Policy talk

Like many countries in sub-Saharan Africa, Ghana is faced with the simultaneous challenges of increasing its health workforce, retaining them in country and promoting a rational distribution of staff in remote or deprived areas of the country. Recent increases in both public-sector doctor and nurse salaries have contributed to a decline in international out-migration, but problems of geographic mal-distribution remain. As part of a research project on human resources in the Ghanaian health sector, this study was conducted to elicit in-depth views from nursing leaders and practicing nurses in rural and urban Ghana on motivations for urban vs rural practice, job satisfaction and potential rural incentives. In-depth interviews were conducted with 115 nurses selected using a stratified sample of public, private and Christian Health Association of Ghana (CHAG) facilities in three regions of the country (Greater Accra, Brong Ahafo and Upper West), and among 13 nurse managers from across Ghana. Many respondents reported low satisfaction with rural practice. This was influenced by the high workload and difficult working conditions, perception of being 'forgotten' in rural areas by the Ministry of Health (MOH), lack of professional advancement and the lack of formal learning or structured mentoring. Older nurses without academic degrees who were posted to remote areas were especially frustrated, citing a lack of opportunities to upgrade their skills. Nursing leaders echoed these themes, emphasizing the need to bring learning and communication technologies to rural areas. Proposed solutions included clearer terms of contract detailing length of stay at a post, and transparent procedures for transfer and promotion; career opportunities for all cadres of nursing; and benefits such as better on-the-job housing, better mentoring and more recognition from leaders. An integrated set of recruitment and retention policies focusing on career development may improve job satisfaction and retention of nurses in rural Ghana.

Business · Developing country · Distribution (mathematics) · Economic growth · Economics · Incentive · Political science · Private sector · Public relations · Public sector · Rural area · Socioeconomics · Sociology · Workforce · Workload · Global Health Care Issues · Global Health Workforce Issues · Global Maternal and Child Health · Medicine · Nursing

• What do Health Workers say About Rural Practice

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• ‘Driving nurses out’

  Open Access•Selorm Adinkra, Razak Jaha Imoro et al.•Cogent Social Sciences•2026

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• Competition and physician behaviour under regulated fees

  Open Access•Adolf Kwadzo Dzampe•International Journal of Social…•2026

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• A crisis in the countryside - Barriers to nurse recruitment and retention in rural areas of high-income countries

  Open Access•Angharad Watcyn Jones, Angharad Jones et al.•Journal of Rural Studies•2019

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• Postings and transfers in the Ghanaian health system

  Open Access•Aku Kwamie, Miriam Asiamah et al.•International Journal for Equity…•2017

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• Supervision of community health nurses in Ghana

  Open Access•Meghan Bellerose, Soumya Alva et al.•Health Policy and Planning•2021

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• Staffing remote rural areas in middle- and low-income countries

  Open Access•Uta Lehmann, Marjolein Dieleman et al.•BMC Health Services Research•2008

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• Human resources and health outcomes

  Open Access•Sudhir Anand, Till Bärnighausen•The Lancet•2004

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• Health worker motivation in Africa

  Open Access•Inke Mathauer, Ingo Imhoff•Human Resources for Health•2006

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