According to the leader of one of the world's largest nursing organizations, the recruitment of nurses from economically disadvantaged nations by wealthy countries has spiraled "beyond limits." This trend is particularly evident in Ghana, where numerous specialized nurses have sought higher-paying positions abroad.
In 2022 alone, over 1,200 Ghanaian nurses registered with the UK's nursing board, coinciding with the National Health Service's increasing dependence on non-EU staff to address staffing shortages.
While the UK claims to prohibit active recruitment in Ghana, the prevalence of social media allows nurses to easily discover available positions within NHS trusts and apply directly. Ghana's dire economic circumstances further exacerbate the situation, acting as a significant motivating factor for nurses seeking better opportunities.
Howard Catton, representing the International Council of Nurses (ICN), expresses deep concerns regarding the scale of nurse migration from countries like Ghana. "As it stands, the situation appears to be spiraling out of control," he stated. "We are witnessing an intense recruitment drive led mainly by six or seven affluent nations, exploiting vulnerable countries that can ill-afford to lose their nurses."
According to Gifty Aryee, the head of nursing at the Greater Accra Regional Hospital, the impact of nurse migration to the UK and US is distressing. In the past six months alone, their Intensive Care Unit has seen the departure of 20 nurses, resulting in severe implications.
"Our ability to provide care is compromised as we cannot accommodate additional patients. Delays occur, and the cost in terms of mortality is higher - patients are losing their lives," expressed Aryee.
She further explained that due to the shortage of nurses, critically ill patients often experience prolonged stays in the emergency department.
A nurse working at the hospital estimated that half of her graduating class had already left the country, and she expressed her desire to join them. The situation highlights the desperate situation faced by healthcare professionals in Ghana.
Critical Staff Shortages Threaten Healthcare Services
Caroline Agbodza, the deputy head of nursing services at Cape Coast Municipal Hospital, revealed that within the past year, 22 nurses have departed for the UK, exacerbating an already challenging situation.
"We have lost all our critical care nurses, our experienced staff. Consequently, we are left with no experienced professionals to work with. Even if the government initiates recruitment, we have to endure the painstaking process of training new nurses," Agbodza lamented.
The ripple effects of staff migration extend beyond large hospitals, affecting smaller clinics as well. The departure of a single nurse from a small health center can have a substantial impact. At Ewim Health Clinic in Cape Coast, one nurse has left the emergency department, while another has departed from the outpatients unit. Both of these nurses were highly experienced and have secured positions in the UK.
Dr. Justice Arthur, the chief doctor at Ewim Health Clinic, emphasized the enormous consequences resulting from the situation. "Consider services like child immunization. If we lose public health nurses, infants who require immunization will be denied, leading to preventable deaths," he expressed.
Dr. Arthur further highlighted the risk to adult patients who may not receive adequate nursing care following surgical procedures.
The primary motivation for Ghanaian nurses to leave their country is the prospect of higher earnings abroad. Mercy Asare Afriyie, from Kwaso healthcare center near Kumasi, disclosed her intention to seek employment in the UK, citing the poor working conditions and insufficient salaries in Ghana.
"The exodus of nurses will continue because our working conditions are deplorable. Our salaries are meager, and within two weeks, we exhaust them. It's a hand-to-mouth existence," she shared.
Ghanaian nurses have been informed that they can earn more than seven times their current salaries in the UK. Perpetual Ofori-Ampofo, representing Ghana's Nurses and Midwives Association, emphasized the need for additional support in Ghana's healthcare system.
Ghana has been included in the World Health Organization's roster of 55 vulnerable nations characterized by a shortage of nurses relative to their population. Referred to as the "red list" by some, this compilation aims to discourage systematic recruitment from these countries.
In a recent move, the UK government allocated £15 million ($18.6 million) to Ghana, Nigeria, and Kenya to support the strengthening of their healthcare workforces.
However, the UK is contemplating a formal arrangement with Ghana, wherein it would engage in proactive recruitment in exchange for providing a financial contribution per recruited nurse to the Ghanaian government. A similar agreement is already in place with Nepal.
Nonetheless, Howard Catton from the International Council of Nurses (ICN) questioned the adequacy of such arrangements. He expressed his concerns suggesting that these deals may be attempting to create a façade of ethical legitimacy rather than truly considering the true costs borne by countries experiencing nurse losses.
Jim Campbell, the Director of Health Workforce at the WHO, explained that Brexit played a role in the UK's shift towards African countries as a source of nurses to fill vacancies within the NHS. "Given the highly competitive global labor market and the cessation of European freedom of movement, we are witnessing the consequences in terms of attracting individuals from Commonwealth nations and other jurisdictions," Campbell explained.
"Considering the numbers, it is unethical for the UK to recruit from Ghana. The ratio of professional nurses to trainees or auxiliary nurses is a critical issue for us," she asserted. However, she acknowledged the right to migration and highlighted the responsibility of the Ghanaian government to take measures to persuade nurses to stay. The Ministry of Health in Accra declined to provide any comments on the matter.