Demographic shift10/7/2023 These efforts have not only resulted in improved service coverage towards UHC, but also the country is being cited as a leading producer of physicians, nurses and midwives in sub-Saharan Africa. It would appear that these efforts to a large extent yielded some fruits as the density of doctors, nurses and midwives dramatically improved from 1. Consequently, the Ministry of Health developed the HRH strategy, 2007–2011 which outlined a number of strategic interventions including the expansion and liberalisation of the training of health workers, the reintroduction of auxiliary nursing programmes, the establishment of postgraduate specialist training colleges (for doctors, pharmacist, nurses and midwives), review of health workers salary structure and the introduction of staff vehicle hire purchase scheme, to name a few. The 2006 World Health Report classified Ghana among 36 countries in sub-Saharan Africa facing Human Resources for Health (HRH) crisis which became a clarion call for concerted efforts to address a myriad of health workforce challenges notably, inadequate production, excessive out-migration and low wages among others. In leaving no one behind as enshrined in the UHC effort, nurses and midwives who undoubtedly have been the bedrock of most healthcare systems and form the bulk of the health workforce would have to be a greater part of the efforts. The global community is increasingly recognising the contribution of nurses and midwives to health service delivery and the need to harness the nursing and midwifery potential towards the attainment of Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) especially goal 3. We further advocate that policymakers should also consider upgrading all professional nursing and midwifery programmes to bachelor degrees as this would not only potentially enhance the quality of training but also address the phenomenon of large numbers of nurses and midwives seeking bachelor degree training soon after employment-sometimes putting them at the offending side of organisational policy. We propose the institution of a national nursing and midwifery mentorship programme and a review of the study leave policy to make it flexible and be based on a comprehensive training needs assessment of the nursing and midwifery workforce. In this commentary, we examine how the drastic generational transition could adversely impact on the quality of nursing care and how the educational advancement needs of the young generation of the nursing and midwifery workforce are not being met. It has, however, also resulted in a dramatic demographic shift in the nursing and midwifery workforce in which 71 to 93% of nurses and midwives by 2018 were 35 years or younger, as compared with 2.8 to 44% in 2008. As part of measures to address severe shortage of nurses and midwives, Ghana embarked on massive scale-up of the production of nurses and midwives which has yielded remarkable improvements in nurse staffing levels.
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