Pharmacists and Migration: Professional Aspirations and Opportunities from the Perspective of Pharmacy Students in Ghana

1. Pharmacists and Migration: Professional Aspirations and Opportunities from the Perspective of Pharmacy Students in Ghana Frances Owusu-Daaku*, Felicity Smith**, Rita Shah** *Faculty of Pharmacy and Pharmaceutical Sciences, KNUST, Kumasi, Ghana; **School of Pharmacy, University of London, UK

2. OUTLINE • Introduction • Objectives • Methods • Sampling and Recruitment • Data Collection • Data Analysis • Results and Discussion • Professional Aspirations • Travel: Home/Abroad • Conclusion

3. Pop about 20 mill 45% under 15 yrs old Female : male ratio – 51:49 Capital: Accra Area: 92,340 sq miles A few degrees north of equator (hot!!) GMT time zone Former British colony Est # of Pharmacists=1200 Hosting 2009 CPA conference! In Brief

4. INTRODUCTION • Many “push” and “pull” factors that encourage or discourage migration have been examined • Tentative suggestions made as to mitigation in terms of achieving MDGs; and responsibilities of “donor” and “recipient” countries • Overwhelming focus on medical and nursing professions- significant gap relating to Pharmacy • Yet pharmacists long recognised as an under-exploited healthcare resource, especially in developing countries

5. OBJECTIVES • Examine professional aspirations of final year students in Ghana (a developing country) • Obtain their views on opportunities to fulfill their ambitions at home and abroad • Consider what developments may encourage them to remain in, and contribute to, healthcare in their own country

6. METHODS: Sampling and Recruitment • Fourth (final) year undergraduate pharmacy students (n=93) in Faculty of Pharmacy and Pharmaceutical Sciences, KNUST • 22 students randomly selected- all agreed to participate • 10 (2 groups of 5) participated in one of 2 FGD • 12 participated in individual face-to-face interviews • Interviews conducted by RS (“independent” investigator)

7. METHODS: Data Collection • 4 Main topic areas • reasons for decisions to study pharmacy • aspirations regarding their professional careers • extent to which they believed they could fulfil their goals and aspirations in Ghana including potential barriers to their achievement • thoughts regarding possible travel to other countries and within Ghana

8. METHODS: Data Analysis • All data transcribed verbatim (with respondents permission) • Themes and issues identified for each topic • 10 codes derived independently, results compared and resolved by discussion • 20 codes – more detailed analysis derived in a similar way • Argumentative validation employed throughout

9. RESULTS: Professional Aspirations(1) • Aspirations to excel in professional activities “I want to lead, want to be the best in whatever I do, I want opportunities to progress to highest level” • Further education a distinct component of short or medium term goals “A first degree is not adequate for me to contribute to my nation, Ghana, and to help my people. I feel I could be more useful in hospital or industry if I did a post-graduate programme” • Recognition as health professional important (Hospital, industry, community, academic, other) “I want to know my product is helping the patient; to read, apply knowledge, feel like a health care professional”

10. RESULTS: Professional Aspirations(2) • Reserved optimism regarding opportunities in Ghana • “I believe there are opportunities in Ghana – if you have the education (beyond a first degree) and finances” • Often disillusioned by Pharmacy Practice • “We don’t feel we are part of the health professions, that is a big question mark” • And Health/ Medicines Policy • “When they [government] talk about health personnel, they say doctors and nurses. Even the National Insurance they are bringing out, they place us as ‘others’”

11. RESULTS: Travel within Ghana • In general, cities seen as providing best environment for offering high quality services • Distinction drawn between regional capitals and rural areas “ Would work in the town where I come from in the north. Our place is deprived we need more health personnel, but rural areas not part of my plans, differences in lifestyle is too vast. I can manage change from city to town, but some rural areas, no lights, potable water, electricity. Though people try to shove it away, the tribal issue is there, if you go to a place you are not from, the treatment is not good”

12. RESULTS: Travel Abroad • All respondents stated that should they travel abroad, their wish would be for this to be for a limited time and/or a specific purpose following which they would return. “I would like to travel outside my country for some time, but not for that long, may be to have enough experience, adventure, money, then it will enrich you as a person. I would like to have the experience once in my life” “I would stay in Ghana if there was the appropriate [post-graduate] course”

13. DISCUSSION- Policy Implications • Education most common reason for travel: Any educational initiatives, need to be carefully tailored to the ‘market’ if they are to have any impact on workforce movements. • Lack of attention to measures to exploit the potential contribution of pharmacists in developing countries represents a lost potential human resource for health in policy, clinical and community settings.

14. RESPONSE OF VARIOUS BODIES • MOH/GHS? • School(s) of Pharmacy? • PSGH? • Pharmacy Council? • ETC?

15. CONCLUSION First detailed examination of professional aspirations of pharmacy students in a developing country: • Ambitious prospective young professionals wanting to excel and be seen as health professionals • Displayed • commitment to their country • Wish to be formally involved in healthcare and make a greater impact in public health and patient care • Disillusioned about lack of recognition AND lack of initiatives of pharmacists themselves

16. Some Key References • Adams O, Stilwell B. (2004) Health professionals and migration. Bull. WHO; 82: 560 • Astor A, Akhtar T, Matallana MA, Muthuswamy V, Olowu FA, Tallo V, Lie RK. (2005) Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Soc. Sci. Med; 61:2492-2500 • Connell J, Zurn P, stilwell B, Awases M, Braichet J-M (2007) Sub-Saharan Africa: beyond the health worker migration crisis. Soc. Sci. Med. 64:1876-1891 • Dovlo D (2005) Taking more than a fair share? The migration of health professionals from poor to rich countries. PloS Medicine; 2(5):0376-0379. • FIP (2006) Global Pharmacy Workforce and Migration Report: a call for action. FIP • Hassen E (2005) Developed world is robbing Africa of health staff: health of nations needs more than health professionals. British Medical Journal 330; 923 • World Health Organisation (1988) The role of the pharmacist in the health care system. Geneva, WHO. • World Health Organisation 2006a. Working together for health: The World Health Report 2006. Geneva, WHO.

17. Acknowledgment • All fourth year students of Pharmacy in the Faculty of Pharmacy and Pharmaceutical Sciences, KNUST; • especially those who took part in the FGDs and the interviews • DFID funded Higher Education Link programme, administered by the British Council

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