REPORT HUMAN RESOURCE FOR HEALTH (HRH) STATUS IN MEMBER STATES: DATA COLLECTION AND REVIEW; GHANA COUNTRY INFORMATION Dr. Ken Sagoe Leader Mr. Said Al-Hussein Member Mr. Victor Francis Ekey Ms. Margaret Chebere Mr. Bright Adanfo
Table of Contents Table of contents 2 Acknowledgements 3 Acronyms 4 Executive summary 5 Background and introduction 6 Objectives 6 Terms of Reference 6 Expected Outcomes 7 Method of Work 7 Findings/discussion 8 Health Worker Profile 8 Health Training Institutions Profile 12 Conclusions 13 Recommendations 13 References 15 Annexes 16 Annex 1: Terms of Reference 16 Annex 2 Plan of work 17 Annex 3 Health Worker Profile 18 Annex 4 Health Training Institution Profile 22 List of Tables Table 1: Categories of Health Worker Profile by Percentage 9 Table 2: Urban Rural Distribution of Health Workers in Ghana 10 2
Acknowledgement We would like to thank Dr. Melville George (WHO Country Representative) and Mr Selassi Amah d Almeida also of WHO Ghana Office and WHO/AFRO for initiating the assignment. The HR data collection and review will enhance HR data management in the country. We are also grateful to the Regional Directors of Health Services, Regional Health Administrators, Regional HR Managers and their Personnel Officers and the Heads of the Health Training Institutions for their cooperation in providing us with the necessary information, when we visited their institutions and facilities. 3
List of Acronyms DPF Donor Pool Fund GHS Ghana Health Service HR Human Resource HRDD Human Resource Development Division HRH Human Resource for Health IGF Internally Generated Fund MOH Ministry of Health RHA Regional Health Administration WHO World Health Organisation WHO/AFRO WHO Africa Regional Office 4
Executive summary Human Resource forms a key component of any country s health services. The quality and quantity determines the level of health service available. It is thus important to maintain accurate and up-to-date records of the country s human resources. This will facilitate the planning and delivery of quality of health services in the country. The WHO collates and publishes human resource information in its member countries annually. This helps to determine the capacity of the countries to meet their health services operations. It also helps to determine the technical support needs of member countries in meeting their health needs. This report is on the collection and review of HRH in Ghana. It covers Health Workers Profile and the profile for the Health Training Institutions in the country. 5
Background and Introduction WHO collates and publishes human resource information in its member countries annually. This helps to determine the capacity of the countries to meet their health services operations. It also helps to determine the technical support needs of member countries in meeting their health needs. The WHO Office in Ghana is collation of the human resource information within the health service is being conducted in collaboration with Human Resource Development Directorate (HRDD), Ghana Health Service. HRDD has built a database of human resource information over the years. This information is relevant to the Needs of WHO. The range of information required includes: - Categories of health workers in the country - Differentiation of the various categories of health workers - Human resource information of training institutions The excise to collect and collate the HR information on Ghana has therefore been initiated with discussions and the planning for the data collection. Objectives The main objective of the mission was to collect/review data/information on health workers and health training institutions in Ghana. Terms of Reference The terms of reference of the mission were to review available information on health workers in Ghana and information on health training institutions, and collect and update this information where necessary. Specifically the mission was to: Collect information on Health Worker profile in Ghana Collect information on Health Training Institutions in Ghana. Review the data/information on health workers and health training institutions in Ghana. Prepare and submit report on HR information, accompanied by data collection tools used. 6
