Challenges of Job Rotation as a Measure of Improving Productivity in the Health Sector in Ghana Volume 63- Issue 2

Anthony Kwame Apedzi*

• St John Ambulance, Ghana

Received: August 22, 2025; Published: September 10, 2025

*Corresponding author: Anthony Kwame Apedzi, St John Ambulance, Ghana

DOI: 10.26717/BJSTR.2025.63.009861

Abstract PDF

Introduction: This study investigates the challenges and prospects of job rotation as a strategic tool for enhancing productivity in Ghana’s health sector. Job rotation, though recognised for its potential to improve employee motivation, broaden skills, and reduce workplace monotony, remains inconsistently applied across health institutions in Ghana.
Methodology: Adopting a qualitative research design, the study engaged health professionals, administrators, and policymakers through interviews, focus group discussions, and document reviews.
Findings: Findings reveal that while job rotation is practiced in some institutions, it is often unstructured and unsupported by formal policy frameworks. Key challenges include inadequate orientation, limited training, resistance from staff, and lack of performance tracking mechanisms. The study also highlights the mixed perceptions of healthcare workers—some acknowledging its benefits, others citing relocation stress and role confusion.
Conclusion: Despite these challenges, structured and well-communicated job rotation programmes, when aligned with performance appraisal systems, can contribute significantly to organizational effectiveness. Recommendation: The study recommends policy development, stakeholder engagement, and training as critical steps toward successful implementation.

Job rotation is a systematic practice in which employees are periodically assigned to different positions within an organisation. This is considered as a potential measure to improve productivity in Ghana’s health sector. This approach is intended to enhance employee skills, reduce burnout, and foster a comprehensive understanding of various roles within healthcare settings. Job rotation forms part of job redesign where regular or routine work is changed for some time or permanently. Despite the benefits of job rotation, the implementation in Ghana faces notable challenges that undermine its effectiveness, including inequitable distribution of health workers, employee resistance, and a lack of ongoing professional support (Gami, et al. [1,2]). One significant challenge is the uneven distribution of healthcare personnel across regions, which results in inefficiencies and resource wastage. Studies indicate that up to 65% of Ghana’s health facilities operate at a technical inefficiency level, leading to unnecessary expenditure on staffing in areas with critical shortages compared to those with surpluses. This disparity poses a significant barrier to job rotation, as many health workers resist relocation from preferred positions, exacerbating existing workforce inequalities and impacting service delivery (Vulpen, et al. [3,4]). Moreover, the high dropout rates from health training programmes contribute to workforce instability, further complicating job rotation efforts.

As health professionals pursue better opportunities abroad, the sector grapples with gaps that job rotation cannot address effectively (Middlesworth Mark, et al. [4,5]). The government’s initiatives to enhance the health workforce face hurdles such as insufficient funding and inadequate training facilities, limiting the potential for successful job rotation strategies to improve overall healthcare outcomes (Asamani A J, et al. [5]). Overall, while job rotation holds promise for addressing productivity challenges in Ghana’s health sector, the complexities of its implementation necessitate comprehensive strategies and collaborative efforts among stakeholders to overcome existing barriers and enhance workforce stability (Gami Pankit, et al. [1,3,4]).

Job rotation is a systematic approach in which employees are periodically assigned to different positions within an organization. This practice allows workers to engage in various job roles, gaining exposure to multiple functions, responsibilities, and departments over a pre-determined period. The main objectives of job rotation include enhancing employee skills, preventing burnout through variety, and promoting a deeper understanding of how various parts of the organization fit together (Gami Pankit, et al. [1,2]).

Purpose and Benefits of Job Rotation

The effective implementation of a job rotation programme can lead to significant benefits for both employees and employers. For employees, rotating roles provide opportunities for skill development and knowledge acquisition, thereby enriching their professional toolkit and enhancing their adaptability in a fast-paced business environment (Gami Pankit, et al. [1,2]). This variety not only keeps employees engaged and motivated but also reduces the monotony that can lead to burnout [6]. From an employer’s perspective, job rotation fosters a flexible workforce capable of tackling diverse tasks. This adaptability is particularly valuable in the dynamic landscape of the health sector in Ghana, where a versatile team can respond effectively to changing demands and challenges (Gami Pankit, et al. [1,7]). Furthermore, job rotation can facilitate better monitoring and feedback, ensuring employees receive guidance that enhances their performance in new roles.

