Surviving without allowance: The ordeal of over 5000 allied health interns and rotational nurses

About 5, 239 health interns are still restless and doubtful although the Ministry of Finance has given the green light for their mandatory internship allowance to be paid.

A letter signed by a Deputy Minister for Finance, Abena Osei-Asare, on September 19, 2022, “granted approval” to the Ministry of Health to permit the Controller and Accountant-General’s Department to pay the allowances of the 2021/2022 rotational nurses, midwives and allied health interns.

Although the letter indicates that the “emoluments of the interns should be charged against the Compensation of Employees Vote of the Ministry of Health in the 2022 Annual Estimates,” it does not specify exactly when the health interns will start receiving their allowances.

A rotational nurse, Daniel Kwasi Agyei, told The Fourth Estate that the words of the ministries of Health and Finance were like pillars built with straw to him now.

“If I’m to tell you the truth, even if they call me today to tell me they are going to release it, I will never believe it,” he stated emphatically.

Daniel’s absolute loss of faith in the ministries is because the ministries had given countless assurances in the past but failed to deliver.

Daniel has been working as a rotational nurse since December 2021 at the Ahafo Ano North Municipal Hospital in Tepa in the Ashanti Region, but he is yet to receive his allowance.

A few months into his internship, he was cut off from enjoying the utilities in his rented apartment because he could not pay his bills. Although there is access to tap water on the compound, Daniel told The Fourth Estate that, he treked to fetch water.

“As I said, today I couldn’t go to work. I have no option. Yesterday I walked. Last Monday I walked. Today too I have to walk. I’m tired!” Daniel’s voice broke as he sobbed while recounting his ordeal.

He told The Fourth Estate that if he missed a day’s work, his supervisor would add a week’s work to his routine without recourse to his plight.

“They say that is the system and they don’t care,” Daniel said.

This was the plight throughout the one-year mandatory internship of the Allied Health Interns. Unlike their colleague nurses and midwives, they have completed their internship but are yet to receive their rotation allowance.

An allied health intern, Precious Takyi (not her real name), who is also six months pregnant, says she relied on her younger sister and God to complete the mandatory internship.

“I have been taking money from my kid sister. I am 32. She is 25. She stays in Kumasi and is into petty trading. So, she has been the one supporting me. Other than that, it has been God’s intervention.”

Precious completed the Duayaw Nkwanta Saint John’s of God College of Health in 2018. During her time in the school and the internship, her most reliable source of income was an occasional GHS100 she got from singing gigs with a band.

But opportunities do not always come in handy for her band.

“For about two months now, I just went for a programme yesterday. It can be three months and there will not be any programme,” she told The Fourth Estate.

Precious lost her mother three years ago. Her father is dependent. She, therefore, had to borrow GHS 2,000 to be able to secure accommodation in Sunyani to complete her mandatory internship. She pays GHS200 interest on the principal amount every month.

As a pregnant woman, Precious’ precarious financial situation makes it impossible to eat nutritious foods as recommended by the doctor.

“Even today, at the lab, they told me I have protein trails in my urine so I have to eat a lot of fruits, but where is the money to buy the fruits?  Whatever I get, I eat. Even banku and hot pepper, I just grind it and eat. So, I can’t get the nutrition for the child,” she narrated.

According to the Allied Health interns, they were expected to pay GHS300 by September 9 for their license exams in October 2022. Failure to sit this exam means one cannot practise as a professional.

Precious, who owes GHS3,000 school fees, was anxious about how she would settle this amount when she spoke with The Fourth Estate. But she got GHS200 from a gig and borrowed GHS100 to be able to pay for the license fees.

Jacob Addai, an Allied Health intern from Aputuogya in the Ashanti Region, is in the same situation as his other colleagues. His parents are at loggerheads with him because they do not believe his claims of non-payment of his allowance.

Jacob lived 45 minutes away from the Amansie South District Assembly in Edubia, a three-hour drive from his hometown. Vehicles shunned the road he used to work so he relies on commercial motorbikes that charge GHS14 to and from work.

To survive as an intern, he sometimes eats once a day. At other times, when things get worse, he goes back to Aputuogya for food relief.

“It takes a toll on you and you cry within you knowing that everyone around you thinks you are okay,” he told The Fourth Estate.

Jacob, who completed the Tamale School of Hygiene, says his financial situation prevented him from completing most of the tasks he had to accomplish to become a better environmental health officer.

For Patience, a more critical issue pecked her mind. The uncertainty of being employed anytime soon is her deepest worry. The Medical Laboratory Scientist says this leaves her future in limbo.

Patience, a native of Kintampo, where the College of Health and Well-being is located, had to relocate to Breman in the Ashanti Region to undertake her mandatory internship.

