Training Nurses for Export: Perspectives of Stakeholders in Ghana

Training Nurses for Export: Perspectives of Stakeholders in Ghana

Emmanuel Graham Nyameke, John Windie Ansah, Defiin Isaac

Department of Sociology and Anthropology, Ghana Faculty of Social Sciences, University of Cape Coast

DOI: https://dx.doi.org/10.47772/IJRISS.2025.905000243

Received: 24 April 2025; Accepted: 05 May 2025; Published: 10 June 2025

ABSTRACT

Nurse unemployment has become a headache for many developing countries that are not able to absorb the nurses produced yearly. Because of that, some countries have resorted to exporting their services. Although the exportation of nurses by some countries has gained grounds, research on labour exports has not paid particular attention to the exportation of labour. Literature such as Abuosi & Abor (2015), Boafo (2016), and Anarfi et al. (2010) have looked at nurses and other health professionals’ migration in general, but little or no literature has specifically looked at the views of stakeholders on the training of nurses for export. This paper presented the views of stakeholders on training nurses for export by conducting in-depth interviews with some stakeholders at the Mininstry of Health (MOH) and Ministry Employment and Labour Relations (MELR) of Ghana. Five stakeholders were purposively selected. Analysing the views of stakeholders on the exportation of nurses, thematic narrative analysis was employed. The study found that training nurses for export helps reduce nurse unemployment and is an avenue for revenue generation for the government. Further, stakeholders revealed that in order for countries to export nurses, the countries should invest in the infrastructures. In order for sending countries not to fall short of nurses to serve the local health sectors, the government must increase the number of students admitted. Also nurses trained locally must meet the international standard, Therefore, attention must be paid to the content studied and the government must invest in the technological training of nursing students.

Keywords: nurse export, stakeholders, training of nurses, training for Export, nurse migration.

INTRODUCTION

According to the United Nations Conference on Trade and Development’s (UNCTAD) findings in 2017, the service economy and its associated trade represent a novel avenue for developing nations to contribute to their economic development (UNCTAD, 2017). The service sector at large has emerged as the predominant segment and driving force of the economy, progressively augmenting its contribution to gross domestic product (GDP), international trade, and employment (UNCTAD, 2017). The skills of health professionals are in demand in some developed countries like the USA, UK, and Canada (Patsy Lewis, 2011). The migration of nurses from developing countries to advanced countries has received some attention. Although the World Health Organization has advised countries to reach a nursing-to-patient ratio of 1:1,000, some developing countries have continued to send nurses abroad through some government-to-government arrangements due to the pressure from unemployed nurses. Nurse unemployment has become a headache for many developing countries that are not able to absorb the nurses that are produced. The situation poses some security challenges as well as revenue losses for governments. Some African countries, in order to ease these problems, have resorted to exporting nurses to some of the developed countries the have been the destination countries for  nurses who migrated on their own. Ghana, one of the African countries facing nurse unemployment, has not been spared from this problem. According to the MOH, nurses who graduated from nursing colleges since 2019 up to 2023 have not been posted. As a result, the Ministry of Health and the government have decided to export some of the nurses. Caught in the situation of nurse unemployment in Ghana, the government of Ghana has adopted the exportation of nurses. However, little is known about the views of stakeholders on training nurses for export.

Rationale of the study

The aim of the study was to underscore what must be done as the government of Ghana adopts the idea of exporting nurses by unearthing the views of stakeholders on what needs to be done as the government goes into

exporting nurses.

METHODOLOGY

The researchers employed the exploratory design to explore the perspectives of key informants (stkaholders) at the MoH and MELR on exporting nurses in Ghana. A one-on-one in-depth interview was conducted with five key informants (stakeholders) of the Ministry of Health and the Ministry of Employment and Labour Relations of Ghana using an in-depth interview guide. The purposive sampling technique was employed to select participants for the study. After the raw data was transcribed, themes were developed and codes were assigned to help with the discussion of the results. In analysing the data, thematic narrative analysis was employed. As part of ensuring confidentiality, the real names of the participants were omitted, with the exception of the offices they hold.

Ethical Consideration

Because the study involved human beings participatinng, ethical clearance was received from the University of Cape Coast Ethical Review Board before the study was conducted (UCCIRB/CHLS/2023/46). The study also ensured informed consent. Also, participants had the liberty to withdraw from the study at any stage of the research even though they had given their consent to be part of the study initially.