Expected Outcomes The expected outcomes at the end of the assignment were as follows: Information on health workers profile by category and distribution. Information on health Training institutions Methods of work Some data was available, but require to be organised into the categories as required. Other necessary information was collected from the institutions in the regions. A team five (5) visited the 3 zonal areas to collect the relevant information/data to complement the data already available. The zones are Southern (consisting of Western, Central, Greater Accra and Volta Regions) Middle zone (consisting of Eastern, Ashanti and Brong Ahafo regions) and Northern zone (consisting of Northern, Upper East and Upper West regions) The main methods used for the data collection included the following: 1. Structured questionnaire (provided by WHO) 2. Records review, 3. Interviews and discussions. Teams were sent to facilities (RHA) and training institutions to collect the information required. HR staff information was obtained from the Regional Health Administration and the HRDD/GHS. All the identified training institutions were visited and the form for the Training institution profile was used for data collection. The questionnaire was also sent to the School of Public Health, the School of Nursing, University of Developmental Studies and University of Ghana Medical School. Generally there was a very high response and cooperation from the institutions visited. Most of the forms were completed and returned. In many cases the forms were completed in the presence of the data collection officer. There were however a few areas of non-cooperation. The Nurses Training College, Kumasi and Midwifery Training School also in Kumasi declined to provide the information. The reason given was that the form did not come from Ministry of Health. 7
Findings and Discussion All health facilities and training institutions have kept records of data/information on their operations in one way or another. Data and information is regarded as essential and necessary for the operations of the institutions/facilities. However, the quality of data collection, management storage and retrieval vary considerably from one institution to another. All the institutions keep records manually in the forms of files and records/note books. These are often not well organised. Some of the bigger facilities and regional officers have well-designed and computerised HR information system. This was observed in Eastern and Volta Regions. In these two institutions, data update is still going on. Because of the manual handling of data, some of the data was lost or difficult to retrieve. This has created significant gaps in the information provided by the institutions. Health Worker Profile The main categories of health workers in Ghana include the following: Registered Nurse 16.3% Ward Assistants/Clinical Attendants 11.8% Enrolled Nurses 9.6% Registered Midwives 7.5% Community Health Nurses 4.6% Doctors and Dentists 5.7% Generalists 4.0% Specialists (including Public Health) 1.5% Dentists 0.2% The trained administrators working within the health sector constitute 1.8% of health workers in Ghana. The other technical categories make up between 0.3 0.8%. 8
Medical Assistants who form an major category of staff at the sub-district level (considered as rural areas) make up 1.5% and Laboratory Technologists that are also important for diagnostic services at all levels constitute 1.3% of the total health work force. Table 1 shows the breakdown of category of health workers by percentage. Table two also presents the distribution of health staff according to the urban rural dichotomy. Table 1: Categories of Health Worker Profile by Percentage Grade Percentage (%) Generalists : 4.0 Specialists : 1.5 2. Nurses : Registered nurses (Professional Nurses) 16.3 Enrolled nurses 9.6 Ward Assistant/Clinic Attendant 11.8 3. Midwives : Registered Midwives (Midwives) 7.5 Enrolled Midwives No data Auxiliary/Assistant midwives No data Traditional birth attendants (TBA) No data 4. Dentists : Dentists : 0.2 Dental technician/technologist/therapist 0.3 Dental clinic assistant : 0.3 5. Pharmacists 0.0 Pharmacists 0.8 Pharmacy technicians (Dispensing Technicians) 1.9 Pharmacy assistants (Dispensing Assistant/Attendant) 0.8 6. Physiotherapist 0.1 7. Medical assistants 1.5 8.Clinical officers 9. Laboratory Laboratory scientists 9
Laboratory technologist/technicians 1.3 Laboratory assistants 0.4 10. Radiographer 11. Environmental and Public Health Officers No data Community Health Nurses 4.6 With Local Environmental and Public Health Officers Professionals Government Environmental and Public Health Officers Technicians 12. Other Technicians and Health Care Cadres No Data Captured as CHN. or 13. Community Health Workers Technical officers 14. Administrative and support staff Health Services Administrator 0.3 Skilled administrative staff 1.8 Other support staff 0.5 15. Others categories specify * 0.0 Anaesthetist Assistant 0.3 Other Categories 34.3 100.0 Some of the staff categories are not under the health department and some are non-existing in Ghana. For example the category of clinical officer does not exist in Ghana. A category of community health workers that is not represented in the form are the Nutrition technical officers and Disease Control Officers. These categories of personnel Table 2: Urban Rural Distribution of Health Workers in Ghana Category Urban areas (%) Rural areas (%) 1. Physicians : Generalists : 70 30 Specialists : 100 0 2. Nurses : Registered nurses (Professional Nurses) 70 30 Enrolled nurses 40 60 Ward Assistant/Clinic Attendant 30 70 3. Midwives : Registered Midwives 40 60 Enrolled Midwives 10
Auxiliary/Assistant midwives Traditional birth attendants (TBA) 4. Dentists : Dentists : 95 5 Dental technician : 95 5 Dental assistant : 95 5 5. Pharmacists Pharmacists 70 30 Pharmacy technicians 60 40 Pharmacy assistants 70 30 6. Physiotherapist 100 0 7. Medical assistants 30 70 8.Clinical officers 9. Laboratory Laboratory scientists Laboratory technologist 80 20 Laboratory assistants 75 25 10. Radiographer 11. Environmental and Public Health Officers Community Health Nurses 30 70 Environmental and Public Health Officers Professionals Environmental and Public Health Officers Technicians 12. Other Technicians and Health Care Cadres 13. Community Health Workers 14. Administrative and support staff Health Services Administrators 70 30 Skilled administrative staff 70 30 Other support staff 50 50 have been merged and they undergo the training in Community Health Technical Officers training programme at Kintampo. These categories of health worker and their auxiliary grade (the field technicians) constitute about 0.5% of health workers in the country. Statutory bodies in their practice govern most of the professional grades of health personnel. The few that do not have are the community and diagnostic services. The Medical Assistants (who basically are nurses) are out of the mainstream control of the Nurses and Midwives Council. The Medical and Dental Council neither control them. The Community Health Technical Officers (Disease Control and Nutrition Officers) do not have regulatory body. 11
The Environmental Health Officers (who are under Local Government) also do not have a regulatory body governing the practice. A detail of the health worker profile is presented in Appendix 1. Health Training Institutions Profile The health training institutions found it difficult to determine the average cost of training one student. The main inputs used to determine the cost of training by most schools were: - FE, - Donor Pooled Funds (DPF) - Service budget - Internally generated funds (IGF). Some schools included the salaries and emoluments of staff of the institution while others still include the capital budget. Some institutions could not provide information on cost of training because they did not operate their budget. The cost of training a student, as given by the training institutions, range from 3.5 million to 13.5 million. This varies significantly from what the GHS announced, which is 33M for nurses and analogous grades and 66M for doctors (Daily Graphic page 1 column 1; 7 th May 2005). The service based training programmes (including Medical Laboratory, and Radiography have a high number of part-time lecturers. These programmes have only one or two full-time lecturers. Over 95% of those teaching in these programmes do so on part time basis. This has implications for the continuity of the programme. Some of these programmes do not have permanent infrastructure e.g. lecture rooms. All the Health Training programmes have upgraded most of their lecturers/tutors to at least the bachelor degree level. Many of the tutors are in school pursuing degree courses. This was initiated to meet the changing trends in the educational system of the country. The schools are now diploma awarding institutions. 12
Conclusion The exercise to collect and collate HR information from the health facilities and institutions requested by WHO, Accra Office was worthwhile. GHS and MOH require the information to plan health care programmes and service delivery. The HR available in the country determines the type and quality of services that may be planned and given to the population. The health sector needs adequate and accurate data to plan and implement quality health care delivery. The exercise provided an opportunity to establish baseline information on human resource for health in the country. There is HR information already available. This has been reviewed and data collected from the facilities, regions and training institutions has helped to update what is available. The updated HR information is ongoing in all regions. The information obtained from the health training institutions also provided data on the HR potentially available for service delivery. It must be indicated however that for some of the categories of staff, especially nursing, a significant proportion of those represented under admissions are already staff in service. It is estimated that about 20% of nurses and midwives are students in one-programme/training institutions or another, at any given time. The exercise to collect HR information may be considered as a baseline exercise and the information obtained as baseline data for human resource for health. Subsequent reviews would then help to update and improve on the quality of HR data/information in Ghana. Recommendations The following recommendations are made to the various stakeholders in the system. It is hoped that this will help improve the collection, collation and utilisation of HR information in the country and promote HR planning for quality health care delivery. Recommendations to the Institutions: Institutions and health facilities should; - Establish HR information systems by the end of 2005. 13