Luckily, her parents support her with Ghc100.00 intermittently, expecting such an amount to last for at least two weeks.

“I’m a lady. I do menstruate. I need to get stuff for myself. How do I manage that GHC100.00 to get all of this stuff? It is very pathetic,” she lamented.

In August 2022, the last month of her service, she trekked to the Breman SDA hospital every time she was on duty. The journey, which takes about 30 minutes, leaves her sweaty and tired whenever she got to work.

Patience told The Fourth Estate that she got anxious for her safety whenever she worked the afternoon shifts. This is because if it rained or the one on the night shift delayed, she had to walk home alone at night.

Using a strike action as an excuse, she absented herself for a month during her internship period because she couldn’t feed herself.

“Working on an empty stomach is a threat to the patient. It got to a time when I went to work and didn’t feel like working. I wasn’t sick or anything, I just didn’t have the zeal to work,” she recounted.

Patience thinks her situation persists because there is no association that speaks for her and her colleagues under the Allied Health Professions Council, unlike the nurses, who are regulated by the Nursing and Midwifery Council.

Normalizing Trauma

A month after the students started their internship in September 2021, the National Health Students Association of Ghana (NHSAG), petitioned the Minister for Health, Kwaku Agyemang-Manu, to expedite the release of their allowance.

They thought this action was crucial because the delay of their allowances had, to them, become part of the numerous perennial problems the country is saddled with.

The Vice President of NHSAG, Balom Rahim Maasubee, told The Fourth Estate that they didn’t expect to receive their allowance until, at least, four or five months into their National Service.

Regardless, the executives of the association had pleaded and sent numerous letters to the ministries of Health and Finance and the human resource departments of the various health facilities. These efforts have yielded no results.

On July 19, 2022, the leadership of NHSAG met with the Deputy Minister of Finance, Abena Osei-Asare, to enquire about their delayed allowance. They were told the documents the Ministry of Health was supposed to send for the payments to be processed had not reached the ministry.

However, the Ministry of Health had told them that every required document had been sent to the Ministry of Finance in October 2021 for the process to begin.

Even though the Ministry of Finance has released a statement that may kickstart the process for the interns to receive their GHS817 monthly allowance, there is a long way to go before they receive their allowance if the usual pattern is to be followed.

Usually, all the important steps begin after the Ministry of Finance releases a financial clearance for all the interns.

Afterward, the interns fill out forms at their respective health facilities and attach them to their financial clearance. This is then sent to the Ministry of Health. The Ministry processes the forms and gives each student a staff ID. After the students have received their IDs, their biometric details are captured and sent to the Controller and Accountant General’s Department for payments to be made. According to the vice president of NHSAG, but for the statement, nothing in this process has been tackled.

The Fourth Estate understands that although a press statement has been released, the interns have not received any prompt from the various human resource departments of the health facilities they interned in.

According to the interns, they are rather encouraged by the HR officers to ask whether their colleagues in other institutions have received their clearance letters yet.

Efforts by The Fourth Estate to get the Deputy Minister of Finance to confirm whether her ministry has received all the required documents from the Ministry of Health proved futile. After numerous attempts to reach her, she directed The Fourth Estate to the Ministry of Health when asked if her outfit had received all the necessary documents to make the payment of the allowances seamless.

Sources at the Ministry of Health will not speak on record but indicated that they had completed their duties in the process. A request for an interview was sent to the Minister of Health on September 12, 2022, but there hasn’t been any determination on it.

When the Registrar of the Allied Health Professionals Council, Dr. Samuel Yaw Opoku, was contacted, he admitted having knowledge about the plight of the interns. He however said it was not the mandate of the council to settle the allowance of the interns.

“It is rather the responsibility of the council to ensure that the interns meet the required criteria to start their internship,” he indicated.

When asked whether his outfit had provided all the needed documents for the Ministry of Health to be forwarded to the Ministry of Finance, he emphasized that they did not have “any outstanding” issue with documentation.

“The documentation that we need to provide to the Ministry is to compile the list of the eligible people for the Ministry. So, the human resource division of the Ministry of Health handles the rest of it. If that wasn’t done, they won’t be doing the internship,” he noted.

Although he doesn’t know why the allowances have not been paid, he thinks “the buck stops” with the Ministry of Finance.

The vice president of NHSAG, Balom Rahim Maasubee, said the allowance payment process, which often took close to four months after the release of clearance forms, had been “deteriorating since the New Patriotic Party administration assumed office.

He added that there had “never” been a year in which Health Interns have completed their internship without receiving at least a month’s allowance.

The writer of this report, Edmund Agyemang Boateng, is a Fellow of the Next Generation Investigative Journalism Fellowship at the Media Foundation for West Africa.