Empirical Review

Views on Labour Export

According to the International Monetary Fund, service exports are a way to create job opportunities for the unemployed (Loungani, P. et al., 2017). Stakeholders and some individuals have in diverse ways expressed their views on skilled labour exports. It has been recorded that for the problem of unemployment of graduates from the various professional trainings, contribution to economies of countries, an avenue to develop skills of people, and the fact that there is a high demand for labourers in the west, countries that have labourers that they are not able to absorb must think of exporting them abroad.

According to the Viatnamese Women Association Forum held in 2006, the ministry of labour was advised to train labour for export (Hoa, 2006). According to the Indian Prime Minister, exporting skilled manpower to other countries should be the core strategy of India’s skills mission (Modi, 2021)

In a similar vein, Antwi-Kwateng (2023), CEO of Aspire Business Network, also advised African countries to take the demand for labour from the west as an opportunity to export labour. Speaking on the training of labourers for export, Hoa concluded at the forum that the labourers should be given quality training and also be trained in some foreign languages. Highlighting why the government should expand labour exports, Hoa said that there is a high demand for labour workers in foreign countries, which calls for training people in electronics assembly, garment and textile, services, domestic labour, and forest and agriculture production to be exported (Hoa, 2006). Also, on labour exports in Africa, Antwi-Kwateng (2023) emphasized that the export of labourers should not be limited to health workers but must be expanded to other skilled labourers. On countries that African countries can export labourers to, Antwi-Kwateng (2023) suggested that governments could send labourers to countries such as Canada, the USA, Japan, and Australia. Confronting the unemployment situation in Africa, African countries must export labourers to western countries, which are demanding their services. Sharing

The export of labour can be very beneficial to the sending country. According to Antwi-Kwateng (2023), governments can benefit by charging a fee for each worker released; there can also be a yearly tax on the absorbing facility through the agent the government decides to work with, providing a direct source of revenue to support training and development programmes in sectors with high demand. More so, the Labour Principal Secretary Engineer of Kenya observed that the country stands to get remittances, which will revive and spur the economic growth of Kenya.  Governments should channel resources into training more skilled labourers for export. The CEO also sent an invitation to government agencies in Africa to enter into a win-win agreement with export labourers.

Further, the president of GRNMA in 2022 advised unemployed nurses in Ghana to look outside the country for employment opportunities (Ghanaweb.com, 2022). In addition, the secretary of health acknowledged that Kenya is seeking to send 20,000 nurses to UK hospitals. To export nurses, Kenya Medical Training College has included English training in the colleges to help improve their communications in order to meet the competition on an international level. She further added that it is those nurses who have not been absorbed into the health system of Kenya who will be exported.

Critique

Although Hoa (2006) stated that labourers should be given training before exporting them, the work fails to highlight training nurses for export and what must be done to enhance their training. Also, even though Antwi-Kwateng (2023) stated that the African government should explore the western demand for labour to export labourers, he failed to also consider the kind of training that the labourers should be given to enable them to fit international demand. More so, Modi (2021) observed in his speech that the mission of sending manpower abroad should become the focus; however, he refused to look at how those individuals to be exported should be trained to meet the international standard.

RESULTS

The findings of the study have been presented under the major themes. In presenting the results, were presented in a narration form following commentaries on some of the issues revealed. Presenting the results in this format not only makes it easy for readers to engage with the paper but also makes the reader know when the data comes in to support the findings.