Implementation Considerations

When implementing a job rotation programme, organizations should carefully identify which jobs are suitable for rotation. This process typically involves consulting with management, supervisors, and employees to determine roles that present different ergonomic stressors and are appropriate for rotational shifts. Moreover, establishing a rotation schedule that minimizes the risk of physical strain on employees is critical. Acceptable rotations involve switching between jobs with different ergonomic demands, while avoiding rotations that may result in similar physical stresses (Ghana Healthcare Workforce Planning [8]).

Objectives of the Studies

The objectives of the Study Can be Summarized as Follows: • To explore the concept and purpose of job rotations as a strategic tool for improving productivity in Ghana’s health sector.

• To identify the benefits that job rotation offers to both employees and employers, particularly in terms of skills development, burnout prevention, and enhanced understanding of organizational roles.

• To examine the challenges and limitations associated with implementing job rotation in the Ghanaian health sector, including workforce distribution, resistance to relocation, and lack of training support.

• To analyse case studies and existing practices (e.g., nurse rotations, performance appraisal systems, CHPS initiative) to assess the real-world effectiveness and shortcomings of job rotation strategies.

• To recommend best practices and policy measures that could improve the implementation and outcomes of job rotation programs in the health sector, with a focus on stakeholder engagement, monitoring, and fair distribution of resources.

Research Questions

What are the challenges and benefits of implementing job rotation as a strategy to improve productivity in the health sector in Ghana?

Sub Questions of the Study Were:

• What are the main objectives of job rotation in the health sector?

• How does job rotation impact staff motivation, skill development, and service delivery?

• What are the barriers to effective job rotation among healthcare professionals in Ghana?

• How do health institutions implement and monitor job rotation practices?

• What strategies can be adopted to overcome the challenges of job rotation in the sector?

Research Design

The study adopted a qualitative research design to gain in-depth insight into the implementation, benefits, and challenges of job rotation in Ghana’s health sector. This design allows for the exploration of perceptions, experiences, and practices of healthcare professionals and administrators.

Study Area

The research is conducted within selected health facilities in Ghana, focusing on institutions known to implement or have considered job rotation strategies (e.g., teaching hospital, regional or secondary level hospitals, and CHPS compounds).

Target Population

The population included:

o Health sector workers (nurses, medical officers, administrative staff)

o Human Resource Managers

o Facility heads and directors

o Policymakers at the Ministry of Health or Ghana Health Service Sampling Technique

A purposive sampling method was used to select participants who were directly involved in or affected by job rotation policies. This ensured the collection of relevant and rich data.

Sample Size

Forty-two (42) participants were selected, including both management- level staff and operational-level healthcare workers, to ensure balanced perspectives.

Data Collection Methods

1. Interviews: Semi-structured interviews with HR personnel and facility managers.

2. Focus Group Discussions (FGDs): With groups of nurses, doctors, and administrative staff.

3. Document Review: Analysis of existing policy documents, rotation records, and performance reports.

Data Analysis

The data generated was analysed using thematic analysis. The responses were coded and categorized under key themes such as benefits, challenges, resistance, training needs, and policy support.

Ethical Considerations

o Informed consent was obtained from all participants.

o Participants’ confidentiality and anonymity were maintained.

Job rotation in Ghana’s health sector faces several challenges that hinder its effectiveness in improving productivity and addressing workforce disparities. One major issue is the inequitable distribution of health workers across regions, which exacerbates existing inefficiencies within the healthcare system. Studies have shown that a significant portion of Ghana’s health facilities are technically inefficient, with estimates indicating that up to 65% of health facilities use more resources than necessary for their output, leading to substantial financial waste (Vulpen van Eric [3]). This situation is compounded by a workforce that is unevenly spread, with some areas experiencing staff surpluses while others face critical shortages. The financial implications of this uneven distribution are profound. For instance, it has been noted that up to 28% of the staffing expenditure is allocated to areas deemed to have an inequitable distribution of workers, suggesting that a redistribution of health personnel could lead to significant savings and more effective resource use (Vulpen van Eric [3]). However, implementing such changes through job rotation is challenging due to resistance from health workers and professional organisations who may oppose transferring personnel from their preferred locations or specialities. Moreover, the high dropout rates from health training programmes further complicate the issue. A lack of ongoing support and professional development can lead to increased turnover intentions among health workers, as many seek better opportunities elsewhere, thereby undermining efforts to stabilise the workforce [4].

