‘It’s a timebomb’: Ghana grapples with mass exodus of nurses as thousands head to the west | Global health
WWhen Bright Ansah, a nurse in Accra, goes looking for colleagues who have failed to show up for a shift at the overcrowded hospital where he works, he knows where to look. “When you see ‘In God we trust’ on their WhatsApp status, you know they are already in the United States,” he says.
The United States currency has been taken over by Ghanaian health professionals who are leaving the West African country in droves. Many believe their faith was finally rewarded when, after years of planning, they reached the promised land of well-equipped and well-resourced American hospitals.
Since the Covid pandemic wreaked havoc on global health systems, the number of nurses, midwives and doctors leaving Ghana has increased exponentially. It is estimated that at least 6,000 nurses will leave in 2024, due to factors such as low wages, unpaid salaries and deteriorating infrastructure. Although the United States is a huge draw, nurses also migrate to other countries, including the United Kingdom, Ireland, Canada, Australia, and the United Arab Emirates.
Meanwhile, in May and October, Ghana’s Ministry of Foreign Affairs signed agreements with Jamaica and Grenada to send hundreds of nurses to the Caribbean islands, expanding a 2019 agreement with Barbados. In July, the Minister of Health announced that more than 13 countries had expressed interest in implementing similar recruitment arrangements.
The government’s justification for these projects is that Ghana has a surplus of nurses, with tens of thousands unemployed.
But Ghana is also one of 55 countries on the WHO Support and Safeguard List, which identifies countries facing the most pressing workforce challenges related to universal health coverage. And those working on the front lines of health care feel like they are on the brink of a crisis.
“It’s a ticking time bomb,” says Ansah. “In Ghana, you have a population of 35 million people, and the nurse-to-patient ratio is so high that the nurses are overworked; they are exhausted. Yet the government wants to export its most experienced nurses to a place like Grenada, which has a population of 125,000.
“I agree that most of our nurses want to leave,” he said, “but we don’t have to intentionally kick them out. »
Nursing has long been considered a sought-after profession in Ghana, providing job security in a country where stable jobs are rare. It has also become increasingly attractive for other reasons. A well-established migration route, it has seen an increase in newcomers as people seek to relocate, although programs are only open to experienced doctors.
Three nurses who chose different paths explain why they decided to stay, leave or wait to see what happens.
Stay: Bright Ansah, 36 years old, breastfeeding officer
“Personally, I am happy to stay because I still feel that I can do a lot for my country,” says Ansah, who receives daily messages from former colleagues, now abroad, showing off their state-of-the-art equipment and comfortable lifestyle.
While he understands the frustrations that led them to leave their jobs, their families and their country, he remains stoic about his decision to stay. “I believe I can help save lives. If we all leave, who will take care of our mothers and fathers when they need medical attention?” he asks.
Although he calls the average monthly salary of 3,000 Ghana cedis (£197) “demoralizing” and admits that some nurses have resorted to selling drugs to patients as a means of survival, he has managed to make things work by adopting an entrepreneurial approach to his career.
With a doctorate in public health, he combines academic teaching and nursing, hoping to equip the next generation with the skills and mindset needed to stay. He also established a healthcare company providing consulting services.
“We need a multi-sector approach from stakeholders. We should not only be interested in scoring political points but in solving the problems. Why are they leaving? What can we do to retain them as much as possible? Even those who migrate are interested in coming back to contribute to nation building. These are things we need to look at.
“I had a few colleagues who vowed to stay in the country no matter what, but when the pressure became more than they could handle, they all left. We must do better.”
Exit: Nana Yaa Mills39 years old, intensive care breastfeeding officer
Nana Yaa Mills, a mother of three, is happy to take her family and leave Ghana for good, but her mother and sister dread having to say goodbye. “They’re so sad,” Mills says. “They say, ‘But you’re there every time we call. Now you’re leaving, who will we call?” I tell them: “You can always call me. I’m leaving, but life goes on.
For Mills, that life now takes place in the United States. Although she has spent the last 12 years treating patients in various hospitals in Accra, she has had enough of the stress and chaos, and she is not alone. Of the 15 nurses she started with in 2017 at the hospital where she worked, only three remain in Ghana. “The majority went to the United States,” she says. “Three are in the UK and one is in Ireland.”
The move was a long time coming. In 2022, Mills traveled to South Africa to take the NCLEX, a standardized exam required to work as a nurse in the United States and Canada.
The job offer came earlier this year, but Mills believes she can still make a difference.
“The authorities only respect you once you leave,” she says of her hospital directors. “We diaspora nurses have big plans to use our influence to make things better. We are organizing; we want to make a change.”
Mills is part of a group of more than 1,000 nurses that started as a learning platform on WhatsApp, but has since evolved into a support forum for those looking to migrate. Many feel they have been forced out and there is real bitterness and anger towards the system and patients.
“The same people we defend don’t do that for us. When we strike, they’re the same people who insult us. So everyone is left to their own devices now.”
Although hostility toward immigrants is strong in the United States, Mills is not worried. “I’m just happy. Even here we face it. Patients’ relatives just come and insult you, so it’s normal. Racism is everywhere. We just need to grow a thick skin.”
Biding her time: Afua Tetteh, 23, rotational nurse
“Sometimes they don’t understand how they walked you to school hoping that once you finish, some of the burden will be lifted, but you still depend on them for food, transportation and rent,” Afua Tetteh says of her parents. “And you’re working. So it just doesn’t make sense to them.”
Tetteh is part of a cohort of nurses who took to the streets in October to protest months of unpaid salaries, although she did not participate herself, despite her own grievances.
She had to wait nine months after graduation before being assigned a hospital placement. Five months later, she has just been paid, but not in full, even though she goes to work every day, travels 21 km round trip on public transport and returns home late from work.
Tetteh’s aunt, who is also a nurse, was instrumental in helping her adapt and stay on track. One of the biggest problems caused by the flight of experienced nurses is that new recruits like Tetteh have no one to turn to for advice and support. They must learn processes and procedures on the job that would normally be carried out by senior managers.
“There are about 30 patients in the ward and only two nurses, plus two of us military and maybe one or two students. It’s extremely stressful.
“I’m lucky to have my aunt, so if I’m having trouble, I just pick up the phone and call her. When you see the nurses, you realize how tired they are from all this work. I really don’t want this to be my share of the work in this country.”
Age and inexperience prevent Tetteh from leaving Ghana in the short term. She therefore views her immediate future with pragmatism. When asked if she has considered a career change, she says that while it has crossed her mind and some of her peers have left nursing for less stressful jobs, she hopes to stick with it.
“Life is happening the way God wants it to be,” she says, “but hopefully in five years I could have left the country or maybe gotten a side hustle so I can get my life together and know where I’m going. Right now, things seem very unclear for someone who’s just starting out.”
*All names have been changed to protect identities