Train More Nurses

Exporting nurses will require training more nurses. In the case that the government of Ghana should embark on exporting nurses, will it require expanding the enrolments of nurses in the various colleges that train nurses? Answering this question, some interviewees disclosed that regulating migration through the export of nurses will mean that the intake of students in the various nursing colleges should be increased. Increasing the number of nursing students admitted will mean the government has a way to sustain the health system in the country. It is ideal that the government train more nurses. To drive home this point, a participant shared that … If the government has the intention of exporting professional skills, especially with nurses, it means that the government must open up the training colleges and also think of giving them quality skills, so that there will always be a replacement of what is being exported. As much as the country will want to export, it means the intake of nursing students must increase so that even after exporting some, there will be enough nurses for the health system. (Mr. Kwaku, a 30 years old man in-charge of migrations at MELR). Similarly, a 36 years old man at MOH HR/PD also said that …. definitely, going by the export of nurses will mean boosting the enrollment levels of the colleges. But this will also come with some cost. Does the government have the finances to build new schools, employ teachers, and so on? So, I think the government should engage the respective stakeholders to plan what should be done. The two voices above indicate that if the government of Ghana engages in any export of nurses, that should be reflected in the numbers enrolled in the various nursing colleges. That is, if the colleges were admitting 500 students each year, it should be increased to like 700 students each so that some can be exported and some can be maintained. Although they suggest some increase in the number of students admitted, a 36 years old man at MOH okays it if the government has the financial strength to do so.

No Need to Increase Enrolment Number

Contrary to increasing enrolments levels in the nursing training colleges if the government should export nurses, Mr. Kofi, a 35-45 years old man, head of HMIS at MOH said that for now I don’t think there will be the need to again increase the enrolments or expand the quota system because it will call for more financial obligations on the government. May be this can be done in the future when the country will have money. Let me be frank with you, this government is broke. For this participant, increasing the intake levels at the various nursing colleges will not be necessary since that will call for additional financial obligations. And for him, it will not be necessary again because the government of Ghana is facing financial challenges. Although some of the participants have earlier alluded to the fact that there will be the need to double up the enrolments level, for this particular participant, looking at how the government is suffering financially and the constraint that will bring on the government if the government should allow colleges to admit more, there would not be any need for increasing the quota system.

Upgrading Nursing Training Colleges

It was found out from the study that the government must upgrade the various nursing training colleges to meet international standards if it wants to export nurses. Some participants revealed that upgrading the colleges will require upgrading the colleges to offer degree programmes and increasing the number of tutors at the training colleges.

Nursing Colleges to Degree Level

The study found that in the quest to export nurses, there will be a need to upgrade all nursing colleges to degree levels. The colleges, when upgraded to degree levels, will be able to award their students with degree certificates. If that is done, it will also help the nurses trained locally meet the educational qualifications of their international colleagues. Talking about the various nursing colleges upgraded to award degrees to their subsequent students, it was observed from Miss Effua’s (a 29-year-old woman in charge of employment from MELR) response that; in fact, upgrading all nursing colleges to degree level will save our health sector. You know something, most nurses after three to four years of employment, ask for leave to go and upgrade. When they are away, the workforce of that hospital reduces. So, upgrading the schools to degree levels will mean that all subsequent nurses will have degrees and would not be applying to upgrade within a short period of their employment. Also, when this is done, it will put our nurses on par with international nurses. Sharing a similar view with Miss Effua, Mr. Kwaku, a 30-year-old man in charge of migrations at MELR also shared that I believe that in order to improve the skills of our nurses, the number of years they spend in training schools should increase to university levels. Thus, all nursing colleges should be allowed to award degrees to their graduates. In this case, it will reduce the number of nursing leaving work to go to school for upgrade. From the above statements, the two participants agree that nursing colleges should be awarding degrees to their students. Thus, doing so will enable qualified students to be awarded degrees. It will also mean that the number of years should also increase from three to four to meet university standards. Also, for Miss Effua, if the nursing colleges are allowed to award degrees, it will prevent the nurses from leaving the job and going for further studies since it is something that most of the nurses do as they are awarded diplomas. Because they are currently awarded a diploma, most of them leave the job in a short while to pursue degree programmes, which sometimes become disturbing.

Again, on the issue of nursing colleges awarding degrees, a participant also shared a diverting view. For that participant, attention must be paid to the quality of the training given and not necessarily the awarding of a degree. He shared this in the words; we must first look at the type and quality of nurses we want. We must assess the training institutions and know their capabilities before anything is implemented. Look, those individual doctors and nurses who go out there, most of them first do top up before they can fit into the system there. So, we must be thinking of how to improve the training system here to meet the international level. So, I will not just say they should be awarded a degree but consider the quality (Mr. Kofi, a 35-45 years old man at MOH, head of HMIS). He observed that nurses must be trained to meet international standards since most of the nurses and doctors who go outside have to upgrade themselves before they can secure a job. Although upgrading nursing colleges to award degrees would be better, the training should focus on giving the nurses the best training for the job. Nurses for this participant must be trained to meet the level of internally trained nurses. Thus, the nurses trained in Ghana must be able to compete with nurse’s training in other countries.