The absence of a robust strategy to address these migration challenges complicates the implementation of job rotation, as many health professionals may leave the country for better prospects, leaving gaps that job rotation cannot fill. Additionally, the government’s collaborative approach to enhancing the health workforce, while well-intentioned, has seen limited progress due to systemic issues within the health sector, including insufficient funding and inadequate training facilities (Asamani AJ, et al. [5]). This creates a scenario where job rotation is not only a logistical challenge but also a strategic one, as it requires a comprehensive understanding of the healthcare needs across different regions and effective stakeholder engagement to ensure that any movement of personnel aligns with broader health system goals.

Qualitative Exploratory Study on Newly Qualified Nurses A qualitative exploratory study was conducted to investigate the experiences and challenges faced by newly qualified nurses during their one-year clinical rotation programme in Ghana. The research utilised a combination of semi-structured individual interviews and focus group discussions (FGDs) to gather data from twenty newly qualified nurses and midwives across two secondary and one tertiary health facility in the Volta Region (Adatara Peter, et al. [9]). The study aimed to understand the practical workings of the postings and transfers process, decision-making factors by staff and district managers, and personal experiences regarding postings and study leave (Kwamie Aku, et al. [10]). The semi-structured interview guides were developed based on a review of the human resources for health literature, which informed the questions directed towards understanding the complexities of job rotations within healthcare settings. Each interview lasted between 45 and 60 minutes, providing a detailed insight into the participants’ experiences (Adatara Peter, et al. [9]).

Performance Appraisal Systems in Health Facilities

Another case study involved the implementation of behaviour checklists and 360-degree performance appraisal systems in health facilities, aimed at enhancing employee productivity and job satisfaction. The research highlighted that effective performance appraisals can lead to significant outcomes, including improved employee trust and commitment. Howeve, these benefits were challenged by issues such as poor communication, high commitment to standards, and socio-cultural variables (Lumor Dora [11]). Recommendations from the study included adopting transparent management systems and online-based performance appraisals to address the shortcomings observed in traditional methods. By doing so, the health sector could enhance its performance and meet its organisational goals more effectively (Asamoah-Atakorah, Shadrach, et al. [12]).

Community Health Planning and Services (CHPS) Initiative

The Community Health Planning and Services (CHPS) initiative in Ghana is an example of a strategic approach to enhance health service delivery through community involvement. Launched in the early 2000s, CHPS focused on integrating health services into district planning and promoting community care, which has been instrumental in addressing healthcare delivery challenges (Asamani A J, et al [5]). This programme encourages collaboration with traditional community leaders, which is vital for the sustainability of health initiatives. By establishing health compounds and engaging community members, CHPS aims to improve health outcomes and address the challenges faced by health workers, including those related to job rotation and postings (Obeng Asare Hayford, et al. [13]). These case studies collectively underscore the complexities and challenges associated with job rotation in the health sector, highlighting the need for effective management strategies to enhance productivity and employee satisfaction.

To effectively implement job rotation in Ghana’s health sector, organisations should adhere to several best practices and strategies that can help maximise benefits while minimising potential challenges.

Establish Clear Guidelines

Creating detailed guidelines for both managers and employees is essential for successful job rotation programmes. These guidelines should set clear expectations, define roles, and outline the rotation process. Effective communication of these guidelines is crucial to ensure that all staff members understand their responsibilities and the objectives of the rotation programme (Techy Las, et al. [14,9]).

