Abstract:
Introduction: The lack of appropriate policies and procedures to ensure transparent transfer practices is an
important source of dissatisfaction among health workers in low- and middle-income countries. In order to alter
and improve current practices, a more in-depth and context-specific understanding is needed. This study aims to
(1) identify rationales behind transfer decisions in Ghana and (2) examine how transfers are managed in practice
versus in policies.
Methods: The study took place in 2014 in three districts in Eastern Ghana. The study population included (1) national,
regional, and district health administrators with decision-making authority in terms of transfer decisions and (2) health
workers who had transferred between 2011 and 2014. Data was collected through semi-structured and structured
face-to-face interviews focusing on rationales behind transfer decisions, health administrators’ role in managing
transfers, and health workers’ experience of transfers. A data triangulation approach was applied to compare identified
practices with national policies and procedures.
Results: A total of 44 health workers and 21 administrators participated in the study. Transfers initiated by
health workers were mostly based on family conditions and preferences to move away from rural areas, while
transfers initiated by administrators were based on service requirements, productivity, and performance. The
management of transfers was not guided by clear and explicit procedures and thus often depended on the
discretion of
decision-makers. Moreover, health workers frequently reported not being involved in transfer decision-making
processes. We found existing staff perceptions of a non-transparent system.
Conclusion: Our findings suggest a need to foster incentives to attract and retain health workers in rural
areas. Moreover, health worker-centered procedures and systems that effectively guide and monitor transfer
practices must be developed to ensure that transfers are carried out in a timely, fair, and transparent way.