Contrary to the above views that support the upgrading of all the nursing colleges to degree levels to award degrees to their students, a participant did not share the same sentiment with his colleagues. He said, I don’t think all nursing colleges in the country should be awarding degrees to trainees. My reason is that based on the qualifications for entry into the colleges, some prospective nursing students may not meet the requirement if moved to degree levels. So, the diploma is okay since not every student may get all the grades needed to do a degree. That is why the universities are there. We have a lot of government universities offering degree nursing and so those who want to go there must go. Second, you know that this is a profession and there must be assistance, like nurses will need junior nurses to assist them at the workplace. So, there will be the need for the assistance of junior nurses and that can be realised with the diploma and the degree differences (a 36-year-old man at MOH HR/PD). Not agreeing to upgrading all nursing colleges to degree levels to award degrees, he based his reasons on the fact that some students go to the nursing colleges based on their academic strengths and so upgrading it to that level will be indirectly discouraging students to go there. Again, for him, the universities are there to award degrees and so students who want the degree directly should go to the universities.

Infrastructural Investment

A country thinking of exporting nurses on a large scale should be prepared to add to the infrastructures. There should be some additions to the facilities of the various colleges. Also, technology development should be promised in the training of nurses. The exportation of nurses cannot be done on a large scale by a country without investing in the infrastructure of the various colleges in order to accommodate the students. A country that is thinking of exporting nurses should be thinking of improving on existing infrastructural facilities and also thinking of adding some to the already existing ones since the exportation will require the training of more nurses. Addressing this concern, Mr. Kwame, a 39-year-old lawyer at MELR, said that, actually, you cannot take out development without enhancing the infrastructure and motivating those handling the training of nurses. Of course, we need more facilities in the various nursing institutions as far as we will want to export nurses. And not leaving out the instructors, he further added that tutors must be well motivated as well to enable them to stay to lecture. Mr. Kwaku’s view supported what Mr Kwame of MELR said: Surely, as the government may want to export, there should be massive infrastructural expansion. Government must add on to existing buildings, think of employing additional lecturers and so on. So, for these paparticipants, it’s not enough to just add more infrastructure to the various colleges without paying attention to those who work in the colleges. Motivating the workers too will go a way to strengthen the aim of whichever policy that will be rolled out. For Miss Effua, a 29 old woman, in-charge of employment at MELR, adding to the existing infrastructure in the various colleges will be key. If the country will have to export nurses, the government must add up to the classrooms, dormitories, chairs, and everything else. From the above discussions so far, the addition of infrastructure in the various nursing colleges is highlighted. That is, there will be the need for some classrooms, additions of chairs for the classroom, and other facilities added to the already existing facilities. Also, the salaries of the workers should be considered, as well as other motivations that should be given to the workers to ensure the smooth running of the training.

Diverting a little, Mr. Kofi, a between 35-45 years old man, head of HMIS at MOH said that already, the materials and infrastructures in the various colleges are not enough, and the government is struggling to add more. Even Though it will be proper to build more infrastructures and provide various colleges with other materials needed. Like I have been saying, the government is now in a tight situation and will not be able to meet such demands. For this participant, adding on to the materials is not a bad idea, but the government of Ghana is suffering financially. Thus, the government of Ghana is not in a good financial position to add to infrastructure. He further revealed that even without the exportation of nurses the government is not able to add to the infrastructure. The big question is, can the government add to that in this financial situation the country finds itself in? So, the participants bring in another issue concerning finance. Although it is a good thing for the government to add to the already existing infrastructure, this requires money, which, in his view, per the current financial position, will be difficult to think of.

