The recruitment of nurses by high-income countries from poorer countries is “out of control”, according to the head of one of the world’s largest nursing groups.
The comments come as the BBC finds evidence that the Ghanaian health system is struggling due to the ‘brain drain’.
Many specialist nurses have left the West African country for better paying jobs abroad.
In 2022, over 1,200 Ghanaian nurses have joined the UK Register of Nurses.
It comes as the National Health Service (NHS) increasingly relies on staff from non-EU countries to fill vacancies.
Although the UK says active recruitment in Ghana is not allowed, social media makes it easy for nurses to see vacancies available in NHS trusts. They can then apply directly to these jobs. Ghana’s dire economic situation acts as an important push factor.
Howard Catton of the International Council of Nurses (ICN) is concerned about the scale of the number of people leaving countries like Ghana.
“My feeling is that the situation is currently out of control,” he told the BBC.
“We have intense recruitment taking place primarily in six or seven high-income countries, but with recruitment in countries that are among the weakest and most vulnerable that can ill afford to lose their nurses.”
Greater Accra Regional Hospital chief nursing officer Gifty Aryee told the BBC her intensive care unit alone had lost 20 nurses in the UK and US over the past six months – with serious implications.
“Care is affected because we can’t take any more patients. There are delays and it costs more in mortality – patients are dying,” she said.
She added that seriously ill patients often had to be held longer in the emergency department 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 have left”
The BBC uncovered a similar situation at Cape Coast City Hospital.
The hospital’s deputy director of nursing, Caroline Agbodza, said she had seen 22 nurses leave for the UK last year.
“All of our intensive care nurses, our experienced nurses, are gone. So we end up having nothing – no experienced staff to work with. Even though the government is hiring, we have to endure the pain of training nurses again.”
Small clinics are also affected by staff migration as even a nurse leaving a small health center can have a strong ripple effect.
At Ewim Health Clinic in Cape Coast, one nurse left her small emergency department and another left the outpatient unit. Both nurses were experienced and had found employment in the UK.
The chief medical officer there, Dr Justice Arthur, said the effects were huge.
“Let’s take services like vaccinating children. If we lose public health nurses, then babies who need to be vaccinated will not be vaccinated and we will be killing babies,” he told the BBC.
He said adult patients would also die if there were not 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 Kwaso Health Center near the city of Kumasi, Mercy Asare Afriyie said she hopes to find a job in the UK soon.
“The exodus of nurses is not going to stop because of our poor conditions of service. Our salary is not extraordinary and in two weeks you spend it. It is from hand to mouth.”
Ghanaian nurses told the BBC that in the UK they could receive more than seven times what they received in Ghana.
Perpetual Ofori-Ampofo of the Ghana Nurses and Midwives Association said her country’s health system needed more help.
“If you look at the numbers, it is unethical for the UK to recruit from Ghana because the number of professional nurses versus trainee or auxiliary nurses is an issue for us,” she said.
But she added that it was not possible to stop the nurses from leaving as migration was a right and the Ghanaian government needed to do more to persuade 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 – dubbed by some the “red list” – is designed to discourage systematic recruitment in these countries.
The British government recently gave £15 million ($18.6 million) to Ghana, Nigeria and Kenya to help boost their health workforce.
But the country is known to be considering negotiating a formal deal with Ghana whereby it might be able to recruit more proactively in exchange for giving the government a set amount of money per nurse.
It already has a similar agreement with Nepal.
But ICN’s Mr Catton wondered if that was enough.
He told the BBC he believed such deals were “trying to create a veneer of ethical respectability rather than a proper reflection of the true costs to countries losing their nurses”.
WHO health workforce director Jim Campbell told the BBC Brexit was a factor in the UK looking to African countries for nurses to fill NHS vacancies .
“The job market is extremely competitive around the world and, having closed the potential job market to European freedom of movement, we are seeing the consequences in terms of attracting people from the Commonwealth and other jurisdictions.”