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High-income countries’ recruitment of nurses from poorer countries is “out of control,” said the head of one of the world’s largest nursing groups.
The comments come as the BBC finds evidence of how Ghana’s health system is struggling as a result of the “brain drain”.
Many specialist nurses have left the West African country for better paying jobs abroad.
In 2022, more than 1,200 Ghanaian nurses joined the UK nursing register.
This is because the National Health Service (NHS) increasingly relies on staff from non-EU countries to fill vacancies.
While the UK says active recruitment is not allowed in Ghana, social media makes it easy for nurses to see available vacancies in NHS trusts. They can then apply directly to those vacancies. Ghana’s dire economic situation acts as a major push factor.
Howard Catton of the International Council of Nurses (ICN) is concerned about the magnitude of numbers leaving countries like Ghana.
“I feel that the situation is out of control at the moment,” he told the BBC.
“We have intense recruitment driven primarily by six or seven high-income countries, but with recruitment from countries that are among the weakest and most vulnerable and cannot afford to lose their nurses.”
Greater Accra Regional Hospital’s head of nursing, Gifty Aryee, told the BBC that her Intensive Care Unit alone had lost 20 nurses to the UK and US in the past six months – with dire consequences.
“Care is compromised because we can’t take in any more patients. There are delays and it takes more mortality – patients are dying,” she said.
She added that critically ill patients often had to be held longer in the emergency room due to the shortage of nurses.
A nurse at the hospital estimated that half of those she graduated with had left the country — and she wanted to join them.
‘All our experienced nurses gone’
The BBC found a similar situation at Cape Coast Municipal Hospital.
The hospital’s deputy head of nursing services, Caroline Agbodza, said she had seen 22 nurses leave for the UK in the past year.
“All of our intensive care unit nurses, our experienced nurses, are gone. So in the end we have nothing — no experienced staff to work with. Even if the government recruits, we have to go through the pain of retraining nurses.”
Smaller clinics are also affected by staff migration, as even one nurse leaving a small health center can have a major domino effect.
At Ewim Health Clinic in Cape Coast, a nurse has left the small emergency department and another has left the outpatient department. Both nurses were experienced and had found employment in the UK.
The head doctor there, Dr Justice Arthur, said the effects were huge.
“Let’s take the immunization of children for example. If we lose nurses, the babies who need to be immunized will not get their immunization and babies will die,” he told the BBC.
He said adult patients would also die if there weren’t enough nurses to care for them after surgery.
Most of the nurses the BBC team spoke to wanted to leave Ghana because they could earn more elsewhere.
At the Kwaso health center near the town of Kumasi, Mercy Asare Afriyie explained that she hoped to find a job in the UK soon.
“The exodus of nurses will not stop because of our poor working conditions. Our salary is nothing to write home about and in two weeks you will spend it. It is hand to mouth.”
Ghanaian nurses told the BBC they could get more than seven times as much in the UK as in Ghana.
Perpetual Ofori-Ampofo of Ghana’s Nurses and Midwives Association said her country’s healthcare system needed more help.
“If you look at the numbers, it is not ethical for the UK to recruit from Ghana because the number of professional nurses compared to trainees or auxiliary nurses is a problem for us,” she said.
But she added that it was not possible to stop nurses from leaving as migration is a right and the Ghanaian government needed to do more to convince them to stay. The health ministry in the capital Accra declined to comment.
Ghana is on the World Health Organization’s list of 55 vulnerable countries, which have a low number of nurses per capita. The list – sometimes referred to as the “red list” – is designed to discourage systematic recruitment in these countries.
The UK government recently gave £15 million ($18.6 million) to Ghana, Nigeria and Kenya to boost their healthcare workforce.
But it is known that the country is considering making a formal deal with Ghana that might allow it to recruit more proactively in return for giving the government an amount of money per nurse.
It already has a similar agreement with Nepal.
But Mr Catton of the ICN wondered if it was enough.
He told the BBC he believed such deals “try to create a veneer of ethical respectability rather than a true reflection of the true cost to the countries losing their nurses”.
WHO’s director of health staff, Jim Campbell, explained to the BBC that Brexit had been a factor in the UK turning to African countries for nurses to fill NHS vacancies.
“The job market is extremely competitive around the world and now that we have closed off the potential job market from European freedom of movement, we are seeing the impact in terms of attracting people from the Commonwealth and other jurisdictions.”
