Leadership Matters, but Leaders Cannot Do It Alone: Retaining Ghana’s Nurses and Midwives

Most of us entered nursing and midwifery because we wanted to care for people. That sense of purpose is powerful, but it should not be mistaken for an unlimited resource. 

Across Ghana, our colleagues continue to serve under difficult circumstances. Some work with too few colleagues. Some begin a shift without reliable equipment, essential supplies or, in some rural facilities, a steady power supply. Others pursue further education, only to find that their new qualifications are not recognized in their roles or career progression. In rural facilities, staff can be particularly isolated from professional opportunities and decision-making. 

When these experiences persist, even the strongest professional commitment can be tested. 

This is why we see wellbeing as a workforce issue, not simply a personal one. It is shaped by whether staff have manageable workloads, functioning equipment, sufficient rest, fair treatment, professional recognition, psychological and physical safety, and a credible path for growth. 

The stakes are significant. The State of the Health Workforce in Africa 2026 reports that more than 3,000 nurses and midwives migrated from Ghana in 2022. A national survey included in the report found that 62.8 percent of surveyed health workers in Ghana intended to migrate, although an intention to migrate does not necessarily mean that a person will leave. Low wages, poor working conditions, constrained career advancement, inadequate equipment and supplies, and weak health-system governance are among the pressures identified. 

Listen to what nurses and midwives are telling us 

We invited 12 early-career nurses and midwives in the leadership fellowship we mentor to share their views in an anonymous consultation, all whose priorities were closely connected. Their responses are not formal research and do not represent every nurse or midwife in Ghana, but they offer valuable perspectives from emerging leaders. 

They called for better staffing and workload management, functional equipment, fair remuneration and allowances, safe accommodation, opportunities for further study, and recognition of new qualifications. Several urged leaders to move beyond equal staff allocation across wards and to match staffing more closely to patient volume, workload, and the intensity of care required. They also proposed practical actions, including reviewing duty rosters, collecting staffing and workload data, documenting equipment shortages, creating regular staff-feedback channels, and presenting evidence-based proposals to management. 

One participant described a facility where “most of us have degree certificates lying in our bags” because roles have not been upgraded to match. Another wrote that while the desire to help patients is what brings nurses into the profession, “extrinsic motivation is what sustains them in challenging systems.” 

These perspectives echo a central recommendation from the IMNHC 2026 Health Workforce Synthesis: health systems should treat working conditions, wellbeing, and gender equity as a retention strategy. The synthesis calls for action on workload, workplace safety, and equitable advancement. It also highlights the importance of organizational culture, teamwork, professional recognition, mentorship, supervision, and the active use of workforce data. 

What institutions can do 

Across the Christian Health Association of Ghana (CHAG) network in Ghana, member institutions and denominational health services operate within a shared faith-based mission, while adapting workforce support to their own contexts and resources. Examples shared during the consultation included medical benefits, allowances, credit or loan arrangements, modified duty schedules, recognition of strong performance, social and wellbeing activities, and access to training and development opportunities such as in-service training and study leave. These are facility- or denominational-level initiatives, not uniform CHAG-wide provisions. 

These measures matter. A thoughtful roster can give an exhausted nurse time to recover. Recognition can remind a midwife that her contribution has been seen. A loan, accommodation allowance, medical benefit, or opportunity to continue learning can ease practical pressures and signal that an institution is invested in its staff. 

But staff are also asking for something deeper: a workplace in which they can do their jobs well. Financial and social benefits cannot compensate for a lack of oxygen, essential equipment, adequate staffing, supportive supervision, or fair career structures. As one of us, Lily, often puts it, nurses and midwives want “the right resources, the right environment” and the opportunity to perform at their best. 

One approach we would like to see more widely explored is acuity-based staffing for nursing and midwifery. Rather than relying only on fixed numbers or distributing staff equally across units, this approach considers the intensity and complexity of individual patients’ care needs when planning each shift. It can help leaders identify when a unit needs additional or surge support, with the aim of protecting quality of care and patient safety on every unit and every shift. It will not solve an overall workforce shortage, but it can help facilities use available staff more responsively and make staffing gaps more visible to decision-makers. 

Investing in the leaders already within our systems 

Leadership development is one practical way organizations can invest in their workforce. The NextGen Nurse Leaders Fellowship is a four-month blended program for 25 early-career nurses and nurse-midwives in Ghana, implemented in partnership with CHAG. 

The fellowship combines in-person workshops, self-study modules, webinars with established nurse leaders, peer check-ins, a moderated community of practice, and individual mentorship. Its competency-based curriculum covers communication, collaboration, evidence-based decision-making, transformation and change, governance, systems leadership, and political savvy. The fellowship is funded by the Health Carousel Foundation. 

As fellowship mentors, we have seen fellows become more willing to ask questions, express informed opinions, think critically, and engage with others. These emerging nursing and midwifery leaders have long wanted to contribute; the fellowship is helping them translate that motivation into practical influence. 

We saw this shift in the fellows’ anonymous responses. Rather than only identifying shortages and frustrations, they proposed collecting workforce data, organizing staff-listening processes, documenting resource gaps, building support among colleagues, and presenting practical recommendations to facility managers. 

At the network level, CHAG can help sustain this investment by supporting fellows to apply their learning within member institutions, promoting exchange across facilities, and exploring how leadership-development opportunities might reach more nurses and midwives over time. We look forward to seeing how these fellows will be leading changes within their institutions, with their colleagues, using the resources that they have available to address their unique priorities. 

Continuing this fellowship and other leadership initiatives can strengthen the pipeline of nursing and midwifery leaders across the network. That collaboration should connect leadership development with institutional action on the conditions that determine whether nurses and midwives can do their jobs well and remain in the workforce. 

The fellowship is not a solution to retention on its own. Leadership development cannot create funded positions, ensure safe staffing, repair equipment, improve remuneration, or reform national promotion and career-progression systems. It can equip fellows to identify problems, use evidence, engage colleagues and decision-makers, and lead change within their spheres of influence. 

Leadership needs an enabling system 

We can prepare a nurse or midwife to lead, but they still require authority, information, resources, or responsive management to put that leadership to use. Without the support of institutions and governments, leadership development risks asking individual nurses and midwives to solve structural problems that others have the mandate and resources to address. 

The Africa Health Workforce Agenda 2026–2035 makes the same point at continental scale. It calls for an integrated approach to plan, train, and retain the workforce, and is clear that training more professionals will not be enough unless health systems can employ, equitably distribute, support, and retain them. 

Every level of the system has a part to play. In our own facilities, that means listening to nurses and midwives regularly, backing the emerging leaders among them, and using staffing and workload data to deploy staff more safely. Across the CHAG network, it means continuing to invest in leadership, mentorship, and shared learning, and carrying what we hear from staff into our advocacy. But the decisions that most shape whether nurses and midwives stay rest with governments, regulators, and funders: financing posts and safe staffing, equipping facilities, and making pay, promotion, and support for rural service fair and reliable. 

The nurses and midwives we heard from already understand their responsibility and want to lead solutions. In their responses, they proposed staff audits, listening sessions, workload data, and written proposals to management. What they are asking is for the system to meet them halfway. Nurses and midwives should not have to choose between serving their communities and pursuing a safe, fulfilling professional life. If we want them to stay, we must do more than appeal to their dedication. We must invest in their leadership and build workplaces and systems worthy of it.