Financing Health Education in Ghana: Policy Alternatives

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.