Demand and Production of Health Workforce in Ghana: Perspectives of Health Workforce Policy Actors

Ghana has embarked on several health workforce policy initiatives and health workforce governance structural changes, with critical shifts in the production and demand of health workers over the last two decades. Many more policy proposals are being made regarding the production and recruitment of health workers due to current challenges, such as skills mismatch, underproduction of some essential cadres, a huge surplus of some cadres, and fiscal space challenges leading to 40% unemployment rate in the health sector. It is imperative to generate evidence, from the perspective of practicing health workforce policy actors, on what influences the production of and demand for the health workforce to inform future health workforce policy.

We adopted an exploratory, descriptive qualitative design guided by the Standards for Reporting Qualitative Research (SRQR), enabling us to capture nuanced perspectives of health workforce policy actors on production and demand dynamics. Participants were purposively sampled from health workforce policy actors within Ghana’s public health sector, prioritising those actively involved in health workforce policy formulation or implementation at national or organisational levels while excluding those outside the health sector. The sampled participants represented the sector ministry, three service delivery agencies (collectively accounting for about 70% of the public health workforce), and a professional labour group (representing 60% of the total health workforce), engendering broad institutional representation. Semi-structured interviews were conducted, audio-recorded with consent and transcribed verbatim, and thematically analysed following Braun and Clarke’s six-step framework, supported by MaxQDA software.

Our findings reveal a complex interplay between structural limitations, fiscal constraints, and political interference in shaping Ghana’s health workforce landscape. Limited production capacity for upper-level cadres (doctors, pharmacists) intersects with political patronage, which influences the proliferation and citing of training institutions. These dynamics exacerbate skill-mix imbalances and inequitable distribution, where, due to fiscal space constraints, the government is unable to absorb surplus cadres, reflecting a structural disconnect between production planning and demand absorption.

Repurposing nursing and midwifery training schools to award degrees instead of certificates is essential in increasing the quality of the health workforce and the services provided. Moreover, politicians should use their influence to support health workforce planning and ensure the implementation of plans. A managed migration of surplus health workers with the signing of recruitment agreements with countries in need of health workforce, particularly enrolled nurses who were overproduced and remained unemployed, is an inevitable policy reform consideration for Ghana.

These findings underscore the need for integrated governance frameworks that link production decisions to labour market analytics and fiscal realities.