British Missionary with diabetes and hypertension is moving to Ghana

HCA 4303, Comparative Health Systems 1

Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to:

1. Examine how the healthcare systems in both a developed country and a developing country approach both prevention and resources.

Reading Assignment Chapter 7: The Healthcare System in the United Kingdom Chapter 14: The Healthcare System in Ghana

Unit Lesson In this unit, we continue comparing and contrasting two countries on two different elements of the eight factors determining true access to health care. We will examine the prevention and resourcing of the healthcare delivery systems in the developed United Kingdom (England, Wales, Scotland, and Northern Ireland) and the developing country of Ghana. We will focus most of our attention on the well-established and often imitated system in England. As we discussed in the last unit, a comparative analysis goes beyond just comparing and contrasting known facts about two groups. A true analysis finds several links or connections and examines them to gain a deeper understanding of the material. It goes beyond facts and assesses meaning to behavior. It looks at not only relationships but interrelationships. In this unit, we find such a connection between Ghana and England. Beyond the fact that Ghana was a British colony until 1957, they share many qualities. Much like sibling rivalry, there continues to be competition and even an occasional disagreement between the two sister countries. As the two countries have remained financially connected over the decades through ongoing trade, their medical communities are also intrinsically linked. Since we are talking about medical resources in this unit, and medical professionals are one of the most significant resources in any healthcare system, it is important to understand that there is an ongoing debate throughout the global healthcare system about affluent, developed countries poaching trained professionals from less developed countries by offering them better wages, better working conditions, and an overall higher quality of life. That exact situation has existed between England and Ghana since the 1970s. Although international professional migration in the health sector includes most occupations (physicians, dentists, optometrist, pharmacists, occupational and physical therapists, and mental health providers), one of the most common is within the field of nursing. We know from the literature that there is a global shortage of nursing that is predicted to reach epidemic proportions by the year 2025 (Spetz & Given, 2003). What has notoriously been a female-dominated profession throughout most of the world has consistently failed to reach recruitment, training, and retention goals. Women have many options today and no longer feel limited to the professions of teaching and nursing, secretarial work, or homemaking. The educational system for nurses has also lagged behind as have wages and working conditions. Since today’s nurses often enter the profession out of a sensed calling to help people, they can often be attracted to a better life being offered outside of their home country while continuing to serve mankind. This is the case with many nurses educated and trained in Ghana. A meta-analysis study conducted by Martineau, Decker, and Bundred (2004) reviewed the literature and tracked contemporary issues related to England recruiting trained nurses from Ghana over a 40-year span of

UNIT V STUDY GUIDE

United Kingdom Compared to Ghana in Regards to Prevention and Resources

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time. They trace the behavior back to a 1978 World Health Organization (WHO) study on the “brain drain” being experienced in developing countries due to an overreliance of richer countries on importing less expensive, foreign-trained, healthcare workers. Offering free visas and relocation assistance is a very attractive way to obtain additional medical professionals at a fraction of the cost of training or hiring a trained native of most developed countries. The United States is no stranger to mass recruiting techniques of trained nurses from countries, such as the Philippines, Thailand, Cuba, India, Columbia, and other countries with equitable training standards for registered nurses. Although this migration-type behavior can have a very positive impact on the gaining nation, there can be a profoundly negative impact on the nation hemorrhaging large numbers of healthcare professionals. The question remains if the receiving country has any overall global responsibilities to the provider country. In a global system where all parts are interconnected, any interaction between two countries has a visible impact on both. Clearly, the migration of trained nurses between Ghana and England is no exception. In the early 2000s, England reported needing 10,000 additional trained nurses to meet the expanding health care they had committed to provide to their citizens (Martineau et al., 2004). Much of that pool came from Ghana and other developing countries. The literature and even textbooks in Ghana’s nursing education represent this harmonizing of worldwide standards of nursing care, which increases both their ability to become licensed in a developed country and their level of attractiveness to countries like England (Henry, 2007). The question remains, is it reasonable for one country to address their nursing shortage at the expense of less developed countries? When viewing this question through the lenses of equalities, inequalities, and disparities, the reasonable answer is “no.” Yet England is known to have increased the number of nurses being imported from Ghana from 40 per year in 1999 to 195 in 2002, and the numbers continue to rise steadily (Martineau et al., 2004). The benefits to the receiving country are numerous. In addition to avoiding the costs of training the English- speaking nurses, they will often work for lower wages and work the less desirable shifts and in less attractive locations. Although there are countless stories of Ghanaian nurses being cheated out of earnings or exploited in numerous ways by unscrupulous recruiters, overall great advantages can be measured based on the improved quality of life for not only the nurses but their families that accompany them to a better quality of life. Henry (2007) documents numerous examples of Ghanaian nurses facing blatant discrimination within the field of nursing in England based on perceived language barriers and gaps in training. Yet, they tend to prefer remaining in England instead of returning home. There are no advantages to the health system of the provider country. The negative impacts can be felt in extreme measures when 60% of the registered nurses at certain Ghanaian hospitals depart for countries like England in a short span of time (Martineau, Decker, & Bundred, 2004). For the poached country, the ability to provide quality care is greatly diminished, patient deaths increase, and the morale of those nurses remaining plummets as does the working conditions they face. This toll does not even include the millions of dollars Ghana has invested in recruiting and training nurses that depart, often without providing any services back to the country. Even though numerous groups, including British-sponsored non-governmental organizations (NGO), complain that their efforts are being subverted by their own country as they try to improve the healthcare system in Ghana, it is clear that this practice will continue for the foreseeable future. Unless policies are put into effect that make it more challenging for nurses trained in Ghana and other developing countries to migrate are enacted while the country simultaneously increases the attractiveness of nursing in their country, they will likely continue to depart for promises of a better future (Henry, 2007). The challenge for healthcare administrators determined to be good stewards of the world’s healthcare resources is to find creative ways to meet the nursing shortage without causing harm to any other country. In your written assignment for this unit, you are asked to do a comparative analysis given specific parameters. You are asked to research available medical resources for an individual with both diabetes and hypertension in both England (United Kingdom) and Ghana. This will require some work. Remember everything you have already learned. A matrix would be a good place to start. Then, put the facts together in a few paragraphs. It does not have to be lengthy, but it must be accurate. Imagine telling a patient the wrong information just to find out that it led to a negative healthcare outcome—even death. Given that perspective, let’s enjoy the reading and written assignments.

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References Henry, L. (2007). Institutionalized disadvantage: Older Ghanaian nurses’ and midwives’ reflections on career

progression and stagnation in the NHS. Journal of Clinical Nursing, 16(12), 2196–2203. Lovett-Scott, M., & Prather, F. (2014). Global health systems: Comparing strategies for delivering health

services. Jones and Bartlett Learning. Martineau, T., Decker, K., & Bundred, P. (2004). “Brain drain” of health professionals: From rhetoric to

responsible action. Health Policy, 70(1), 1–10. Spetz, J., & Given, R. (2003). The future of the nurse shortage: Will wage increases close the gap? Health

Affairs, 22(6), 199–202.

Key Terms

1. Allopathic 2. Human resources within medicine 3. Medical professional migration 4. Nursing shortage 5. Traditional healing