The so-called healthy compromise for the health of the poor
A case for Ghana.
The generic word is poverty. Multiplicity of factors, including the health of an individual contributes to his/her susceptibility to poverty. It is for this reason that we cannot afford to take the health of a nation for granted.
An important event has taken place that will in no small way affect the health care delivery system of many poor countries including Ghana's, and can hardly go uncensored. The British Prime Minister, Tony Blair, has decided to back a proposal by Hilary Benn, the international development secretary, to compensate African countries whose medical professionals have been exploited to support the NHS in Britain. As part of the proposal, African countries will receive staff training, medicines and medical text (Financial Times Friday August 19 2005).
The Financial Times describes this development as a healthy compromise. But the appetite for any discerning mind to consider the benefits that may accrue to these nations vis-à-vis the wider implications for their health sectors is as instinctive just as it is intriguing.
Human resource development is a very essential part of every dynamic institution. It involves both transfer of technical expertise to the neophyte and the continuous in-service training offered to the professional to keep him up-to-date.
The above assertion is further consolidated by the aim of every professional to attain the highest level of professional development in his/her chosen field. It is by reason of these synergies that most courses and programmes geared towards career enhancement and progression are very important and form an integral part of career plan for the highly-skilled individual, especially the medical professional and the very institutions that turn them out.
Where these opportunities are non-existent or very limited, the skilled worker is tempted to go out to pursue it in order to be abreast with the state-of-the-art in his/her chosen field.
Such is the case for the health sector in Ghana. Evidently, medical doctors from the now three medical schools in Ghana qualify in general medicine. The propensity to migrate to the developed countries to seek opportunities for specialization and career development is therefore a great allurement among these individuals.
First, there is a high international recognition for the quality of Ghana's clinical training making her medical graduates accessible to the international schools and job markets.
Second, the limited number of places available for postgraduate training, coupled with unavailability of some specialist programmes, makes it imperative for these professionals to look for such opportunities for specialization in the developed countries.
It was until recently that the College of Health Sciences was established to cater for the need and the rising number of general practitioners who may be seeking opportunities for specialization and development.
The Ministry of Health acknowledged that even with the establishment of this institution, staff development at this level is still inadequate.
The above situation is further aggravated by the improper structure of most programmes run by the school resulting in unduly long residency programmes. In some cases too, the desired programmes are simply not available.
There is also the problem of non-academic nature of some of the courses for nurses and other health professionals. Concomitantly, some of the programmes do not lead to the award of internationally recognised certificates. Therefore those who acquire further training on some of those programmes are not rewarded for them. In effect most health workers are not motivated to enrol on such programmes locally.
There is then the socio-cultural notion among Ghanaians that anything coming from the West, especially America and Britain, in terms of education is of the highest quality. This socio-cultural complex has created some assortment of cognoscenti health professionals in the medical field in Ghana. Those who train in the West, especially America and Britain, are perceived to be of the best quality as far as health delivery is concerned. This rather spurious perception is not limited to only the medical profession, but it has to do with the Ghanaian psyche. This crop of doctors, nurses and paramedics therefore are regarded as the cream of the medical profession. Doctors, nurses, and paramedics in this category are therefore likely to gain more recognition than their locally trained counterparts.
A young house officer at the Emergency Ward of the Korle-Bu Teaching Hospital in Accra (main referral hospital) intimated to me in confidence that it is very important for one's career development for one to pursue his/her specialist training in the developed countries if one really aspires to reach the apex of his career. The following were his words verbatim:
'If you really aspire to reach the apex of your profession, then there is the need for you to go out there to develop your God-given talents or potentials. You can then gain your place in this profession. Consider the big names in this profession-Professor Kwabena Frimpong Boateng, the Chief Executive of the Korle-Bu Teahing Hospital and the head of the Cardio Thoracic Centre, Professor Agyeman Badu Akosa among others. These are people who have made it big in this profession. But, in fact, they are have been educated abroad and served long periods there. That is why they have the recognition today'.
The question of study leave is also another impediment. It is generally agreed that the Ghanaian economy is at the moment going through its most difficult moments and this is reflected in all sectors of the economy including the health sector. There are therefore very limited numbers of study opportunities available for doctors, nurses and paramedics who may want to embark on study leave.
