Background
and Arguments
When the debate for
scrapping off teacher trainee allowances was raging, it was voraciously
expected that same will shift to the health sector. Lo, same debate has been commissioned
with some people calling for the allowances of health trainees to be equally
scrapped off.
The proponents of the
scrapping off of the allowances base their arguments principally on equity
across board – education and health sectors. They also think that there is no
accountability in the disbursement of allowances and that salaries and wages account
for 90% of the health sector’s budget while the remaining 10% goes into service
delivery.
Be it as it may, one
must not necessarily call for the killing of the gander simply because the
geese have been killed. That notion simply does not click. While I do not
undermine the teaching profession, I think that the condition that exists in
their sector is not the same as it is in the health sector. The ministry of
education and the ministry of health are not operating on the same budget;
therefore if the education ministry thinks that its budget cannot support the
payment of allowances to trainee teachers’, it does not necessarily imply that
the health ministry should do same. The health of a nation’s citizens is
directly linked to its productivity and development and we must not lose sight
of that fundamental fact to behave in a way that will shift the balance of the
forces holding the health of the nation in equilibrium.
Trainee allowances were
introduced to attract students to the health professions because people in past
times considered nursing as a ‘dirty’ job. It was also introduced to attract
human resource to bridge the widened gap between the population ratios of
nurses and for that matter other health professionals and the population at
large. Suffice it. Are we saying that we have been able to achieve these
crucial indices? Or are we saying that we have been able to meet the health
related Millennium Development Goals? However you answer the rhetoric, few
things needs consideration.
If 90% of the health
sector budget goes to the payments of salaries and wages, 90% of that goes to
the payment of salaries of doctors and directors and not to trainees. That is
the inequity policy makers should be addressing and not scrapping off of the
meager allowances paid to health trainees. If those in policy are arguing that
there is no accountability in the payment of these allowances, it is simply an
administrative fiasco on their part and I honestly think they should not stick
their heads to discuss this issue publicly. They must be held accountable for
that lapse because it is the taxpayer who suffers when such heinous flaws are
committed.
There is every justification
why health trainees like any of their colleagues in the other sectors should
enjoy their allowances. In 2006, the average fee per annum in health training
institutions was about GHC 350 and GHC 450, today, it is well over GHC 1500.
Many trainees rely on their allowances which are raked back by government in
the form of fees. What is the allowance here then when all you receive is paid
back to government through fees? Another
dimension of inequity policy makers are in oblivion of is the fact that scrapping
off of the allowances will mean that the poor cannot go to school. Only the
rich who can afford college education should be in school. This is inequity
better defined.
The proponents of this
chauvinist policy further submit that as a result of the allowance, the right
calibers of people are not admitted into the health system. To this end I agree
conditionally. The right caliber of people can be admitted into the health
system if the processes of admission into health training institutions are purged
of nepotism and undue pressure on principals and directors to admit their
cronies. Attending an interview before you gain admission into a health
training institution was meant to filter the right caliber of health trainees
into the health system but that effort has been completely defeated due to
pressure from politicians and policy makers to by all means gain admission for
their cronies and sympathizers. That is the real problem not trainee
allowances!
Before I submit my
opinion on policy alternatives to solve the problem, I will like to bring to
bear that scrapping off trainee allowances will logically usher in the rebirth
of brain drain. It does not make legal sense to bond a nurse you have not
financed his/her education. And for that matter, if a nurse struggles to
survive high school fees on his/her own, he/she should equally have the moral right to determine who and where he/she wants to
work.
Policy
Alternatives
The
ageless adage – there are many ways of killing a cat – is still true even
today. I submit below some of the ways we can finance health education in Ghana
bearing in mind that budgetary allocation to the health sector is constrained –
about 4.8% of GDP (2011).
Instead of scrapping it
off completely, trainee allowances (health and teacher alike) can be granted as
repayable bursaries payable by installments over the bond period that trainees
are bonded. With this, the onus rests with government to ensure that trainees
are promptly placed and hooked onto the public payroll grid to facilitate easy
recollection so that the scheme will be self-financing in a revolving manner. A
very low interest rate – say 5% p.a can be imposed on it. To this end, if you
are unable to complete your training within the stipulated time frame, you
begin to receive 50% (half) of your training allowance for the rest of the
years you are adding on. While others may be paying 15% interest rate over the
three year period corresponding to their training, such a person who defaults
in completing his/her studies within the stipulated time period will pay an
additional 5%p.a for each additional year. This is one way.
In certain provinces in
South Africa, bursaries are available to health trainees based on the composite
annual earnings of both father and mother. So that, if one qualifies into a
health training school, the annual income of your parents are calculated, if it
is below a certain value amount, you qualify for a full training allowance, if
it falls within a particular range, you qualify for a partial allowance and if
it falls above a certain range, you are out. This is possible in Ghana only if politics
is not meddled into it. It is working across the SADC countries. Your father
cannot be a doctor and your mother an MP and you expect a bursary from
government – that is unfair!
The last option I would
suggest is that, if it comes to the worse that trainee allowances should be
scrapped, then, school fees should be drastically slashed by over 70% to make
it affordable. There should be affordable accommodation. Plus, allowances must
be paid trainees on clinical rotation for their accommodation and daily
subsistence.
But the notion that
trainee allowances should be totally scrapped off is misplaced and therefore
should be out-rightly dismissed.
