Ghana's Proactive Health Workforce Strategy vs. Nigeria's Stagnation: A Comparative Analysis

The study compares how Ghana and Nigeria address health workforce shortages, revealing Ghana's proactive and successful approach contrasts with Nigeria's stagnation due to governance challenges and policy lag. The findings underscore the importance of strong political will and cohesive strategies in achieving Universal Health Coverage.

The comparative policy analysis between Nigeria and Ghana in addressing health workforce shortages reveals a stark contrast in the effectiveness and outcomes of their approaches. Conducted by researchers at the Dalla Lana School of Public Health, University of Toronto, the study delves into the critical shortage of health professionals in sub-Saharan Africa, focusing on how these two countries, which share similar geographical and socio-economic characteristics, have responded to this challenge. The health workforce is essential to achieving Universal Health Coverage (UHC), yet both Ghana and Nigeria have faced severe shortages that threaten their healthcare systems' stability and capacity. The global shortfall in health professionals, projected to reach 15 million by 2030, disproportionately affects developing countries, particularly in Africa. The inequitable distribution of healthcare workers, both globally and within these countries, exacerbates the situation. In Africa, the density of health professionals stands at 1.55 per 1,000 people, far below the 4.45 per 1,000 threshold needed for UHC.

Ghana's Proactive Response and Its Success

Ghana's response to this crisis has been proactive and robust. The government has implemented policies aimed at increasing the production of health professionals, improving their welfare, and retaining them within the country. By prioritizing health workforce development, Ghana has made significant strides, increasing the density of physicians and nurses to 2.65 per 1,000 population by 2018, up from 0.53 in 2006. This success is attributed to several factors, including the establishment of new training institutions and the upgrading of existing ones. Furthermore, Ghana implemented a consolidated salary structure, which has addressed pay disparities among health professionals and created a more transparent and performance-based reward system. These efforts have not only increased the number of health professionals but also improved their job satisfaction and reduced migration rates, putting Ghana on a promising path towards achieving UHC.

Nigeria's Stagnation and Policy Lag

In stark contrast, Nigeria's approach has been marked by stagnation and a lack of effective policy change. Despite sharing similar challenges with Ghana, Nigeria has not prioritized the health workforce crisis to the same extent. The Nigerian government's reluctance to invest in health workforce improvement, coupled with inadequate infrastructure and financing, has led to a worsening situation. The density of health professionals in Nigeria remains low, with only 0.92 physicians and nurses per 1,000 population, reflecting a decline over the past decade. This decline is partly due to the ongoing brain drain, with significant numbers of Nigerian health professionals migrating to Europe and America in search of better opportunities. The root causes of Nigeria's policy lag can be traced to its complex governance structure, where the federal government holds significant control over resources and policy direction. Despite operating a federal system, states and local governments rely heavily on federal funding and guidance, limiting their autonomy in addressing local health workforce challenges. Additionally, interprofessional rivalry within the health sector has further complicated the situation. Physicians, through the Nigerian Medical Association (NMA), have maintained significant control over healthcare administration, often to the detriment of other health professionals. This dominance has created tensions and hindered efforts to grant greater autonomy to non-physician health workers, such as nurses and pharmacists, who seek to improve their career progression and job satisfaction.

The Role of Governance and Political Context

The study applies the 3-I framework interests, ideas, and institutions and Punctuated Equilibrium Theory (PET) to understand the factors driving policy change or stagnation in both countries. In Ghana, there has been a clear alignment of interests, ideas, and institutions, which has facilitated policy change and the successful implementation of health workforce strategies. The Ghanaian government’s strong political will, coupled with broad stakeholder engagement, has resulted in a coordinated and effective response to the health workforce crisis. Conversely, in Nigeria, conflicting interests, complacent ideas, and institutional inertia have led to a fragmented policy landscape. The federal government's denial of the severity of the health workforce shortage, combined with the NMA's resistance to granting autonomy to other health professionals, has stalled necessary reforms.

Lessons for Future Health Workforce Planning

The analysis underscores the critical role of political context and governance in shaping health workforce policies. Ghana's political actors have demonstrated a commitment to improving health workforce production and welfare, recognizing its importance for achieving UHC. In contrast, Nigeria's political and professional dynamics have perpetuated a cycle of inaction and policy lag. The study concludes that while Ghana has made significant progress in addressing health workforce shortages, Nigeria’s path toward achieving UHC remains uncertain without substantial policy reform and stronger political will. The lessons from Ghana’s experience highlight the importance of a cohesive and inclusive approach to health workforce planning, one that aligns the interests of all stakeholders and leverages strong political leadership to drive change. For countries facing similar challenges, this analysis offers valuable insights into the factors that can either propel or hinder progress towards a sustainable and effective health workforce, essential for achieving universal health coverage.