CARIBBEAN | Exporting a Shortage: Why Ghana’s Health Service Cannot Bear the Caribbean’s Cuban Reckoning

Washington forced the Cuban medical brigades out, and Caribbean governments turned to Accra. But Ghana is not sending nurses it can spare — and Jamaica, which has supplied Britain and the United States for generations, is in no position to pretend this is anything other than a shortage changing hands.

MONTEGO BAY, Jamaica, August 25, 2026 - Calvin G. Brown | On 3 August, at King’s House in Kingston, President John Dramani Mahama inspected a guard of honour, laid a wreath at the shrine of Marcus Garvey and sat down at the University of the West Indies with Sir Hilary Beckles to talk reparations.

Somewhere in the communiqué that followed sat a colder item: an agreement to recruit Ghanaian health professionals into Jamaica’s public hospitals. Mahama’s framing for the visit was that this era is about “economic emancipation for our people”.

The nursing contract is what economic emancipation looks like in practice — and it deserves harder scrutiny than the Pan-African photography around it tends to invite.

Because the nurses are not arriving on a wave of Ghanaian abundance. They are arriving because Accra cannot afford to hire them, and because Washington has made the alternative untenable.

The ultimatum

The sequence is not in dispute. On 25 February 2025 the US State Department, under Secretary of State Marco Rubio, expanded its Cuba-related visa restriction policy to cover foreign government officials deemed complicit in Cuba’s overseas medical missions, along with their immediate families. Rubio has characterised the arrangement as “basically human trafficking” — a description regional leaders rejected almost unanimously at the time. Grenada’s finance minister was among those reported to have lost a visa.

The unanimity did not last — though it is worth being precise about what broke it. Jamaica’s medical cooperation with Cuba dated from 1976 and had run for half a century without public grievance on either side: no dispute over terms, no complaint from Kingston, none from Havana.

The arrangement did not collapse under its own weight. A thumb went on the scale. Kingston duly announced a review of compliance with domestic labour law, centred on how salaries were paid and how travel documents were handled; when the two sides could not agree revised terms, the agreement lapsed and Cuba withdrew a brigade of 277. Guyana’s mission departed on the same footing.

In Antigua and Barbuda, Gaston Browne spent much of 2025 defending Cuban doctors as the core of Caribbean health care, then watched the last of them leave in December. He has since been unusually frank about the calculation, telling a local radio programme that the United States is “very hostile” to the Cuban brigade and that recruiting Ghanaians was insurance against having to send the Cubans home suddenly.

More than a hundred Ghanaian nurses landed in St John’s in January. Barbados had gone first, receiving an initial cohort in 2020 and some 370 nurses since. The Bahamas signed a memorandum in October 2025. Jamaica’s four-year agreement, covering roughly 400 nurses, was concluded in Accra in May at the third session of the two countries’ Permanent Joint Commission — its first sitting in 21 years. Trinidad and Tobago sits on Accra’s list of labour-mobility partners.

What Accra actually has

Jamaica’s health minister, Dr Christopher Tufton, has put the appeal plainly: Ghana, he said, is “one of those countries that has an excess of nurses”, trained on a comparable protocol. The first half of that sentence needs interrogating.

Ghana’s Ministry of Health acknowledges a backlog of roughly 105,000 trained but unemployed health professionals. Some have been waiting since 2018. Before this year, the last general recruitment of nurses took place in 2020.

In April the Finance Ministry issued clearance for about 8,000 hires; 6,245 nurses and midwives were absorbed against 6,500 slots, and officials described the process as ferociously competitive — even as 87 posts in northern districts went unfilled, because nobody would take them. Health Minister Kwabena Mintah Akandoh has said roughly 100,000 professionals remained off the public payroll at the end of 2025, and his ministry has warned the figure could approach 180,000 by 2028 if training output continues to outrun the wage bill.

That is not a surplus of nurses. It is a surplus of unfunded posts.

Ghana is simultaneously rolling out a Free Primary Healthcare programme, launched by Mahama in April across 150 underserved districts and due to reach national coverage by 2028 — a policy whose entire logic is placing more health workers in precisely the communities that struggle to attract them. The country needs these nurses. It cannot pay them.

The red list and its doorway

This is why Ghana sits on the World Health Organization’s Health Workforce Support and Safeguards List — the so-called red list of countries whose health systems are judged too fragile to absorb active international recruitment. Britain’s code of practice bars its employers from targeting Ghanaian staff on precisely that basis.

The list does not forbid movement. It discourages active recruitment while leaving two doors open: individual applications, and recruitment under government-to-government agreements, provided source-country health ministries are consulted and domestic supply is protected.

Every Caribbean arrangement now in force runs through the second door. That is not abuse of a loophole; it is the mechanism the WHO designed. But the safeguard that door is supposed to carry — evidence that the source country can genuinely spare the workers — has been satisfied by pointing at a budget line rather than at a health-needs assessment. Ghana’s northern districts are not short of nurses because Ghana has too many of them.

What Cuba gave that Ghana cannot

Nor is this a like-for-like substitution. Cuban brigades supplied specialists and doctors, deployed under state-to-state terms at costs no open labour market would match, into rural and marginal postings local staff routinely decline.

Ghanaian nurses arrive as individually contracted professionals on local pay scales — which is precisely the labour standard Washington demanded, and considerably dearer per head.

The region should be honest that this is a trade rather than an upgrade, and honest too about the friction it has produced. In February, nurses in Antigua and Barbuda circulated a public letter complaining that recruits from abroad receive housing and transport packages local staff can only dream of, while locals train them and are left behind when the contracts end.

Published research on the Barbados cohort found Accra slow to police its own agreements on behalf of the nurses it sends. Neither ministry has covered itself in glory on worker welfare — the very ground on which the Cuban programme stood condemned.

The chain nobody names

Step back and the picture is a chain of substitution — and Jamaica stands in the middle of it, not at the end. This country has been supplying nurses to Britain and the United States for generations. A World Bank study cited by our own health ministry found that three times as many CARICOM-trained nurses work outside the region as within it, and that roughly half of an English-speaking Caribbean cohort is abroad within fifteen years of graduating.

Dr Tufton has said Jamaica loses about 500 specialist nurses a year to migration while carrying a deficit of some 400, and he has been candid that the ministry “may not be able to compete on a salary basis”.

So Jamaica has no surplus either. It has Ghana’s condition one rung further up the ladder: nurses it trained, cannot pay and cannot keep. Ghanaian nurses now fill the space those departures leave. Ghana’s own northern districts go short. Every link in the chain is a rational response to a price set somewhere else, and nobody standing in it is choosing freely.

Ghana has decided to formalise its position within it. Ministers have outlined a national labour-export strategy modelled explicitly on the Philippines and India, with talk of eventual inflows in the region of ten to twenty billion US dollars a year.

Whether that constitutes emancipation or a modern variant of a very old extraction is a debate Ghanaians are having loudly among themselves — the nurses’ association struck in 2025 over conditions of service, and thousands leave the country annually with or without any bilateral agreement.

What the Caribbean cannot do is pretend it is a neutral party to that argument. We are now a purchaser in a market our own people also supply.

A more honest compact

There is a version of this that would deserve the wreath at Garvey’s shrine. It would pair recruitment with investment: Caribbean money into Ghanaian training capacity, so that the region pays to enlarge the pool it draws from instead of simply drawing down. It would build genuine two-way exchange, with Caribbean specialisations offered to Ghanaian nurses on return rather than a one-way conveyor.

It would tie every deployment to enforceable welfare terms with a named authority answerable at both ends. And it would arrive alongside a regional retention policy serious enough to slow the northward leak that set all of this in motion.

None of that is in the communiqués so far. What is there is a workable emergency fix, arrived at under duress, dressed in the vocabulary of Pan-African solidarity. That solidarity may yet become real. It will not do so by accident — and it will not do so for as long as both governments keep describing a fiscal failure as a surplus.

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