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

HCA 4303, Comparative Health Systems 2

UNIT x STUDY GUIDE

Title

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.

HCA 4303, Comparative Health Systems 3

UNIT x STUDY GUIDE

Title

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