Introduction
The Minister of Health, Mr. Kwabena Mintah Akandoh, announced the government’s commitment to introduce a 20% increase in the base salary of health service providers who accept postings to work in rural and underserved communities. According to him, this strategy aims at addressing the persistent shortage and uneven distribution of health workers in rural areas. While this move is widely seen as a step in the right direction, questions remain about its feasibility, long-term sustainability, and whether incentives alone can address the deeply rooted disparities in the distribution of healthcare workers. This article examines these issues, providing a broader reflection on what is truly required to retain health workers in rural Ghana.
Uneven Development and Workforce Distribution
Ghana has made progress in increasing health worker density but faces significant maldistribution, with rural areas remaining underserved. Urban areas continue to attract more skilled health workers, resulting in persistent shortages and imbalances in rural communities (Asamani et al., 2021). For example, between 2022 and 2023, the number of doctors in the Greater Accra Region increased from 2,344 to 2,777, while the Northern Region saw a marginal increase of just two doctors, from 298 to 300 (MoH 2023). To address this, the government has proposed a 20% in the base salary of health workers who accept postings to rural communities, an incentive aimed at making such postings more attractive and improving retention. This strategy is not new, as financial motivation has always been one of the tools governments use to encourage postings to less attractive locations.
At the core of the rural health workforce crisis in Ghana is the broader issue of uneven development in the country (Boye et al., 2025). Decades of investment in urban areas have left many rural communities without basic amenities. This disparity influences not only where health workers are willing to work, but also where people choose to live, study, and raise families. The result is a concentration of health professionals in urban centers where conditions are more favorable. Rural and remote areas, on the other hand, are left underserved, creating wide gaps and inequities in health service access and outcomes, reinforcing cycles of disadvantage for rural populations (Asamani et al., 2021). These imbalances may persist unless the country adopts a more equitable development agenda that ensures all communities, not just cities, are livable and thriving.
Is the 20% Allowance Enough to Attract and Retain Health Workers?
This decision by the government marks a step in the right direction, but it raises a critical question: Is the proposed 20% increase in salary truly enough to attract and retain health workers in rural communities?
A study by Okyere et al. (2022) examining how health workers in rural communities perceive incentives revealed that while salary increases are important, they are not the only factors that matter. Health professionals placed high value on adequate and decent housing, recognition, reliable medical supplies at the health facilities, and risk allowances. In the same study, these professionals recommended that incentives go beyond salary increases to include benefits such as vehicle importation waivers, reduced waiting periods for study leave, and the opportunity to pursue desired courses.
If a health worker stays in a community with poor infrastructure, isolation, limited opportunities for professional development, and fewer educational opportunities for workers’ families, even a higher salary may not be enough to compensate for the social and professional sacrifices. Therefore, the government must ensure that any incentive package given to these workers is substantial enough to outweigh the challenges of rural life. Also, the packages should be structured to avoid demotivation or resentment among workers who feel left out.
Retaining Workers: Beyond Incentives to Holistic Development
While financial incentives may attract workers initially, retention is another challenge altogether. Health workers are more likely to stay in rural communities when they feel safe, respected, and supported, not just financially but socially and professionally. This means providing proper staff accommodation, well-equipped facilities, among others (Twineamatsiko et al., 2023). It also means investing in the broader social fabric: schools for their children, decent housing, clean water, electricity, security, recreational facilities, road and telecommunication infrastructure.
Health issues cannot be addressed in isolation as it is closely tied to education, infrastructure, and economic development. Any attempt to fix the rural health workforce crisis must therefore adopt a comprehensive, cross-sectoral approach. Thus, a holistic approach that integrates health workforce policies with broader rural development initiatives.
Conclusion
To truly transform rural health care, we must go beyond monetary incentives. We must address the systemic inequalities that make rural postings unattractive in the first place. This means investing in people, infrastructure, and communities, and not just paying more, but doing more. Only then can we hope to build a health system that leaves no one behind.
References
Aninanya, G. A., Howard, N., Williams, J. E., Apam, B., Prytherch, H., Loukanova, S., Kamara, E. K., & Otupiri, E. (2016). Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study. Global Health Action, 9(1), 32404. https://doi.org/10.3402/gha.v9.32404
Asamani, J. A., Ismaila, H., Plange, A., Ekey, V. F., Ahmed, A.-M., Chebere, M., Awoonor-Williams, J. K., & Nabyonga-Orem, J. (2021). The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: an analysis towards evidence-based health workforce planning and management. Human Resources for Health, 19(1). https://doi.org/10.1186/s12960-021-00590-3.
Boye, B. O., Subhash Pokhrel, Cheung, K. L., & Anokye, N. (2025). Drivers and barriers to rural and urban healthcare placement in Ghana: a Delphi study. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1436098
MoH: Holistic Assessment Report 2023.
Okyere, E., Ward, P. R., Marfoh, K., & Mwanri, L. (2022). Incentives management among health workers in primary health-care facilities: addressing important issues in rural Ghana. Journal of Health Organization and Management. https://doi.org/10.1108/jhom-08-2021-0322
Twineamatsiko, A., Mugenyi, N., Yvonne Nabachwa Kuteesa, & David Livingstone Ejalu. (2023). Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study. Human Resources for Health, 21(1). https://doi.org/10.1186/s12960-023-00870-0
