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Health brain drain

Last week, I was privileged to be a panellist on Joy News to discuss the above. Naturally, in a one-hour program, there is not enough time to fully explore such an important topic. Let me congratulate Joy fm and other media for the seriousness with which they address important national issues. As a friend remarked, “Joy has investigated galamsey more thoroughly than the OSP and the Attorney-General combined.” Indeed, sometimes, the media platforms have more substantive deliberations than Parliament itself.

The brain drain amongst doctors, which also affects nurses and other healthcare professionals is truly a global phenomenon. It occurs within countries–from rural to urban and between countries — from poor to rich countries. In Europe, it has particularly affected the Eastern European countries. The proportion of Israeli physicians practising abroad rose from 10 to 14% from 2006 to 2016 while Romania lost half of its doctors from 2009 to 2015!

Obviously, it is a more acute problem between the rich and the poor. The 10,000 doctors actively practising in Ghana are far below what is required by WHO standards and the shortage of nurses is even more acute.

Currently, one out of five of all physicians practising in the US is foreign-born and amongst those from Africa, Ghanaians rank third in numbers, despite our paltry population compared to other countries, according to the American Medical Association. While low salaries, poor equipment, lack of opportunities for professional advancement and arbitrary promotions are common in most countries, Ghana has some peculiarities.

First, after training, it takes, quite often up to a year to post young Doctors and nurses because of a lack of “financial clearance” from the authorities! Frankly, this delay while the sick have no caregivers and some die is the equivalent of ” medical malpractice” and ” negligent homicide”. How can a government that knows the number of vacancies of nurses and house officers is not able to do “financial clearance” in advance?

Every July, thousands of new Doctors some from around the world, start internships right on cue because hospitals and the government plan for it. Why do we tolerate incompetence that cost lives?
Second, there is the issue of professional advancement. Ghana’s health professoriat, with few exceptions, seem to think it is their responsibility to hold their juniors back rather than train and mentor them to reach their potential.

A senior colleague tells me that a group of 5 young Doctors took the professional exams for post-graduate training in Ghana and only one passed. A few months later, 3 of the 4 took the West African exams and three passed. Quite a few young doctors have complained of “failure-oriented” professors who don’t encourage them. When your contemporaries who were no better leave for other places and report both professional advancement and financial success, it whets the appetite to leave.

Third, aside from academic advancement, there are arbitrary and non-meritocratic promotions that demoralize. Promotions, too often are based on connections and ethnicity etc and this fuels the desire to leave.

The absence of a professional work environment and lack of equipment also fuels the desire to leave. I was told that in the last few months, CT scanners, MRIs, etc have been down at Ridge Hospital for some time while Korle-bu had no dialysis services for some time. These episodes demoralize those trying to provide the best care to their patients and fuel the desire to leave.

The last factor that fuels the desire to leave is the absence of retirement security — or what doctors of my generation call the “Mustafa-Hiadze” syndrome. This is the situation where doctors who have given decades of service to Ghana retire and live in poverty for lack of retirement security. The solutions to most of these are self-evident and should not be belaboured.

We can make arrangements for Doctors and nurses who have served for about 10 years to use part of their retirement savings, matched by government as a down payment for a retirement home to be paid for over 25 years.

More money or resources will help. Moving from the average of 4% of GDP spent on health to about 8% will certainly help, not to speak of the 15% pledged in the Abuja declaration. And while the “cake is small” some equity and prudence will help. Those who preach altruism must practice it. It is hard to inspire sacrifice when the powerful pay themselves well, get lavish allowances and get “all-expenses-paid” healthcare abroad while insisting the national coffers are empty. Meanwhile, Doctors and Nurses who get sick must rely on the National Health Insurance which is not accepted by most of our major hospitals.

Next, we must understand the inevitability of the professional exodus and make the best of it. In the 1960s Brazil passed a law banning the export of Pele, their most celebrated soccer player. Today, all talented Brazilian soccer players play abroad! Indeed, they produce for export. But most of these still aspire to put on the famous yellow shirts of the Selecao.

We must use our health professionals while they are abroad with telehealth/telemedicine for practising and teaching, give cross-appointments and encourage short-term service visits. And when they/we are ready to come home, we must be welcomed. Too often, Diaspora professionals who desire to return are treated more as “prodigal sons” or traitors than as full-blooded Ghanaians who have a lot to offer. They are subject to demeaning exams and condescending procedures. The Chinese transformation was fuelled by the wealth and expertise of the Chinese Diaspora and India has benefited immensely from its Diaspora health professionals in its transformation into a Health tourism and vaccine production behemoth.

Even in our own history, it was a Diasporan, Kwame Nkrumah, who returned to give our independence struggle the decisive shot in the arm. And in 2006, it was a bunch of diaspora soccer stars who took us to the World Cup and almost made history four years later in South Africa. Before these, Tetteh Quarshie gave us cocoa!

Finally, we should look at the possibility of turning our talented health professionals into an organized export commodity who can be sent to advanced countries along the lines of Cuba to earn revenue, some of which can go to government to support health and education and retirement security for their colleagues who stay behind.

If the government can export nurses to the Bahamas while we are understaffed why can’t we produce more for export for experience and revenue while being ready to welcome them home when they are ready?

Let’s think creatively to turn the “brain drain” into a “brain gain”. May God bless Ghana.

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