Design a Strategic Rotation Path

A well-thought-out rotation path is vital for ensuring that employees gain a diverse set of skills and experiences. Organisations should consider the specific skills and competencies required for various roles within the healthcare system. By strategically aligning rotations with the career development needs of employees, organisations can enhance job satisfaction and employee performance while fostering a more versatile workforce (Asamani A J, et al. [5,9]).

Monitor and Evaluate Performance

Continuous monitoring and evaluation of employee performance during and after the rotation process are essential. By using performance appraisal systems, organisations can identify strengths and weaknesses, allowing for targeted development opportunities. This feedback loop not only aids in employee growth but also ensures that the organisation’s overall performance aligns with its strategic objectives (Asamoah-Atakorah Shadrach, et al. ([12,11]). The agencies under the Ministry of Health can employ such practices to monitor performance under job rotation.

The implementation of job rotation as a strategy to enhance productivity in the health sector in Ghana has been met with varied responses and results across different contexts. Studies have shown that both public and private health organisations employ performance appraisal systems to motivate and train employees, indicating a shared recognition of the importance of employee development in improving service delivery (Asamoah-Atakorah Shadrach, et al. [12,11]). However, the effectiveness and reception of job rotation can differ significantly between these sectors.

Public vs. Private Sector

Public health institutions often face unique challenges that may hinder the effectiveness of job rotation. For example, employees in these organisations may exhibit resistance to change due to job security concerns and attachment to established roles, which can impact overall morale and productivity (CHRMP [15]). This is compounded by the bureaucratic structures prevalent in many public institutions, which may limit the flexibility needed for effective job rotation programmes. In contrast, private health organisations typically operate with greater agility, allowing for a more seamless integration of job rotation initiatives. Employees in these settings may be more open to the concept as it aligns with a culture of continuous improvement and skills development (Carin Vreede [2]). The ability to adapt to new roles can be seen as an opportunity for career growth rather than a disruption, fostering a more positive attitude towards job rotation.

Ghana Civil Service

Ghana Civil Service has a policy of transfer within the service every four years for all categories of staff. It is a concept of Job Rotation which aims at using experience gained in the current place of work for another Ministry or department. At times, transfers are done when there is a vacancy in a different department. The civil service implements this policy religiously across all the Ministries, Departments and the local government agencies. This cures boredom and increases productivity at the new place of work. It is also not permanent as the hope holder will be transferred again in the next four years. Every newly recruited employee of the Civil Service is made aware of job rotation during orientation. At times, it is written boldly in their appointment letters.

Employee Development and Satisfaction

Research indicates that job rotation can enhance employee engagement and reduce monotony, which is particularly critical in highstress environments like healthcare (Andreev Ivan [16]). By rotating staff through various roles, organisations can prevent burnout and improve job satisfaction. This strategy not only helps employees acquire new skills but also provides management with better insights into individual strengths and capabilities, allowing for more effective workforce planning (Asamani A J, et al. [5]). However, the effectiveness of job rotation in achieving these outcomes largely depends on the implementation strategies employed. Organisations therefore, must set clear objectives and ensure that employees are adequately trained to transition between roles without a significant dip in productivity [16]. Inadequate training can lead to temporary declines in performance, particularly if employees struggle to adapt to new responsibilities (CHRMP [15]).

Findings

The findings of the study are summarised as follows: 1. Job Rotation is Practised but Informally Structured: Many participants do not understand why they should be transferred to other departments of other facilities. Others see it as a punishment from superiors

2. Mixed Perceptions Among Staff: Health workers have divided opinions about job rotation. Some view it as an opportunity for skills development and reducing monotony, while others perceive it as disruptive, especially when relocated to unfamiliar or rural environments without adequate support.

3. Productivity Impact is Context-Dependent: In some cases, job rotation was seen to improve performance by broadening competencies and improving teamwork. However, in other instances, it caused stress, reduced morale, and adaptation difficulties, especially when rotations were sudden or poorly communicated.

4. Lack of Orientation and Training: A major challenge is the absence of pre-rotation training or orientation, which results in inefficiencies and confusion, particularly when staff are rotated into unfamiliar units or departments.

5. Performance Appraisal Systems are Inadequate: Though some appraisal tools (e.g., Open Appraisal Reports) are in place, they are not always linked to rotation outcomes, limiting their usefulness in evaluating how job rotation affects individual or team performance.

