BRAIN GAIN IN THE HEALTH SECTOR OF GHANA – DIASPORA COLLECTIVE IN-KIND REMITTANCE AND KNOWLEDGE TRANSFERS

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ABSTRACT

Migration is gradually becoming an important feature of globalization, due to the individual’s will to overcome adversity and to live a better life. Several reports have emerged on migration of health professional from developing countries to developed ones. Studies have tagged this form of migration as ‘Brain Drain’ and concluded that health professionals’ migration poses a major challenge to the health sector of the country, in this case Ghana. Against this background, this study sought to fill in the research gap regarding the benefits of Ghana losing some of its medical professionals to developed countries. Hence, the study examined, the ‘Brain Gain’ in the health sector of Ghana: diaspora collective in-kind remittance transfers. Specifically drawing on the pull and push migration theory of Lee, the study explored; the motivation drivers that influence health professionals to migrate. The purposive sampling technique was used to collect data from five (5) medical stakeholders, health organization, and medical associations in Ghana, while the snowball sampling technique was use to gather information from seven (7) returnee medical practitioners in Ghana. The study revealed that, most medical professionals migrate due to poor condition of services in Ghana and their desire to better their lives. These health migrants mostly remit in-kind to the state and they do that through donation of medical equipment, medical supplies and through organization of medical outreach programs for poor and deprived communities in Ghana. Most of the respondents affirmed that remittances from this migrated health professionals’ helps to reduce the burden on government budget in the health sector of Ghana. On the other hand, the findings revealed that, Government has no deliberate policy to manage migration of health professionals from Ghana.

CHAPTER 1

      INTRODUCTION AND BACKGROUND

Global migration has grown tremendously and as it has, developing countries have increasingly become immigration destinations in their own right (ACBF, 2018), and due to this, international migration is now high on national, regional and global policy agendas (Asare, 2012). In 2015, the global immigrant population stood at 243.7 million, an increase of 41 percent from 2000. Although the majority of immigrants (about 58%) still lived in developed countries, immigrant populations in developing countries grew faster than those in developed countries. Traditional destinations for migration still dominate, but Asia’s steep growth of 52 percent after 2000 has led to immigrant population parity with Europe, while North America follows with 55 million people (ACBF, 2018).

Most sub- Saharan African migrants often migrates to countries within the African continent, while other African migrants (comprising those from North Africa), have destination countries outside Africa has been important. Africa’s emigrant population has continued to grow in absolute and relative terms with net migration increasing from 7 million to 12 million (International Migration Report, 2017). In 2015, the population of migrants of African origin across the world was 32.5 million, a 53 percent increase from 2000. In 2015, Africa hosted 20.6 million immigrants, a 39 percent increase from 2000. Africa’s share of the global population increased marginally from 12 percent in 2000 to 13 percent in 2015.

According to the United Nations, highly skilled migrants from the sub-Saharan countries living in OECD countries varied between 33 and 35 per cent (United Nations, 2006). For island nations like

Haiti, Fiji, Jamaica, and Trinidad and Tobago, the proportions were above 60% and 83% in Guyana. It is estimated that more than half of their university-educated practitioners was lost to Haiti, Cape Verde, Samoa, Gambia and Somalia in 2006 (UNCTAD, 2007 in Ronald Skeldon, 2008). It bears noting that within the developing world or Global South, emigration of skilled labour has contributed and still contributes to their countries development in diverse ways. According to the World Bank (2016), Chinese emigrants contributed immensely to their technological capability building and the same for Brazil and India. The same report highlights the significant contribution of skilled emigrant Jews in the diaspora to Israel’s health, industrial, and technological sectors.

The health sector of Ghana generally comprises the formal and informal sectors. The formal sector is composed of public sector health institutions established by government, and are governed by the Ghana Health Service (GHS). They include Government medical facilities (health care centres), Quasi Government Institutional Hospitals, Teaching Hospitals, Polyclinics and Health Centres. The Board of Private Hospitals and Maternity Homes is responsible for the private sector; they include Mission Based Providers and Private Physicians and Dentists. In addition, traditional medicine in the private sector has coexisted over the years with the public and private institutions, managed by the Traditional and Alternative Medicine Department. It includes Traditional Providers of Medicine, Alternative Medicine and Healers of faith.

The study on the benefits of collective in-kind remittances focuses on the formal public and private sectors of Ghana’s health sector. The inadequacy of staff in the health sector of Ghana, both public and private has inevitably created the need for a targeted policy framework to attract and optimize in-kind remittances of Ghanaian health labour migrants. In particular, the existing doctor-patient

ratio of 1: 10,450 as of 2017 (GHS Annual Report) is above the WHO recommended ratio of 1:1320, and this makes Ghana’s case intolerable. The consequences of this disproportionately high ratio has far-reaching dire consequences for the health system in Ghana and foregrounds the urgent need to prioritize Ghana’s health labour migrants as a strategy to improve service delivery and quality.

In the past, Ghana’s economy, along with its educational system and political instability has been combined factors responsible for migrant outflows (Awumbila, 2008). Harsh economic conditions have continuously forced Ghanaians to adopt alternative strategies for survival and emigration presents an alluring alternative. Today, the first two factors (the economy and education) continue to drive emigration from Ghana.

Available data on international migration statistics of selected African countries show that between 1999 and 2002, Ghana had a cumulative migrant stock of 465,932, an annual average of about 186,000 over the same period (Awumbila et al 2008). In the case of health professionals, it is estimated that the OECD countries is the destination for more than half of the physicians trained in Ghana. The number of physicians trained in Ghana between 1999 and 2004 and registered in the UK doubled from 143 to 293 even though among the health professionals migration of nurses is higher with 59.1% followed by doctors at 21.4 %, pharmacists 16.2% and other related health workers at 3.3% (Mensah et al 2005 in Awumbila et al 2008). Notwithstanding the high nurse emigration from Ghana, the country’s nurse-patient ratio is below the recommended WHO level, but high in relation to that of doctor-patient ratio. Certainly, the high doctor-patient ratio is inimical to the future service delivery to the extent the country has to rely on Cuban doctors to bridge the deficit.