The North-South Divide: Investigating the National Split in Doctor Reporting Rates

The Ghana Health Service recently released data details the number of doctors posted by region versus the actual number that reported for duty. This gives a snapshot of where our newly qualified doctors are accepting to go and more importantly, where they are refusing to go.

Below is a visualization of that data as of November 28, 2025, powered by Finex Insights.

The Ghana Health Service posted a total of 463 medical officers to various regions across the country. As the deadline passed, only 158 had reported for duty.

That leaves 305 doctors, nearly two-thirds of the entire batch, who have effectively ghosted their assignments.

The real story isn't just the refusal rate; it’s the geography of that refusal. The map tells a tale of two zones. In the South, compliance is relatively high across the board. Greater Accra Region leads the way with 80%; the Ashanti Region recorded a 76% reporting rate, followed by the Eastern Region at 64% and Central Region at 59%.

Now, look North.

• Upper West: 32 allocated. 0 reported.

• Upper East: 35 allocated. 0 reported.

• North East: 19 allocated. 0 reported..

It is a stark divide: a "Red North" versus a "Blue South."

We all know the "obvious" reasons why this happens. If you ask the average Ghanaian why doctors shun these areas, they will immediately point to the basics of survival. They will talk about the nightmare of finding decent accommodation in a remote district. They will mention the bad roads that make getting to the hospital a daily hazard, or the erratic electricity and water supply that make basic living a struggle.

And yes, those material challenges are real and valid. But this article moves beyond the broken roads to answer three critical questions:

1. The History of Failure: Why have decades of government interventions and incentives failed ?

2. The "Career Trap": Is the refusal really about lifestyle, or is it driven by a deeper professional fear of "skills atrophy" and career stagnation?

3. The Missing 305: If two-thirds of the doctors didn't report, where exactly are they right now?

   
   

1. A History of Failed Policies

This isn't a new crisis. Ghana has been fighting this battle since the colonial era, but the modern version of the struggle began in earnest with the Ghana Health Service and Teaching Hospitals Act (Act 525) in 1996. The goal was decentralization: allocating doctors based on local needs.

It didn't work.

Since then, the government has tried a mix of rewards and punishments. In 2009, following a similar wave of refusals, the Ministry of Health threatened to withhold salaries for those who didn't report: a "no work, no pay" policy. At the same time, they introduced the "Deprived Area Incentive Allowance" to make rural postings more attractive.

So, why hasn't there been change?

The problem is trust. Research shows that these financial incentives are often beautiful on paper but unreliable in practice. The "Deprived Area Incentive" is frequently paid in arrears, sometimes years late. Furthermore, the "Financial Clearance" bottleneck at the Ministry of Finance often means that a doctor moving to a rural area might work for months before seeing their first paycheck.

When the government has a history of delaying payments, a doctor’s refusal isn't just about location; it’s about financial safety.

2. The "Professional Death" Trap

If you dig into the conversations doctors are having in private groups and on social media you realize the refusal isn't just about comfort. It’s about career survival.

Yes, the material deficits are real. Doctors speak of hospitals with no reliable electricity to store drugs and districts with no ambulances. But for a young ambitious professional, the structural deal-breakers are far scarier.

The primary fear is "Skills Atrophy." Medicine is a "use it or lose it" profession. A young doctor trained to use advanced diagnostic tools fears that if they spend three years in a district facility with only basic equipment, their hands will "forget" the skills they spent years learning.

Then there is the issue of Professional Isolation.

In an urban centre like Accra, you are surrounded by seniors, specialists, and mentors. In a remote district, you might be the only doctor. There is no one to learn from, and no one to cover you when you are sick. As one user on X (formerly Twitter) noted, the fear isn't just living in a rural area; it's being "refused transfer" when it’s time to leave, effectively becoming a prisoner of the post.

Doctors fear that going North means "out of sight, out of mind", that they will be passed over for study leave and specialization opportunities in favor of their colleagues who stayed in the South.

3. Where Are the 305 Doctors Who Have Not Yet Reported?

This brings us to the final mystery. If 305 doctors didn't report, where are they?

Most of them are likely absorbed into the "Locum Economy." "Locum" refers to temporary, shift-based work. Private hospitals in Accra and Kumasi need staff, and they are happy to employ these "waiting" doctors to cover night shifts or weekends. This creates a perverse loop: the private sector in the South is effectively subsidizing the refusal of public posts in the North.

Others are in the "Japa" Waiting Room. For many, the refusal to report is just a holding pattern while they study for foreign licensing exams like the PLAB (UK) or USMLE (USA). Emigration rates for Ghanaian doctors remain historically high. Consequently, when faced with a rural posting that offers no possibility for career development, many decide they would rather work on leaving the country than stagnate in a remote district.

Finally, there is a quiet minority who are leaving the profession entirely. Frustrated by the system, some young doctors are pivoting into other career paths: tech, business and other diverse fields where they don't have to fight for financial clearance or worry about lacking basic equipment.

Conclusion: What is a Rural Doctor Worth?

Looking at the empty columns for the Northern, Upper East, and Upper West regions, we are forced to confront a difficult truth. We have built a system that relies on the "goodwill" of doctors to accept postings that limit their finances and careers.

But that goodwill is a currency that is fast devaluing. In an era where doctors have viable alternatives, from the private sector in Accra to opportunities abroad, blind patriotism is no longer enough. For many, a rural posting that offers no path for professional development is not a service to the nation. It is a career dead-end they are simply choosing to avoid.

If we truly believe that a life in Nalerigu is worth saving as much as a life in Accra, why does our posting system feel like a punishment rather than a promotion?

Perhaps it is time to stop asking why doctors are refusing to go, and start asking ourselves: If we want top-tier talent in the hardest-to-reach places, are we actually willing to pay the price in cash, career protection, and respect, to get them there?