Midwifery personnel are a critical group of maternal healthcare providers. Even though there is evidence of shortage of healthcare personnel globally, there is no universal measure of the shortage [
41]. A yardstick often used to plan midwifery workforce is 6 midwives per 1,000 births in a year [
42]. The 2011
State of the World’s Midwifery report estimated Ghana’s midwife to population ratio to be 5 per 1000 live births [
42], which is close to the WHO’s recommendation. While this ratio compares favourably with some developing countries, and almost meets the WHO’s recommended target for midwifery personnel per population, it must be viewed in the context of the country’s particular circumstances. According to the 2014
State of the World’s Midwifery report, due to the ageing population of midwives in Ghana, the country is expecting high workforce losses in a the next 10 years, further depleting the midwifery population [
43]. Unfortunately, published data on the current age distribution and specific rates of exit from the workforce is not available. Statistics on workforce availability in 2012 showed that, the sexual, reproductive, maternal and newborn healthcare in Ghana was only 30 % of what is required [
43]. The 2012 graduates account for nearly a quarter of the 2014 midwifery workforce, a trend, if maintained, that could significantly increase women’s access to midwifery services. Comparatively, the 2011 and 2014
State of the World’s Midwifery reports show a general increase in the total numbers of maternal health staff in Ghana. The number of midwifery personnel has increased from 3,780 to 4,185 with an additional 273 nurses who spend 80 % of their working time on maternal and neonatal services [
42,
43]. Midwives provide the majority of skilled maternity care services in Ghana and any discussion of maternal health workforce must consider recruitment, retention and equitable distribution of midwives. Factors such as poor remuneration, lack of incentives, inadequate resources and lack of social amenities inhibit the recruitment and retention of midwifery and other health staff in rural areas, where services are most needed [
44‐
46]. Many developing countries have experienced significant losses of skilled health workforce, including midwives, to high-income countries [
47]. In 2009, it was reported that over 24 % of nursing and midwifery personnel trained in Ghana were working abroad [
48]. In response to the shortage of midwifery personnel, the government of Ghana has upgraded midwifery training schools and introduced direct-entry midwifery training programmes at the diploma level in 2007 [
49] and as Bachelor of Science in 2011 [
42]. A third entry pathway is the 2-year post-basic midwifery programme, leading to a diploma, targeted at community health nurses and health assistants from underserved communities, which may help increase the number of midwives in remote areas, due to the shorter duration of training [
50]. The impact of the country’s investment in expanding the health workforce needs to be measured to guide further action on current and future needs. However, despite the government’s efforts, there are challenges in retaining these key personnel in remote/rural areas and these challenges need to be addressed to improve retention [
46,
51].
Historically, the country’s healthcare efforts have been reactionary to emergency or advancing healthcare system problems rather than being proactive in preventing such problems. For example, major increases in training of professional midwifery personnel were not pursued, until their numbers dipped significantly, despite the known effects of economic migration and advancing age of existing personnel. Such reactionary measures create conditions where problems become deep-rooted and use of short-term strategies make them more costly and time-consuming to resolve. Targeted investments need to be consistently made in human resources planning and training for the maternal health sector. Ultimately, a more cost-effective and sustainable approach is to invest in standardised midwifery training which equips personnel with the minimum competencies required to provide emergency obstetric care [
43]. Policymakers also need to consider relevant health-worker needs when developing guidelines to improve retention of key personnel, particularly in remote areas [
46,
51].