Technology Investment

Further, some participants held the view that if the government of Ghana should engage in the exportation of nurses, the government must go through some infrastructural development and invest in the technological training of the nurses in order for them to meet both the local and foreign technology demand at the various health facilities. Living in a technological age where technology is what is being used to treat patients and diseases, it is important that the government invest in technology. When technology is incorporated into the training of nurses, it helps in the delivery of health services and enhances human lives. Revealing this, he said, technology has become the order of the day, and in fact, most of our health sectors are behind. So, I think the government must seriously invest in technology in the various nursing institutions. For example, the use of AI to assist healthcare delivery in advanced countries is very helpful and Ghana must be thinking in that direction. The use of drones in delivering health must be incorporated in the training schools for nurses to learn and become familiar with their usage. Today, drones are being used to deliver medicines to health facilities in various geographical areas. And if the country intends to export nurses, they must be properly equipped with the technology and the various institutions must be technologically okay to offer such skills to the nursing students. When this is done it will of course enhance health delivery within the country. Let’s move away from the manual way of delivering health to the technological way. Because if they do not learn their usage from school, they face difficulties using them when they are on the job (Mr. Kwaku a 30-year-old man in-charge of migrations at MELR). In a similar direction, 36 years at MOH HR/PD remarked; everyone needs technological training and such a noble profession must not be left behind. I know the government is struggling with finances, but this is an area which is very important. Today, you go to private hospitals and clinics and all you see are machines. Our nurses must have good technological training to use machines in treating the sick. Besides, if the nurses are to be sent outside to countries that are technologically advanced, our nurses will be found wanting. They will now have to learn when this could be incorporated into their training. But all this involves money. The revelation from the interview was that the government of Ghana should invest in the technology of the various nursing colleges. This is to help the nurses become abreast of the usage of technology in the treatment of diseases. As one of the participants observed, today’s health systems are shifting from the traditional ways of treating diseases to the modern use of technology to treat diseases. mention was made of the use of AI in the treatment of diseases

DISCUSSION

The findings from the in-depth interview suggested that the government should train more nurses to export. The majority of the stakeholders who were interviewed shared with the researcher that the government should train more nurses so that some could be exported. From my perspective, the majority of the participants agreed that the government should train nurses and export them so the government could deal with the unemployment of nurses in the country. According to the information that the Ministry of Health shared with me while on the field, nurses who graduated from 2019 to 2023 have not been absorbed into the local health service. Further, the majority of the participants may have suggested that the government should train nurses for export, probably because of the economic benefits that the country stands to benefit (Antwi-Kwateng, 2022). Income and remittance gains have been one of the factors that have always motivated migration decisions (Kingma, M. 2018). Further, the majority of the participants suggested that the government should train more nurses and export some, which may be the reason not to be in shortage of nurses along the line of exporting nurses. It is better for the country not to lose sight of the health demands of his country while chasing prospects since those prospects may not be adequate enough to resolve the calamities that may result from that. Also, the majority of the participants were of the view that all nursing colleges should be upgraded to offer degree programmes. Upgrading the colleges to offer degree programmes is key, as that may give the nurses the adequate skills they need to meet the demands of today. Also, the upgrading of the colleges to offer degree programmes may put nurses on the same payroll as their colleague nurses outside, who may all be holding degrees. Further, the upgrade of the nursing colleges to degree levels may also enhance the confidence level of the nurses, as their absence may influence them to look down on themselves even though their colleagues may have the degree while they hold diplomas.

As we are in the world of technology and the health institutions have been benefiting from that, there will be a need for the government to also invest in the technological training of the nurses. Nurses trained today must know how to work with machines. Training nurses for export may require the government to train nurses to be able to work with artificial intelligence machines. There is no doubt these machines used in hospitals have been beneficial in treating diseases, and the newly trained nurses must have knowledge about how they can work with them as their new colleagues.

The findings from the data further suggested that the government should expand infrastructure. Thus, as the country exports, there will be a need for the nursing colleges to be expanded in order to accommodate the number of students who may be admitted. Expanding infrastructure may therefore require financial obligations from the government. The government may have to be financially stable to invest in the infrastructural development of the various nursing colleges.

Limitations

This study is limited to the five key informants at the Ministry of Health and the Ministry of Employment and Labour Relations and could not be expanded to stakeholders at the regional health directorates.

CONCLUSION

At the end of the study, it was revealed that the government should train more nurses for export, as the export of nurses is an avenue for governments to reduce nurse unemployment and mobilize revenue.

RECOMMENDATION

I recommend to policy makers at the Ministry of Health and the Ministry of Employment and Labour Relations to invest in the training of nurses in order to meet international standards.

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