers of midlevel cadres in Ghana may be geared towards increasing intake and reducing the rigid barriers to professional practice. In addition, these cadres should be enabled to take on additional roles. This can be achieved by redefining functions, reforms in staffing standards and refocusing on in-service training. Firm decision by policy makers on the most efficient skill mix and numbers of health workers to train to achieve the desired coverage of health interventions cannot be overemphasized.

Lastly, the current strategies/incentives to rectify geographic imbalances have not had the desired results. More innovative strategies are thus needed to achieve an equitable distribution of health workers within and between regions in Ghana.