When more than a dozen doctors were recently posted to the Upper East and Upper West regions, their failure to report sparked familiar headlines about young physicians refusing rural service. But the reality is far more complex than simple unwillingness, according to a physician who successfully helped increase doctor numbers in one northern region from four to 35 in less than a year.
Dr. Dominic Akaateba, who practices in the Upper West Regional Hospital and co-founded Ghana Medical Help, says the problem is structural, not attitudinal — and he has practical solutions drawn from direct experience.
“This is not this year’s problem. It’s a perennial problem. Over the last 15 years of my group as an NGO, I know that every year, in year out, this problem comes up and we all massage it and it goes down again waiting for another posting to be done, then we’ll talk about it,” Akaateba told A1 Radio in an exclusive interview.
The Accommodation Crisis
The most immediate barrier facing newly posted doctors is one that rarely makes headlines: nowhere to live.
“What the media and what most of us don’t know is that there’s no accommodation for the doctors that have been posted there. So some of them actually make contacts and then they come in and then we say, okay, we don’t have a place. Go to Accra or go back home and we’ll look for a place when we are ready,” Dr. Akaateba explained.
Young doctors sent home while facilities search for housing inevitably receive other job offers and never return.
In the current Upper East posting, some doctors actually reported — a fact obscured by the focus on those who didn’t. But even those eight face accommodation challenges.
“Among those who reported, the people here will be frank with you: you don’t have accommodation for all of them. And some of them actually they have asked them to go. When they get their accommodation, they’ll come back,” Dr. Akaateba said.
Hospital administrators find themselves caught between competing priorities, unable to allocate scarce funds to housing when essential medical equipment needs purchasing.
“Is it [that] you will prioritize buying a BP apparatus or an oxygen suction machine rather than going to rent two-bedroom houses? That would be expensive. It’s way expensive,” he said.
Dr. Akaateba called on municipal and district assemblies to step in where hospitals cannot.
“My call is that most of us as community leaders, as stakeholders, municipal chief executives, district chief executives: this is the time to say, oh, the municipal assembly will support the hospital in getting a rented place for these doctors and they’ll come in,” he said.
The Job Market Reality
What appears as “refusal” to report often reflects normal job-seeking behavior in a competitive market, Akaateba explained.
Doctors completing their two-year housemanship program typically apply simultaneously to Ghana Health Service, multiple teaching hospitals (which hire autonomously), and private facilities — while also sitting for foreign licensing exams.
“He gets a call from Korle Bu, you have an interview there. He goes and then they pick him up. So now you’ve been posted to the Upper East, you’ve had a call from Korle Bu, you’ve had one from Cape Coast Teaching Hospital, the Komfo Anokye Teaching Hospital. You have passed your foreign exams. You have a medical center in Accra, private, that is going to pay three times the salary that you are being offered here,” Dr. Akaateba laid out the scenario.
“So the young man is spoilt for choice. Too many options to choose from. So what we think it’s not actually just a refusal to go. It’s like job seeking,” he said.
Delays in the posting process exacerbate the problem. Doctors waiting months for assignments take temporary positions (called locums) in private facilities and become too comfortable to move, or complete foreign exams and leave the country entirely.
The Pay Disparity Problem
Unlike developed countries where rural practice commands premium compensation, Ghana pays doctors identically regardless of location or workload — a policy Dr. Akaateba calls fundamentally unjust.
“There’s no way in this world, apart from the developing world, that doctors are paid the same. So whether I’m in Accra, you are in Bawku, you are in Fumbisi, the salary is the same,” he said.
“The one working in Accra who does an eight-hour shift, he comes in the morning, 2 p.m., he’s off because another group is going to come. And the one in Fumbisi who works because [he’s] the only doctor there, one person: he works, by the time he gets to sleep they call him back, and then throughout the night he has to do an emergency CS. When he’s done, he’s going to brush his teeth, they call him that somebody has probably had a fracture, he’s got to come help.”
The Ghana Medical Association has submitted a proposal for differentiated rural incentives to the Ministry of Health five years ago, Dr. Akaateba said, but it remains unimplemented while the crisis repeats annually.