A senior dentist at the University of Ghana Dental School described this situation as really uninspiring for health professionals to stay on, as opportunities for career development look bleak.
The aggregate effect of the factors identified above result in the decision by most health workers in Ghana to migrate to seek qualifications in the West. These international qualifications are more acceptable in many countries around the globe. Therefore, the desire to return to work in Ghana becomes very limited as most of these professionals who undertake their trainings abroad get integrated or absorbed by health institutions of where they trained. We should also not loose sight of the economic niche attached to the issue making the allurement to remain in the country of training much attractive.
It is in the light of the above difficulties that the proposal to offer staff training to loosing countries is a welcome idea. The sustainable development of Ghana's health care delivery system is already under a serious threat, if the definition of sustainable development is anything to go by-development that meets the needs of the present without compromising the ability of future generations to meet their own needs.
There is a serious yawning gap in the transfer of knowledge and technical expertise in almost all institutions in Ghana and not only the health sector.
During the launch of the 40th anniversary celebration of the University of Ghana Medical School in Accra, the then Dean of the school indicated that the school was experiencing a massive staff shortage as all its departments were operating with less than 60% of required staff whose average age was 50 years. The implications for the transfer of knowledge and technical expertise in their qualitative forms are seriously undermined with far-reaching repercussions.
Now there are some critical questions here to pose. A compromise is a bilateral agreement between two parties who are willingly ready to make concessions on an issue in which both parties have a stake. But a critical look at what the Financial Times describes as a 'healthy compromise' resembles a compromise between number 10 Downing street and its appendage, the office for international development. If this does not tantamount to a unilateral step to step-side the problem, then lets understand the inputs and the terms agreed upon by poor losing countries including Ghana.
Whilst the above question lingers on, there are many more that borders on the very core of this new design which is to see the light of day by the next autumn. What form is the staff training going to take? Is it going to be an in-service training, resident programme demanding a full time studies in the country of origin or abroad? As the proposal is still in the offing, let's be mindful of how development models backed with loans and grants could not make their desired impacts because they were meant to supplant traditionality with modernity sometimes with gross disregard for local needs and conditions.
Other questions would emanate, as a corollary, from how the above questions are addressed. If the programmes are local, what would be the structure? Would it be able to address issues of academic recognition for the training acquired? Would it be able to eliminate that spurious perception attached to training abroad? Are beneficiary countries going to receive lecturers and experts from abroad for this form of training to take place or online facilities would be applicable here for the training?
There are however two important things here; one of which may look quiet convincing but not the other. Surely, this is a true recognition of the harm Britain, America, Canada and other Western countries have done to health care delivery systems of poor countries, including Ghana's. It is therefore a bare-faced attempt to come to the rescue, if the terms and conditions would be based on a more opened bilateral negotiation for all sides-countries of immigration and the losing countries-to discuss what is at stake. The financial requirements attached are no doubts the responsibility of the country of immigration.
The other thing that may have to see the test of time is whether this form of training and medical texts would not be another platform to prepare our health professionals to fit well in the countries of immigration? In addition, whether this form of staff training would increase the number of health professionals available to the population at the current accretion rate of 150 per year.
How will American and Canada fit in this scheme of things? Will they do the right thing by following suit anytime soon or it does not fit well in their budget?
South Africa and Botswana, where do you also fit in this new proposal?
For the records, within Africa too, there is what could be termed as the 'horizontal' brain drain. Whilst South Africa and Botswana continue to loose their home-grown medical professionals to the developed countries, they are in turn drawing from other African countries at the same time. About 150 Ghanaian doctors are on records to be working and living in South Africa.
Working from the premise of the 'golden rule', will South Africa and Botswana also do the right thing by compensating other African countries for the use of their health human resource, as they make strenuous efforts to attract their own back home? I believe they understand that what is good for the goose is good for the gander.
Last but not the least, though the prospects of this new proposal healing the haemorrhage of health professional migration from Ghana and other African countries may not look attractive in the short term, it may help solves some of the health human resource staffing problems Ghana and other African countries are facing currently in the long term. Once it starts achieving the desired goal, their will be medical professionals to dispense the drugs which may be free or otherwise. P.Y. Tsikata Department of Comparative & Applied Social Sciences University of Hull England Views expressed by the author(s) do not necessarily reflect those of GhanaHomePage.