Exploring the gendered dimensions of health workforce (HWF) retention challenges and transformative solutions in three deprived districts of Ghana: An exploratory qualitative study

The HWF is central for Universal Health Coverage (UHC), but the retention crisis threatens progress. Women comprise 70% of HWFs, facing unique challenges. Gender transformative action is needed, but there are knowledge gaps, especially in low-resource settings. Ghana faces a HWF crisis in deprived, remote areas. A project piloting retention interventions in deprived districts highlighted gendered dimensions. This study sought to elucidate the gendered HWF challenges and make gender transformative recommendations. This qualitative study embedded an intersectional approach. Thirty-six (36) key informant interviews (KIIs) were conducted to explore retention challenges, current policies/activities and recommendations. Respondents were purposively selected for cadre and gender. Intersectional gender analysis was conducted using the framework analysis approach and Morgan’s gender framework. Women health workers (HWs) account for most of the deprived district HWF, with the small number of men assigned to more remote districts in island communities, due to perceived resilience to scarce amenities. There was a shortage of HWs in deprived districts, and retention was low, due to women’s unique challenges - primarily family responsibilities. Women juggled difficult working conditions with singlehanded childcare and responsibility for maintaining relationships, hindered by poor communication networks and transport, including unsafe/expensive motorbike journeys and boat crossing fears. Inadequate salaries, high accommodation costs and inability to conduct locum work caused financial stress, with safety and security concerns (e.g., sexual harassment, motorbike accidents and robberies) also common. Current policies are gender-blind; recommendations include tailoring incentives to women with childcaring responsibilities, improving accommodation, security, community support and sexual harassment policy/awareness. • Ghana’s retention crisis threatens UHC progress • Globally, women dominate workforces, but evidence gaps hinder tailored solutions • Women dominate deprived districts, attrition is high, and policies are not tailored • Family, safety/security, transport and financial challenges are driving attrition • Incentives must be tailored, and issues like sexual harassment must be addressed