“Every year we encounter the same problem and we all talk about it. Politicians come and politicians go. But if we really don’t keep up to pace with it, it will keep being the same,” he said, noting he gave a nearly identical interview about doctor shortages in 2022.
The Upper West Solution: Expanded Housemanship
The Upper West Regional Hospital’s success in growing from four to 35 doctors offers a replicable model based on expanded housemanship training programs.
Housemanship — the two-year supervised practice period for new medical school graduates before they become full medical officers — provides a natural entry point for attracting doctors to rural areas.
“The advantage of having an expanded [program], rather than just doing five people like we are currently doing in some of the hospitals here, is that the young man is coming for a house job. He’s a young man who is out of school, doesn’t have a girlfriend, comes into Bolga and of course finds a love story. He’s going to stay here,” Dr. Akaateba said.
Beyond romance, house officers who complete their two-year training in northern hospitals develop familiarity with and appreciation for the local environment, dispelling misconceptions.
“A lot of them now become used to the hospital environment that the notion out there that up north things are very difficult and people are sleeping in thatched houses, they say, ah, this place is good. And he’s away from the traffic in Accra. He probably falls in love with Bolga, the environment, and then he gets on to stay. People also get in and they love the culture,” he explained.
House officers also face lower barriers to trying rural practice than fully qualified medical officers. The posting system allows housemanship participants to request transfers after just six months if they’re unhappy, versus the three-year minimum for permanent medical officers.
“They are more flexible at coming for housemanship than coming for permanent posting because with the permanent posting, once you get in and you sign on, unless you are going to resign and go into the private [sector], it becomes a bit difficult asking for intra-regional posting unless you have done three years minimum,” Dr. Akaateba said.
The strategy has produced tangible results. Most of the 25 house officers trained in the Upper West in 2022 and 2023 have remained in the region, with about 80 percent retention. Many now serve as medical superintendents at various district hospitals including Jirapa and Daffiama.
“That’s the reality we are talking about. But say the guy has done all his life in Korle Bu, he doesn’t — he hasn’t even stepped out of Accra or Kumasi — and then you push him straight to come. It’s a bit difficult,” Dr. Akaateba said.
The Knowledge Gap
Professional isolation — the lack of continuing medical education opportunities — represents another significant deterrent to rural practice, particularly for academically inclined doctors.
“Young people, especially those who, we say in Ghanaian parlance, ‘love book,’ they don’t want to get out of the heated zones. Because today you do ward rounds, tomorrow another professor comes in, so you are on top of the game,” Dr. Akaateba explained.
Ghana Medical Help addresses this through weekly virtual continuing professional development sessions, a model that could be scaled nationally.
However, Dr. Akaateba emphasized that virtual programs alone won’t solve recruitment issues without addressing the fundamental problems of accommodation, compensation equity and expanded training opportunities.
Overcoming Capacity Constraints
Even hospitals willing to expand housemanship programs face infrastructure limitations.
“A couple of our facilities, we don’t even have enough space for the housemen, and so we can’t pick on more. So now that we’ve occupied all of that space, there’s even just no [space] for the medical officer,” Akaateba said.
He noted that hospital administrators often hesitate to publicize these constraints for fear of transfer or other repercussions, leaving structural problems unaddressed.
“The people in charge of the hospital, their hands are also tied. They don’t want to talk about it because if they do, then you either get transferred or you move — you know, victimization. But that’s the reality of it,” he said.
A Call for Systemic Reform
Dr. Akaateba urged stakeholders to move beyond annual hand-wringing toward concrete structural reforms which include, immediate action on accommodation, implement rural incentives, expand housemanship capacity, accelerate posting processes, and scale continuing professional development.
“We should really look at the document the Ghana Medical Association has put in there, that there should be a centralized, uncontrolled kind of rural incentives, that if I’m working in Bawku, my salary should not be the same as the one who is working in Accra and doing eight-hourly shift, meanwhile I do 24/7,” he said.
Without systemic changes, Dr. Akaateba warned, Ghana will continue experiencing the same crisis annually, regardless of which political party holds power.
“I’m talking to you this year. I’ve had an interview just like this three years ago about the same shortage,” he said. “We are in 2025. Same problem.”
Source: A1 Radio | 101.1Mhz | Mark Kwasi Ahumah Smith | Bolgatanga
