The Push and Pull Factors in the Retention of Health Workers in a District in Ghana

Augustine Adomah-Afari *

Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG13, Legon-Accra, Ghana.

Ebenezer Arkoh Ameyaw

Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG13, Legon-Accra, Ghana.

*Author to whom correspondence should be addressed.


Aim: To assess the push and pull factors associated with the retention of health workers in a district in Ghana.

Study Design: This study was an analytical cross-sectional study using quantitative methods in the collection of data.

Place and Duration of Study: Komenda-Edina-Eguafo-Abirem District of the Central Region of Ghana in October 2022.

Methodology: A structured self-administered questionnaire was used to obtain data from 282 health workers who were consecutively selected from various health facilities in the study.  The data collected was cleaned and analyzed using the statistical software STATA version 15. Descriptive statistics were presented in tables and graphs. A Chi-square test and multiple logistic regression analysis were used to assess the association between dependent and independent variables. The significance of association was set at P<0.05 at a 95% confidence interval.  

Results: Overall, 22.0% of the health workers intended to stay at their current organization. Logistic regression analysis predicted that age more than 35 years (AOR: 3.4, CI: 1.025 -11.283, P = .046) and sex - females (AOR: 0.56, CI: 0.016 - 0.223, P = .001) were significantly associated with retention. Institutional factors like lack of supervision of work (AOR: 0.508, CI: 0.176 – 1.472, P = .021), lack of in-service training (AOR:0.045, CI: 0.010 - 0.193, P = .001), inadequate management support (AOR: 0.288, CI: 0.109 – 0.764, P = .012), and poor career progression (AOR: 0.472, CI: 0.019 - 1.873, P = .028) significantly reduced the likelihood of staying. Community factors like the absence of family (AOR: 0.138, CI: 0.051 – 0.376, P = .001) and the absence of alternative jobs (AOR: 0.051, CI: 0.006 – 0.459, P = .008) also negatively predicted retention. 

Conclusion: Only a small proportion of health workers in the district intended to stay. Factors related to retention were predominantly organizational like career progression, management support, and incentives.

Keywords: Health facilities, health workers, Ghana, retention, retention of health workers, push factors, pull factors

How to Cite

Adomah-Afari , A., & Ameyaw, E. A. (2023). The Push and Pull Factors in the Retention of Health Workers in a District in Ghana. Asian Journal of Research in Medical and Pharmaceutical Sciences, 12(4), 104–121.


Szabo S, Nove A, Matthews Z, Bajracharya A, Dhillon I, Singh DR, Saares A, Campbell J. Health workforce demography: a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals. Hum. Resour. Health. 2020;18(1):1-10. DOI:

Yin C, He Q, Liu Y, Chen W, Gao Y. Inequality of public health and its role in spatial accessibility to medical facilities in China. Appl. Geogr. 2018;92(2018):50–62. DOI:

Munga MA, Mæstad O. Measuring inequalities in the distribution of health workers: The case of Tanzania. Hum. Resour. Health. 2009; 7(1):1-12. DOI:

World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva, Switzerland, World Health Organization, 2016a:64. Accessed 10 November 2022. Available:

Esu EB, Chibuzor M, Aquaisua E, Udoh E, Sam O, Okoroafor S, Ongom M, Effa E, Oyo-Ita A, Meremikwu M. Interventions for improving attraction and retention of health workers in rural and underserved areas: a systematic review of systematic reviews. J. Public Health (Oxf.). 2021;43(1):i54-i66. DOI:

Mohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC Fam. Pract. 2020;21(1):1-23. DOI:

Zhu A. Attraction and retention of rural primary health care workers in asia pacific region; 2017. In Pro Quest Dissertations and Theses. Accessed 12 October 2022. Available:

World Health Organization. Workload indicators of staffing need (WISN): Selected country implementation experiences. Geneva, Switzerland, World Health Organisation; 2016b.

Shemdoe A, Mbaruku G, Dillip A, Bradley S, William J, Wason D, Hildon ZJ. Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay?. Hum. Resour. Health. 2016;14(1):1-13. DOI:

Ministry of Health. Staffing norms for the health sector. Ministry of Health. Accra, Ghana: Ministry of Health; 2018.

Ministry of Health. Human resource policies and strategies for the health sector 2007-2011. Accra, Ghana: Ministry of Health; 2011.

Ghana News Agency. Health personnel in deprived communities to enjoy special package. Modern Ghana; 2004. Accessed 20 November 2022. Available:

Kwansah J, Dzodzomenyo M, Mutumba M, Asabir K, Koomson E, Gyakobo M, Agyei-Baffour P, Kruk ME, Snow RC. Policy talk: incentives for rural service among nurses in Ghana. Health Policy Plan. 2012;27(8): 669-676. DOI:

Ministry of Health. Holistic Assessment of the Health Sector Programme of Work 2017. Accra, Ghana: Ministry of Health; 2016.

Ghana Health Service. Human resource directorate annual report for 2017. Accra, Ghana: Ghana Heath Service; 2018.

