REPORT: JUSTIFYING PRESIDENT JOHN MAHAMA’S AND THE NEXT NDC GOVERNMENT
POLICY OF 20% ALLOWANCE ON BASIC SALARY FOR HEALTH WORKERS IN RURAL
AREAS IN GHANA
AUTHORS: SMITH P BOAHENE & CO
Date: 4
th NOVEMBER, 2024
ORGANIZATION: NDC STATION
CONTACT: 0257980428
EMAIL: ndcstation@gmail.com
EXECUTIVE SUMMARY
This report presents an evidence-based justification of John Mahama and the next NDC
government in January 2025 for introducing a 20% allowance on the basic salary of health
workers in Ghana’s rural areas as outlined by the Party in its manifesto as a governing
document. Health workers in rural regions face unique challenges, including inadequate
staffing, high costs of living, and challenging working conditions. This report draws on both
primary data from health institutions and secondary research from studies conducted in
Ghana and other sub-Saharan African countries. Findings demonstrate that financial
incentives, a priority for John Mahama are an effective strategy to improve rural health
worker retention, enhance motivation, and improve health outcomes in underserved areas.
KEY FINDINGS:
- Retention and Motivation: Financial incentives improve job satisfaction and
decrease turnover, particularly in rural areas facing significant resource shortages. - Cost of Living and Financial Burden: Rural health workers incur higher living costs
relative to their income, justifying the need for a salary allowance. - Improved Patient Care and Health Outcomes: Financial incentives contribute to
consistent staffing and higher-quality care, leading to better health outcomes. - Global and Local Policy Support: Recommendations from the WHO and Ghana’s
Ministry of Health advocate for rural incentives as a means to address healthcare
inequities.
This report concludes that a 20% allowance as would be implemented by John Mahama’s
government is an essential investment for the sustainability of Ghana’s healthcare system
and the health of rural populations. - INTRODUCTION
Ghana’s healthcare sector faces pronounced disparities in resource allocation, particularly
between urban and rural areas. Health workers in rural areas experience a range of
challenges that are often unmatched by those in urban centers, leading to high turnover
rates and staffing shortages. To address these issues, this report examines the evidence
supporting a 20% allowance on the basic salary for health workers in rural areas as a policy
framework design by the National Democratic Congress for its next government in 2025. - METHODOLOGY
To investigate the potential impact of a 20% allowance on rural health workers, a mixedmethods approach was used, combining quantitative data analysis and qualitative review:
Quantitative Data Collection: Salary data, retention rates, and cost of living data for rural
health workers were collected from the Ghana Health Service (GHS), Ministry of Health
reports, and the Ghana Statistical Service (GSS).
Literature Review: A review of academic literature and policy reports from WHO, BMC
Health Services Research, and Global Health Action was conducted to evaluate similar
incentive programs in low- and middle-income countries, particularly in sub-Saharan
Africa.
Case Study Analysis: Examples from Ghana and other countries were analyzed to
understand the impact of financial incentives on health worker retention, job satisfaction,
and patient outcomes in rural healthcare settings. - DATA AND RESEARCH SUPPORTING A 20% ALLOWANCE
3.1. Staffing Shortages and Workforce Distribution
Data on Rural Health Worker Shortages: According to GHS, over 60% of Ghana’s doctors
and 45% of nurses are concentrated in urban areas like Greater Accra and Ashanti. Rural
regions, such as Northern and Upper East regions, suffer from low staffing levels, leading to
high patient-to-staff ratios and reduced access to care.
High Turnover Rates in Rural Areas: Studies indicate that turnover in rural areas is
significantly higher than in urban centers, where conditions and compensation are
generally better. A 2021 study in BMC Health Services Research found that rural health
workers in Ghana leave their positions at higher rates due to inadequate incentives and
poor working conditions, underscoring the need for additional financial support.
3.2. The Effectiveness of Financial Incentives on Retention and Motivation
Evidence from Sub-Saharan Africa: In Malawi, a rural retention program offering a 52%
salary increase saw attrition rates fall by 35%. Similarly, in Kenya and Uganda, retention
rates improved significantly when health workers received rural hardship allowances.
These cases suggest that a financial incentive, such as a 20% allowance, could have a
strong impact on rural retention in Ghana.
