Ghana: Fixing the health worker unemployment conundrum
I was in Accra for a few days and had the opportunity to have many conversations with health professionals of all sort. I specifically set myself to speak to as many allied health professionals as I could to get an understanding of what drives health professional unemployment. I wanted to gain the perspective of the unemployed as a means of judging the depth of despondency. Universally, it is accepted that the underpinning of this phenomenon is the inability of the public sector to absorb all the different facets of health professionals we train.
The paradox, however, is that by our population size, demographics, disease burden, and social structure, we require a lot more of all categories of health workers than we can train or have trained. A lot has been said about who to blame and who should take overall responsibility for this failure to utilize a key component of our labour force. On many occasions, I have written on nursing unemployment, the true scale of Ghana’s nursing deficit and other aspects of health unemployment. Today, I intend to look at some of the reasons why many of us health workers have failed to take our destiny into our hands to ensure that this failure does not drive us to destitution.
No one can argue about the determination of the Ghanaian youth. In fact, having spoken to many unemployed nurses, I have come to conclude that in their plight many will do anything to get by. The truth is the social pressures on these individuals from family, friends, and so on, cannot be ignored; but nothing can be more damning than the personal pressures they subject themselves to. In this situation, many have channelled their energies into forming pressure groups as a means of using advocacy to force the hands of the government. Likewise, different political actors have exploited some of these individuals over the years for their own selfish gain. Sadly, little has taken place to ensure the health profession unemployment situation is fixed.
This raises a number of questions including; are there more these individuals can do to help themselves? If not, is it not ironic that we have very well-educated individuals incapable of retooling their own life? Is there a problem with the way we have educated our society generally? Does our education teach us to think, explore, innovate and push the boundaries of conventional thinking? Considering that traditionally the most academically gifted are those who take up the health sciences, it would be ludicrous if suddenly this cohort has not been tooled to be able to eke out a living after years of education. Even more laughable will be the fact that the nurses amongst them have been given allowances to train without the prospects of serving the needs of taxpayers. In a country where on average each citizen visits a health professional less than once a year and our life expectancy is suffering considerably, I set out this week to show why our health economy as it stands needs remodelling. In doing so I will challenge the conventional wisdom that healthcare can only be provided from registered brick and mortar premises across the country.
Over the last ten years, Ghana’s disease burden has shifted to a point where many of the ailments affecting the middle segment of our population (15 years-54 years) are chronic and are not cured but managed. Considering that these diseases show no symptoms at the outset, a large percentage of our workforce both formal and informal are sufferers without knowing. Even more concerning is that official data indicates that most of us attend an outpatient appointment less than once a year. This means that the chances of chronic diseases remaining undiagnosed with our current primary care model are extremely high. Anyone who has spoken to many in our informal sector on why they do not opt for periodical routine health checks would know that for a lot of them the leading reasons are time constraint and the perception that seeking outpatient care in Ghana is laborious. They further argue that “what is the point of seeking care when you are not ill”? Hence, most especially in our markets rely on drug peddlers and other illegitimate dealers when unwell for one reason only; the fact that these illegitimate traders take healthcare to their doorstep. Is there something we can learn from this? In my view yes.
Let’s say we call these groups Chronic Disease Identification Teams. Can they not, on the basis of these screening, redirect identified patients to the appropriate sources of healthcare? Will this not be a way of taking the fight to drug peddlers and quack doctors in a manner that regulation and policing has failed to do? Assuming that even upon diagnosis these patients still cannot find the time to visit the traditional outpatient departments for routine monitoring, is it not possible to constitute other teams of unemployed nurses and physician assistants to be going into these markets and other places of work to monitor them? In this digital era, can they not securely retain any data and information they gather this way? Let’s call these Chronic Disease Monitoring Teams. Would they not be better than the untrained hands we have in our markets with scales and blood pressure monitors who peddle plain lies following a blood pressure measurement? Considering that the segment of our population that is between the ages of 15years-54years is around 53% (16.1 million people), think of how many undiagnosed chronic diseases could be detected by this scheme. Has anyone thought of how this could affect the country’s overall life expectancy? Can we imagine the impact this will have on the spiking midlife death rate? Someone tell me we cannot think creatively and I will ask who cursed us this badly.
This is why I cringe when I hear people claiming we cannot employ these health professionals because the state lacks the financial ability. Though this may be true, I opine that the real reason is that we have failed to study our environment and think creatively, both as a nation and as health professionals. We have failed to challenge the status quo that healthcare must be sought from established premises. We have not learnt from drug peddlers and quack doctors that we can achieve more and create jobs by taking healthcare to the patient using a convenience-based model. We need to begin a different conversation with our unemployed health professionals and those currently in training to dispel the perception that without a government-provided job, they cannot thrive. We need to let them understand that with our current chronic disease burden, there are more people requiring healthcare than are captured by our current system. We need to get them to think outside the box and behave in ways that our generation never dreamt of. If we do and they persevere, the nation would reap the benefits in job creation and health improvement.
Let those who have ears hear and press on.
By Kwame Sarpong Asiedu