6. Policy Gaps and Implementation Challenges: There seems to be a lack of a clear national policy guiding job rotation in the health sector. The Ghana Health Service always take the lead in policy formulation to improve service delivery for other agencies to follow. But the implementation is left to the discretion of institutional, regional or district heads in the name of decentralisation, leading to inconsistencies and, in some cases, perceived favouritism or bias.

7. CHPS System Shows Promise but Needs Improvement: The CHPS (Community-based Health Planning and Services) model offers a good example of structured job rotation, but it faces resource constraints, supervision challenges, and community acceptance issues that affect its effectiveness.

The study concludes that while job rotation holds significant potential to enhance productivity, motivation, and skills development in Ghana’s health sector, its current implementation is inconsistent and fraught with challenges. The absence of a structured national policy framework, limited training and orientation for rotated staff, and a lack of monitoring and evaluation mechanisms undermine the effectiveness of job rotation programmes. Although some agencies or institutions practice rotation with perceived benefits such as breaking monotony, promoting teamwork, and diversifying experience, many healthcare workers view it with apprehension due to relocation stress, poor communication, and inadequate preparation. Performance appraisal systems, when linked with rotation, can serve as useful tools to assess their impact, but in most cases, such systems are underutilised. Overall, job rotation can be a valuable human resource management strategy in the health sector, but its success depends on deliberate planning, stakeholder engagement, training support, and transparent implementation.

To address the challenges associated with job rotation as a measure of improving productivity in the health sector in Ghana, several key recommendations can be proposed. These recommendations aim to enhance the effectiveness of job rotation practices while ensuring the overall improvement of healthcare delivery.

Fair Distribution of Healthcare Workers

One of the primary recommendations is to ensure a fairer distribution of medical workers across different regions and facilities. This strategy can alleviate the issues arising from the adverse effects of migration and uneven distribution of healthcare personnel, which significantly impact service delivery quality and accessibility (Asamani A J, et al. [5,17]). Engaging stakeholders, including policymakers, international donors, and health workers themselves, is crucial for formulating policies that safeguard the rights of migrant health workers and eliminate unnecessary barriers to mobility and practice (Asamani A J, et al. [5]).

Comprehensive Training Programmes

Implementing comprehensive training programs is vital for both healthcare workers and management personnel. These programmes should focus on performance appraisal processes and job rotation methodologies, helping staff understand the importance and benefits of such practices (Lumor Dora, et al. [11,12]). Training initiatives should also emphasise the development of skills necessary for adapting to various roles and responsibilities within the healthcare system, thereby enhancing employee motivation and overall job satisfaction (Appiah Daniel [6]).

Establishment of Clear Policies and Frameworks

Governments and health sector leaders must establish clear policies and frameworks that streamline existing human resource management practices. This includes designing a generic policy framework that respects the autonomy of healthcare managers while facilitating effective job rotation practices [18]. By doing so, healthcare agencies can ensure that competent workers are retained, regardless of political changes, thereby fostering continuity and stability within the workforce (Schenck-Yglesias, et al. [17,10]). Monitoring and Evaluation of Job Rotation Effectiveness Regular monitoring and evaluation of job rotation practices should be instituted to assess their effectiveness in improving productivity and employee morale. This process should involve collecting qualitative and quantitative data from healthcare workers and managers to inform policy adjustments and training needs (Adatara Peter, et al. [9,12]). By engaging in ongoing assessment, healthcare organisations can identify best practices and areas for improvement, ensuring that job rotation initiatives lead to meaningful outcomes (Appiah Daniel [6]).

Stakeholder Engagement and Collaboration

Finally, fostering collaboration among various stakeholders, including healthcare providers, policymakers, and community leaders, is essential for the successful implementation of job rotation initiatives. By establishing strong communication channels and partnership agreements, stakeholders can work together to create a supportive environment that encourages innovative practices aimed at enhancing productivity in the health sector (Asamani A J, et al. [5,11]). By implementing these recommendations, the health sector in Ghana can effectively utilise job rotation as a tool to improve productivity, ultimately leading to better healthcare outcomes for the population.

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