Exploring the gendered dimensions of health workforce retention challenges and transformative solutions in three deprived districts of Ghana: a qualitative participatory action research study

The health workforce (HWF) is central to achieving Universal Health Coverage, but the ongoing global HWF retention crisis threatens progress. Women comprise 70% of the HWF and yet face unique retention challenges. Gender transformative actions on HWF are needed, but there is a knowledge gap, especially in low-resource settings. Ghana is facing a HWF crisis in deprived, remote areas. A project that co-designed and piloted retention interventions in three such districts highlighted gendered dimensions. This study sought to elucidate the gendered dimensions of HWF challenges and make gender transformative recommendations. This qualitative study embedded a participatory action research and intersectional approach. Thirty-six (36) key informant interviews were conducted to explore retention challenges, current policies/activities and recommendations. Respondents were purposively selected for cadre and gender, striving for equal geographical distribution. Intersectional gender analysis was conducted using the framework analysis approach and Morgans gender framework. Women health workers dominated deprived districts, with the small number of men assigned to island communities, as men were deemed more resilient to difficult conditions. There was a shortage of women health workers, and retention was low, primarily due to family responsibilities. Most women juggled difficult working conditions with singlehanded childcare and responsibility for maintaining relationships, hindered by poor telecommunication networks and transport challenges. Many women feared boat crossings and cannot ride motorbikes, necessitating expensive motorbike rider hire, with some attributing long journeys to miscarriages. Women face expensive accommodation, barely covered by salaries - this, combined with high food costs and inability to conduct locum work, causes financial stress. Safety and security concerns, including robberies, motorbike accidents and sexual harassment were commonly highlighted. Current policies are not gender transformative and failed to address womens challenges. Recommendations include tailoring incentives to women with childcaring responsibilities, investing in accommodation and security, strengthening community support, sexual harassment policy and awareness.