Ghana-Specific Research: A study published in the African Journal of Primary Health Care
& Family Medicine in 2021 demonstrated that rural health workers in Ghana who received
financial support, such as allowances, reported higher job satisfaction and were more
likely to stay in their positions long-term. This study supports the argument for a 20%
allowance as a means to reduce turnover and ensure consistency in care.
3.3. High Cost of Living in Rural Areas
Income Disparities: GSS data show that rural health workers face higher costs for housing,
food, and transportation due to limited access to goods and services. Incomes, however,
remain the same as those for urban-based health workers, creating a financial strain that
impacts job satisfaction and motivation.
Research on Financial Hardship: Studies from the International Journal for Equity in Health
highlight that income inadequacy and high living costs are leading reasons for rural health
worker attrition. A 20% allowance could bridge this financial gap, helping to alleviate the
cost burden and improve living standards for rural healthcare providers.
3.4. Improved Healthcare Quality and Patient Outcomes
Consistency in Care: A stable and motivated workforce contributes to better patient
outcomes. Ghana’s CHPS (Community-based Health Planning and Services) program
demonstrated that regions with consistent staffing and additional support had higher
patient satisfaction and improved health indicators, particularly in maternal and child
health.
Global Evidence on Health Outcomes: Research from Kenya and Tanzania revealed that
health workers who received financial incentives were able to offer better care, leading to
improved health outcomes in rural areas. Similarly, financial incentives could contribute to
better outcomes in Ghana, especially in maternal and child health, disease management,
and preventive care.
3.5. Countering Urban Migration of Health Workers
Trend of Urban Migration: Data from GHS highlights a significant trend of rural-to-urban
migration among health workers, who seek better job conditions, career growth, and
support systems. This migration exacerbates the rural health workforce shortage and limits
access to healthcare in rural communities.
Financial Incentives as a Deterrent: By offering a 20% allowance, Ghana can create a
financial incentive for health workers to stay in rural areas, similar to retention programs in
Malawi and Uganda. Reducing rural-to-urban migration could stabilize the rural healthcare
workforce and enhance healthcare delivery in these areas.
3.6. Support from National and International Health Policies
WHO Recommendations: The WHO’s “Global Strategy on Human Resources for Health”
emphasizes that financial incentives are essential for retaining health workers in rural
areas, particularly in low-resource countries. This policy guidance supports the use of rural
hardship allowances as an effective strategy for addressing health workforce imbalances.
Ghana Health Service and Ministry of Health Recommendations: GHS’s five-year strategic
plan highlights the importance of “rural hardship allowances” to retain health professionals
in underserved areas. The Ministry of Health’s policy recommendations further support
retention incentives, reflecting a national commitment to improving rural healthcare
access. - SUMMARY OF KEY FINDINGS
Based on the data and research, the following benefits of John Mahama’s 20% allowance
for rural health workers are identified: - Enhanced Retention and Reduced Turnover: Financial incentives significantly
increase retention, especially in rural areas with difficult working conditions. - Improved Living Standards: A salary allowance would alleviate financial pressures
on rural health workers, enabling them to maintain a better quality of life. - Higher Healthcare Quality: Stable staffing in rural clinics is associated with better
patient care and improved health outcomes. - Reduction in Urban Migration: Financial incentives could reduce the trend of health
workers leaving rural areas for urban centers, addressing rural-urban healthcare
disparities. - Alignment with Global Health Policies: WHO and GHS policies support rural
allowances as an effective strategy to build an equitable healthcare system. - RECOMMENDATIONS
- Introduce a 20% Rural Allowance: The implementation of the 20% allowance on
health workers basic salary must be part of the first 120 days undertaking and
governance commitment of President John Mahama in office - Combine Financial Incentives with Housing and Training Support: To maximize the
impact of the allowance, it should be complemented with housing subsidies,
continuous training opportunities, and career advancement support. - Monitor and Evaluate: Track the allowance program’s effectiveness by monitoring
health worker retention, patient outcomes, and cost savings to ensure it meets its
intended goals and provides value for Ghana’s healthcare system. - CONCLUSION
This report concludes that a 20% allowance on the basic salary for health workers in rural
Ghana is a justified and essential policy adopted by the National Democratic Congress and
President John Mahama in addressing the challenges faced by rural health workers.
Supported by data and research, such an allowance would address rural healthcare
challenges by improving retention, motivation, and healthcare quality. Implementing this
financial support would also align with both global and national health policies,
contributing to a stronger, more equitable healthcare system for Ghana under the
leadership of John Mahama.