- Seek assistance and technical support from HRDD/GHS in establishing the HR system and organising HR information. - Conduct quarterly updates of HR information. Recommendations to GHS/MOH: GHS/MOH, which constitutes the administrative and policy arms of health service delivery, should; - Support health institutions and facilities to set up their HR information system. - Monitor HR information updates in the institutions and facilities. Recommendations to WHO: WHO Accra Office should; - Coordinate update of HR information nationally. - Solicit support for national HR development and information management. 14
References Daily Graphic page 1 column 1; 7 th May 2005 HRDD/GHS, Annual Report 2004. IPPD Data 2004 15
Annexes Annex 1: Terms of Reference Collect information on Health Worker profile in Ghana Collect information on Health Training Institutions in Ghana. Review the data/information on health workers and health training institutions in Ghana. Prepare and submit report on HR information, accompanied by data collection tools used. 16
Annex 2: Plan of Work Time Frame (Week of Activity) April May 2005 Activity 3 4 1 2 3 Identification of data collection teams Orientation of the data collection team Field trips to the regions to collect data Collation of data/information and completion of reporting forms Preparation and submission of report 17
Annex 3: Health Workers Profile Country GHANA - WEST AFRICA Date of completion : 15TH MAY 2005 Variables Sector Area Gender Age Category Total Number Total Public Total Private Total Private notforprofit Urban areas Rural areas Female (Number or estimated proportion%) Under 30 years From 30 to 50 years Over 50 years Exi regu the o (Y 1. Physicians : Generalists : 2,054 1,018 929 107 1,438 616 21% 226 1,684 144 Specialists : 777 150 569 58 777-19% - 443 334 2. Nurses : Registered nurses (Professional Nurses) 8,453 6,727 1,415 311 5,917 2,536 86% 845 3,381 4,227 Enrolled nurses 4,959 3,467 1,362 130 1,984 2,975 86% 496 2,926 1,984 Ward Assistant/Clinic Attendant 6,135 2,464 3,671-1,841 4,295 83% 429 1,166 4,601 3. Midwives : 18
Registered Midwives (Midwives) 3,910 1,414 2,369 127 1,564 2,346 100% 12 2,229 1,681 Enrolled Midwives Auxiliary/Assistant midwives Traditional birth attendants (TBA) 4. Dentists : They are converted to Midwives This category of staff do not pertain to the health sector in Ghana Dentists : 104 22 75 7 5 99 36% 9 80 15 Dental technician/technologist/therapist 135 23 24 88 7 128 8% - 62 73 Dental clinic assistant : 154 76 75 3 8 146 82% 2 105 46 5. Pharmacists Pharmacists 409 254 86 69 123 286 33% 25 339 41 Pharmacy technicians (Dispensing Technicians) 989 528 378 83 593 396 20% 218 524 247 Pharmacy assistants (Dispensing Assistant/Attendant) 399 399 - - 279 120 33% 16 211 176 6. Physiotherapist 76 25 47 4 76-36% - 27 49 7. Medical assistants 787 401 377 9 236 551 45% - 315 472 19
8.Clinical officers 9. Laboratory Laboratory scientists Laboratory technologist/technicians 684 90 528 66 547 137 8% - 629 55 Laboratory assistants 197 195-2 148 49 13% 24 110 63 10. Radiographer 18 15-3 18-6% - 13 5 11. Environmental and Public Health Officers This category of staff are with Local Government (i.e District Assemblies) Community Health Nurses 2,385 2,363-22 716 1,670 100% 405 1,813 167 Environmental and Public Health Officers Professionals Environmental and Public Health Officers Technicians 12. Other Technicians and Health Care Cadres 13. Community Health Workers 14. Administrative and support staff Health Services Administrator 140 124-16 98 42 12% 18 91 32 Skilled administrative staff 955 41 913 1 669 287 20% 229 649 67 20
Other support staff 274 267-7 137 137 29% 33 101 140 15. Others categories specify * Anaesthetist Assistant 134 107-27 94 40 23% - 95 39 Other Categories 17,782 13,482 3,491 809 5,335 12,447 33% 1,423 10,847 5,512 21
Annex 4: Aggregate of Health Training Institutions Country: GHANA - WEST AFRICA Date of completion : 15 TH MAY 2005 Source(s) of information: Intergrated Personnel Payroll Database, Survey Documents, Files. Please fill out by programme (please use different row(s) if one school provides more than one programme) Full name of the school(s) providing basic health education (in English) Contact information Category (please select one for each programme) Professional/ Associate (please selec one) Address phone E-mail Ear Nose and Throat (ENT) Post Basic Nursing Programme ENT Dept, Komfo Anokye Teaching Hospital (KATH), Box 1934, Kumasi 051-22302 - 22