Asamani JA, Amertil NP, Ismaila H, Akugri FA, Nabyonga-Orem J. The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana. Hum. Resour. Health. 2020;18(1): 1-6. DOI:

Snow RC, Asabir K, Mutumba M, Koomson E, Gyan K, Dzodzomenyo M, Kruk M, Kwansah J. Key factors leading to reduced recruitment and retention of health professionals in remote areas of Ghana: a qualitative study and proposed policy solutions. Hum. Resour. Health. 2011;9(1): 1-11. DOI:

Adzei FA, Atinga RA. Motivation and retention of health workers in Ghana's district hospitals: addressing the critical issues. J Health Organ Manag. 2012;26(4): 467-485. DOI:

Mbemba GI, Gagnon MP, Hamelin-Brabant L. Factors influencing recruitment and retention of healthcare workers in rural and remote areas in developed and developing countries: an overview. J. Public Health Africa. 2016;7(2),61-66 DOI:

Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle-and low-income countries: a literature review of attraction and retention. BMC Health Serv. Res. 2008; 8(19):1-10. DOI:

Araujo E, Maeda A. How to recruit and retain health workers in rural and remote areas in developing countries: a guidance note. HNP Discussion Papers, 78506; Accessed 9 October 2022. Available: 2013.

Alhassan RK, Nketiah-Amponsah E. Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana. Health Econ. Rev. 2016; 6(1):1-11 DOI:

Ghana Statistical Service (GSS). Ghana demographic and health survey. Accra, Ghana: GSS, GHS, ICF Macro; 2014a.

Komenda Edina Eguafo Abirem Health Directorate. Annual Health Report. Elmina, Ghana: Komenda Edina Eguafo Abirem District (KEEA); 2016.

Creswell JW, Clark VL. Designing and conducting mixed methods research. Sage publications; 2017.

Ghana Statistical Service. 2010 Population and housing census; District Analytical Report, Komenda-Edina-Eguafo-Abirem Municipal. Accra, Ghana: Ghana Statistical Service; 2014b.

Komenda Edina Eguafo Abirem District Assembly Assembly Profile. 2021. Accessed 21 November 2022. Available: (2021).

Yamane T. Statistics: An introductory analysis. New York: Harper and Row. 1967;2.

Yang K, Banamah A. Quota sampling as an alternative to probability sampling? An experimental study. Sociol. Res. Online. 2014;19(1):56-66. DOI:

Acharya AS, Prakash A, Saxena P, Nigam A. Sampling: Why and how of it. India J Med specialities. 2013;4(2):330-333. DOI:

Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. Am. J. Theor. Appl. Stat. 2016;5(1):1-4. DOI:

Kuper A, Lingard L, Levinson W. Critically appraising qualitative research. BMJ. 2008; 337(7671):687-689. Doi:

Heale R, Twycross A. Validity and reliability in quantitative studies. Evid Based Nurs. 2015;18(3):66-67. DOI:

Worku N, Feleke A, Debie A, Nigusie A. Magnitude of intention to leave and associated factors among health workers working at primary hospitals of North Gondar Zone, Northwest Ethiopia: mixed methods. Biomed Res. Int. 2019;2019(1): 1-9. DOI:

Bonenberger M, Aikins M, Akweongo P, Wyss K. The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Hum. Resour. Health. 2014;12(1):1-12.


Bhattacharya I, Ramachandran A. A path analysis study of retention of healthcare professionals in urban India using health information technology. Hum. Resour. Health. 2015;13(1):1-14. DOI:

Kim MK, Arsenault C, Atuyambe LM, Kruk ME. Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia. Int J Qual Health Care. 2021;33(3),1-9.


Behera M, Prutipinyo C, Sirichotiratana N, Viwatwongkasem C. Living conditions, work environment, and intention to stay among doctors working in rural areas of Odisha state, India. Ann. Trop. Med. Public Health. 2018;11(3):70-77. DOI:https://10.4103/ATMPH.ATMPH_338_17.

Belaid L, Dagenais C, Moha M, Ridde V. Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger. Hum. Resour. Health. 2017; 15(1):1-11. DOI:

Ferede A, Kibret GD, Million Y, Simeneh MM, Belay YA, Hailemariam D. Magnitude of turnover intention and associated factors among health professionals working in public health institutions of North Shoa Zone, Amhara Region, Ethiopia. Biomed Res. Int. 2018; 2018(1):1-9. DOI:

Manafa O, McAuliffe E, Maseko F, Bowie C, MacLachlan M, Normand C. Retention of health workers in Malawi: perspectives of health workers and district management. Hum. Resour. Health. 2009;7(1):1-9. DOI:

Liu J, Yang J, Liu Y, Yang Y, Zhang H. The use of Career Growth Scale in Chinese nurses: Validity and reliability. Int. J. Nurs. Sci. 2015;2(1):80-85. DOI:

Moran AM, Coyle J, Pope R, Boxall D, Nancarrow SA, Young J. Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes. Hum. Resour. Health. 2014; 12(1):1-30. DOI:

Honda A, Krucien N, Ryan M, Diouf IS, Salla M, Nagai M, Fujita N. For more than money: willingness of health professionals to stay in remot Senegal. Hum. Resour. Health. 2019; 17(1):1-11. DOI:

Darkwa EK, Newman M, Kawkab M, Chowdhury ME. A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Hum. Resour. Health. 2015;15(1):1-12. DOI:

Ghana Health Service (GHS). Policy on study leave with Pay. Accra, Ghana: Ghana Health Service; 2021.

Roth C, Wensing M, Breckner A, Mahler C, Krug K, Berger S. Keeping nurses in nursing: a qualitative study of German nurses’ perceptions of push and pull factors to leave or stay in the profession. BMC Nurs. 2022;21(48):1-11. DOI:

Yahere IE, Adeboye M. An evaluation of push and pull factors associated with the emigration of medical consultants from Nigeria: factors associated with medical consultants’ emigration from Nigeria. Niger J Med. 2023; 64(1): 104–114. Accessed 27 October 2023 Available: