Low Pension Benefits- The Overarching Issue of Agitations by Doctors and Nurses in Greater Accra Region, Ghana 2005-2015

This research assessed pension factor in doctors and nurses’ agitations and the role of the new pension scheme in addressing that challenges in Ghana. Due to the deficiencies in the old pension schemes which led to the call for pension reforms and better motivational packages, the introduction of the new pension scheme is therefore expected to induce employees’ satisfaction and motivate workers in general. The aim of the research was to investigate the underlining causes of strikes actions embarked upon by public sector doctors and nurses in the Greater Accra Region between from 2005 to 2015. That period saw several agitations by health workers which made government established two pay policies, namely: The Health; the Sector Salary Structure (HSS) and the Single Spine Salary Pay Policy (SSPP). This research adds to scanty published literature and other sources, which ascertained the actual causes of these health workers agitations and the role of the new pension scheme in Ghana. The investigators used in-depth interviews and a mixed method made up of quantitative and focus group discussions (FGDs). The number of professional nurses and doctors in Greater Accra Region, according to the Ministry of Health, is 5426 (2015). Ten percent (10%) population size was used in the study. A total of 557 questionnaires were administered within four weeks in five public health facilities in Greater Accra Region, namely: Korle bu Teaching Hospital (tertiary healthcare facility), Ridge and Tema General hospitals (secondary healthcare facilities), and LEKMA and Mamprobi Hospitals (primary healthcare facilities). The research revealed that, one of the major causes of health workers agitation is the fear of insecurity after retirement having witness some of their colleagues struggled for survival after they retired from active service. Again it was revealed that majority of the doctors and nurses wish to determine the rate of pension benefits payable to them after retirement. They want to work towards the payment of specific higher premium, to enable them to receive specific higher amount after retirement. The research recommends that more education should be done on the new Pension Scheme for public sector health workers.

This research assessed pension factor in doctors and nurses' agitations and the role of the new pension scheme in addressing that challenges in Ghana. Due to the deficiencies in the old pension schemes which led to the call for pension reforms and better motivational packages, the introduction of the new pension scheme is therefore expected to induce employees' satisfaction and motivate workers in general. The aim of the research was to investigate the underlining causes of strikes actions embarked upon by public sector doctors and nurses in the Greater Accra Region between from 2005 to 2015. That period saw several agitations by health workers which made government established two pay policies, namely: The Health; the Sector Salary Structure (HSS) and the Single Spine Salary Pay Policy (SSPP). This research adds to scanty published literature and other sources, which ascertained the actual causes of these health workers agitations and the role of the new pension scheme in Ghana. The investigators used in-depth interviews and a mixed method made up of quantitative and focus group discussions (FGDs). The number of professional nurses and doctors in Greater Accra Region, according to the Ministry of Health, is 5426 (2015).
Ten percent (10%) population size was used in the study. A total of 557 questionnaires were administered within four weeks in five public health facilities in Greater Accra Region, namely: Korle bu Teaching Hospital (tertiary healthcare facility), Ridge and Tema General hospitals (secondary healthcare facilities), and LEKMA and Mamprobi Hospitals (primary healthcare facilities). The research revealed that, one of the major causes of health workers agitation is the fear of insecurity after retirement having witness some of their colleagues struggled for survival after they retired from active service. Again it was revealed that majority of the doctors and nurses wish to determine the rate of pension benefits payable to them after retirement. They want to work towards the payment of specific higher premium, to enable them to receive specific higher amount after retirement. The research recommends that more education should be done on the new Pension Scheme for public sector health workers.
Spine Pay Policy (SSPP), which was introduced in 2010, pension issues, particularly among doctors and nurses in the public health sector, have been prominent. An effective reform of the pension system in Ghana, was required to respond to the frequent agitations by the doctors and nurses, over pension issues.
There have been various pension reforms in Ghana which dates back as early as the year 1950 (Gockel & Kumado 2003). Before the establishment of a formal pension scheme as a means of providing social security to public sector workers in Ghana, the extended family system was the main source of social protection for most Ghanaian public sector workers after retirement. The extended family was the institution in Ghanaian community that provided social and economic support to various family members at appropriate times of need. It was, traditionally, a source of support when members This uncertainty about pension has also raised concerns as to how the average worker especially in the health sector is motivated and remunerated. Across the globe, the desire to increase productivity has been a major concern for all organizations both in the public and private sectors, great and small alike. Most organizations globally especially in the public health sector usually adopt measures that focus on sophisticated technology, equipment, capital and other materials, more often than paying maximum attention to the 'human side of the enterprise', that is the workforce [1]. Health workers occupy a central position in any health care facility in a country and as such their security after their working years, needs to be assured to allay their fears about their future.