Premier Nurses' Training School Box 3797, Kumasi pntcol@yahoo.com Nurse Anaesthetist Training School KATh, Box 1934, Kumasi 020-8168630 gboak2000@yahoo.com Community Health Nurses' Training School P. O. Box 1, Fomena Adansi, Ashanti Region - - Midwifery Training School P. O. Box 34, Mampong Ashanti 0561-22263 saleeyam@yahoo.com 23
St. Patrick's Midwifery Training School P. O. Box 17, Maase Offinso, Ashanti 051-20351/20337-8 - Kumasi Polytechnic P. O. Box 854, Kumasi 051-22388 - Nurses' Training College SNTC, PMB 4, Sunyani - - Nurses' Training College, Tamale NTC, Box 565, Tamale, Northern Region 071-24112/22515 24
Nurses' Training College, Bawku NTC, Box 45, Bawku, Upper East Region 0743-22362 Midwifery Training School MTS, Box 25, Bolgatanga, Upper East Region 072-22227/24133 Nurses' Training College, Jirapa NTC, Box 3, Jirapa, Upper West Region 0756-22884 Nurses' Training College NTC, P. O. Box 792, Cape Coast 042-33336 25
Nurses' Training College NTC, PMB, Ho 091-26704 jagboada@yahoo.com Holy Family Nursing and Midwifery Training College HF NMTC, P. O. Box 21, Berekum, Brong Ahafo 0642-22124 - School of Radiology P. O. Box 77, Korle Bu 021-685487/88 lawruclat@yahoo.com ( Radiology Technology) Midwifery Training School MTS, Box 142, Koforidua, Eastern Region 22231-26
Peri-Operative Nursing Programme P. O. Box KB 83, Korle Bu, Accra 020-8173611 kwasant2001@yahoo.com (peri operative specilaised Peri-Operative Nursing Programme P. O. Box KB 83, Korle Bu, Accra 020-8173611 kwasant2001@yahoo.com (critical care specialised nursing) School of Medical Laboratory Technology Box 300, Korle Bu, Accra samatel@yahoo.com Public Health Nurses' School (PHNS) Box KB84, Korle Bu, Accra 021-660960/669735 marymkd@yahoo.com 27
School of Hygiene Box 753, Accra 021-668153 Opthalmic Nursing School Eye Clinic, Box 77, Korle Bu, Accra 021-662870 Ext 6456 Nurses' Training College, 37 Military Hospital 37 Military Hospital, Accra 020-8130760 augsiewellington@hotmail.com Department of Community Health, Kwame Nkrumah University of Science and Technology (KNUST) Department of Community Health, SMS- KNUST, Kumasi 051-60293 28
Midwifery Training School MTS, P. O. Box KB 81, Korle Bu, Accra 021-687277/686608 Rural Health Training School - Medical Assistant Kintampo Rural Health Training School, Box 9, Kintampo 061-28664/26018/28884 Medical Assistant) Rural Health Training School - Field Technicians Kintampo Rural Health Training School, Box 9, Kintampo 061-28664/26018/28884 Field Technicians) Rural Health Training School - Community Health Technical Officers Kintampo Rural Health Training School, Box 9, Kintampo 061-28664/26018/28884 29
Rural Health Training School - Technical Officers, Health Information Kintampo Rural Health Training School, Box 9, Kintampo 061-28664/26018/28884 (Health Information Technology) Rural Health Training School - Community Oral Health Officers Kintampo Rural Health Training School, Box 9, Kintampo 061-28664/26018/28884 Community Health Nurses' Training School CHNTS, Tamale, Northern Region 071-226970 Community Health Nurses' Training School CHNTS, Jirapa, Upper West Region 0756-22884/5 30
Nurses' Training College NTC, Box 225, Bolgatanga, Upper East Region 072-23194/24203 ntc91@yahoo.com School of Hygiene School of Hygiene, Box 88, Tamale, Northern Region 071-22746 alassibi@yahoo.com Enviromental Community Health Nurses' Training School CHNTS, Box 185, Navrongo, Northern Region 0742-225151 damalba@yahoo.com (Environmental Health ) Midwifery Training School MTS, Box 3, Jirapa, Upper West Region 0756-22885 angotingeselizabeth23@yahoo.com 31
Community Health Nurses' Training School CHNTS, Box 153, Ho 091-26758 charitykartey@yahoo.com Nurses' Training College, Ankaful Ankaful Nurses' Training College, P. O. Box 1056, Cape Coast 0243379534 dmorny@yahoo.com Midwifery Training School MTS, P. O. Box 792, Cape Coast 042-33336 Nurses' Training College Nurses' & Midwifery Training College, P. O. Box 333, Sekondi 031-33891 32
Midwifery Training School Nurses' & Midwifery Training College, P. O. Box 333, Sekondi 031-33891 Community Health Nurses' Training School Word Alive School of Nursing, Esiama, Western Region 0342-22654 School of Hygiene School of Hygiene, Box 90, Ho, Volta Region 091-26506 Midwifery Training School MTS, P. O. Box 27, Hohoe, Volta Region 0935-22106 33
Community Health Nurses' Training School CHNTS, Box 273, Winneba, Central Region 0432-22217 Midwifery Training School MTS, P. O. Box 253, Atibie - Kwahu, Eastern Region 024-4074598 Community Health Nurses' Training School CHNTS, Box 351, Oda, Eastern Region 0882-22020 Nurses' Training College NTC, P. O. Box 142, Koforidua, Eastern Region 081-22232 34
University of Cape Coast, Department of Science and Maths Education. University of Cape Coast, Department of Science and Maths Education. 042-34890 kamonney@yahoo.com (health science education 35
36
37
38
39