25 Doctors Refuse Postings to Upper West Region, Threatening Healthcare for 1 Million Citizens – Life Pulse Daily

Introduction

The Upper West Region of Ghana is facing an acute health‑service crisis. Out of the 32 newly appointed clinical doctors for the 2025/2026 service year, 25 have declined to report for duty. This unprecedented refusal creates a staffing gap that jeopardises the delivery of essential medical care to roughly one million residents.

In this article we examine the scope of the shortage, explore its root causes, compare the situation with national standards, and outline practical steps that policymakers, health‑facility managers and the doctors themselves can take to mitigate the impact.

Analysis

Current Doctor‑to‑Patient Ratio

The Ghana Health Service (GHS) reports that the Upper West Region currently operates with only 55 practising doctors for a population of about 1 000 000. This yields an average of 1 doctor per 18 181 patients, far exceeding the World Health Organization (WHO) recommendation of 1 doctor per 1 000 patients for adequate primary‑care coverage.

The newly approved allocation of 32 posts was intended to raise the regional ratio to approximately 1 : 15 500, still well above the WHO benchmark. However, the mass refusal of 25 doctors (78 % of the allocated slots) has effectively nullified the expected improvement, leaving the region with a net deficit of 25 doctors.

Impact on Health Services

• Reduced outpatient capacity: Clinics are forced to limit daily consultations, increasing wait times and discouraging preventive care.
• Higher workload for existing staff: Remaining doctors face burnout, which can compromise clinical judgment and increase medical errors.
• Interrupted maternal‑child health programmes: Antenatal visits, immunisation drives and emergency obstetric care are especially vulnerable to staffing shortages.
• Potential rise in morbidity and mortality: Delayed treatment for chronic diseases (e.g., hypertension, diabetes) may lead to higher complication rates.

Why Doctors Are Declining Rural Postings

Interviews with health officials and previous studies on Ghana’s public‑sector staffing reveal several recurring factors:

1. Insufficient infrastructure: Rural hospitals often lack reliable electricity, running water, and modern diagnostic equipment.
2. Poor housing and basic amenities: The region offers limited quality accommodation for medical staff and their families.
3. Professional isolation: Fewer opportunities for peer collaboration, specialist referral networks and continuing medical education.
4. Family and social considerations: Concerns about access to quality schooling, social activities and spousal employment.

Government Response

Dr. Joshephat Nuzagl, Upper West Regional Director of Health Services, has publicly expressed “deep concern” and affirmed that the regional health directorate is pursuing “remedial action” to persuade the doctors to accept their postings. The Ministry of Health has also indicated that it will review incentives, including:

• Housing allowances and renovation grants for staff quarters.
• Transportation subsidies for remote‑area travel.
• Targeted professional development programmes (e.g., short‑term specialist rotations).

Summary

In summary, the refusal of 25 out of 32 newly allocated doctors has amplified an already critical doctor‑to‑patient imbalance in Ghana’s Upper West Region. The shortage threatens to undermine primary‑care delivery, exacerbate health inequities, and increase the risk of adverse health outcomes for a population of one million. Addressing the crisis will require coordinated policy measures, targeted incentives, and sustained dialogue with medical professionals.

Key Points

Practical Advice

For Health‑Facility Administrators

1. Conduct rapid needs assessments: Identify critical gaps (e.g., essential drugs, diagnostic tools) and prioritize resource allocation.
2. Implement temporary staffing solutions: Engage locum physicians, private‑sector partners, or volunteer NGOs to fill urgent vacancies.
3. Enhance staff welfare: Provide on‑site accommodation upgrades, reliable internet access and family support services.
4. Establish mentorship networks: Pair rural doctors with specialists in Accra or Kumasi via telemedicine platforms.

For Policy Makers

1. Legislate clear posting obligations: Define the legal framework for mandatory rural service, including transparent appeal mechanisms.
2. Introduce tiered incentive packages: Combine financial bonuses, career‑advancement points and postgraduate training opportunities.
3. Invest in infrastructure: Upgrade hospital facilities, ensure stable power supply and equip labs with essential diagnostic machines.
4. Monitor compliance: Use a real‑time staffing dashboard to track postings, withdrawals and retention rates.

For Doctors Considering Rural Postings

1. Assess incentive eligibility: Verify housing allowances, travel subsidies and professional development credits before declining.
2. Seek mentorship: Connect with senior physicians who have served in similar settings for guidance and support.
3. Plan family logistics early: Explore schooling options, community groups and spousal employment opportunities in the region.

Points of Caution

While incentives can improve recruitment, they must be balanced against fiscal sustainability. Over‑reliance on financial bonuses without addressing systemic infrastructure deficits may lead to short‑term fixes but long‑term attrition. Additionally, any compulsory posting policy must respect constitutional rights to freedom of occupation and ensure due process for dissenting physicians.

Comparison with Other Ghanaian Regions

The table illustrates that the Upper West Region’s ratio is among the poorest in the country, comparable only to the Upper East Region, where similar challenges persist.

Legal Implications

Ghana’s Public Service Act and the Ghana Health Service (GHS) Regulations outline the duties of civil servants, including mandatory postings. Refusal to report without lawful justification may constitute a breach of contract, potentially leading to disciplinary action such as:

• Formal warnings or reprimands.
• Suspension of salary and benefits.
• Termination of employment after due process.

However, the law also protects employees from unreasonable working conditions. If a doctor can demonstrate that posting conditions violate health‑and‑safety standards (e.g., lack of basic utilities), they may have a legitimate defense. Legal counsel is advisable for both the health authority and the physicians to ensure compliance with constitutional rights and labor regulations.

Conclusion

The mass refusal of doctor postings in Ghana’s Upper West Region is a stark reminder that human resources for health are as much about working conditions and incentives as they are about numbers. Without swift, coordinated action—combining infrastructure upgrades, attractive incentive packages, and clear legal frameworks—the region risks a prolonged health‑service crisis that could affect the wellbeing of a million citizens.

Stakeholders must act decisively: administrators should secure interim staffing, policymakers must allocate budget for sustainable improvements, and doctors should engage constructively with the incentives on offer. Only through such a collaborative approach can the Upper West Region move toward the WHO‑recommended doctor‑to‑patient ratio and ensure equitable access to quality health care.

FAQ

Sources

1. Ghana Health Service Annual Report 2024‑2025, Section 3: Human Resources for Health.
2. World Health Organization, “Health Workforce Requirements for Universal Health Coverage,” 2023.
3. Interview with Dr. Joshephat Nuzagl, Upper West Regional Director of Health Services, published 2 December 2025, Life Pulse Daily.
4. Rafiq Salam, Upper West Regional Correspondent, PleasureNews, 1 December 2025.
5. Public Service Act, Act 351 (1994), Ghanaian Parliament.
6. Ghana Ministry of Health, “Rural Health Incentive Framework,” policy brief, 2025.