The Concept of Social Protection
There has always been a need for social protection universally.
Before the emergence of well-structured or institutionalized social security schemes, the family was the main source of social protection in the pre-colonial era. However the advent of colonial rule or colonialism was one of the major factors responsible for the occurrence of institutionalized schemes in many sub Saharan countries including Ghana. Additionally, the prevalence of other issues pertaining to poverty, health and conflicts caused the role of the family to decline. These issues eventually raised the urgency and popularity of social protection systems which resulted in the introduction of pension schemes [2]. The review looks at the concept of pensions, the new 3 tier pension scheme, benefits of the new scheme and problems of new pension scheme.

Pensions
A pension scheme refers to a long term investment vehicle whose principal objective is to provide decent and reliable income upon retirement [3]. The development of the public pension systems  b) An improvement in the second tier lump sum benefits or returns that are higher than the benefits under the CAP 30 scheme and far higher than that of the SSNIT scheme. This is probably due to fact that, the second tier is privately managed and as such will be invested in high yielding investments.

c)
An opportunity to use future lump sum pension benefits to secure mortgages. This gives a worker the opportunity to own his or her own house before retirement by using their pension benefits as collateral.

d) An opportunity for workers to have better control over
their pension benefits under the second and third tier schemes which are both managed privately.
e) An opportunity for funds to grow since no arbitrary withdrawals is allowed.

Problems of New Pension Scheme
Although on paper, the new three tier pension scheme is the perfect solution to the discrepancies existing in the SSNIT specifically, with its dwindling investment returns and improving access to informal sectors. It has encountered its share of scrutiny and difficulties prior to its implementation. According to Okine There is also concern of whether the contributions paid into the TPF have even been invested because of the NPRA's failure to show records as proof of the fund's availability. Most companies that were established in preparedness for the implementation of the scheme are running out of funds they heavily invested in the business [5].

The Objective of the Research
The main aim of the study was to assess the pension factor and fifty-one (551) respondents, which represents more than 10% of this population of doctors and professional nurses, was chosen from public health institutions in the Greater Accra for this study.
Due to the large population size and resource constraints, the study adopted purposive and random sampling technique for doctors and nurses. Purposive sampling technique was employed to the doctors for the study. Random sampling was also used to select the nurses. The 10% of population size, according to Mason (1997), can be used to make generalization. The sample size was determined using the formula is the population and is the sample.  (Table 1).

Findings
Out of the five hundred and fifty-seven (557) questionnaires administered, five hundred and fifty-one (551) were returned.
The other six (5) were not returned as the respondents seems to be very busy and changing shifts. The major questions solicited in the research is highlighted in Table 2

Discussion
With regards to the issue concerning whether health workers are willing to pay for a higher premium to enable me to receive the specific monthly payment, a high mean of 4.71 and a standard deviation of 0.623 were produced. This outcome suggests that the health workers are willing to pay more premiums in order to increase the monthly payments made to them upon retirement.
Consequently, a mean and standard deviation of 4.45 and 0.363, respectively, were derived for the statement which bothered on the readiness to top up the statutory pension deduction at the end of every month to enable them to receive the payment they desire as monthly benefit. This affirms the earlier view that the health workers agree on the need to pay more pension premiums.
The respondents agreed that they have faith in the current 3 tier pension scheme. However, the recorded relatively low mean value and its standard deviation is 3.98 and 0.724 respectively.
Moreover, the views of the respondents were sought on why they resort to strike actions and the impact they hope to make for such actions. A mean of 4.87 and standard deviation of 0.812 revealed that the respondents agree that delayed salaries are the reasons why they embark on strike actions. Similarly, they agreed that they go on strike to agitate for increment in their salaries (mean=4.77, standard deviation=0.78). They also agreed that strike actions become necessary when decisions concerning their retirement are not in their favor (mean=4.33, standard deviation=0.524).
In addition, it is their conviction that strike actions help them to achieve their aim (mean=4.25, standard deviation=0.475). On the contrary, the respondents agreed that as an essential health provider, they do not have to go on strike since it may affect human life (mean=4.62, standard deviation=0.352).
The study revealed that the main causes of doctors and nurses' agitations are poor remuneration and unattractive conditions of service which according to them, threatens their welfare when they go on retirement. The study also found that, the relaxed attitude of Government towards pension issues and motivational packages, give them no choice but to express their dissatisfaction through the consistent industrial strikes. Again, one major problem that acts as In corresponding terms, 72% did not like the rate of premium paid currently under the SSNIT pension scheme. They say it is small and their pension benefit will also be small. Hence, 22% said they are willing to pay any amount of insurance premium to enable them to receive not less than an equivalent of 600 dollars every month after retirement. While 36% also wish to pay any amount of