Balancing Educational Access and Practice Preparedness in Ghanaian Nursing and Midwifery Education: A Critical Narrative Review

Abstract

Ghana has expanded nursing and midwifery education to increase the supply of health professionals, yet educational growth has not consistently translated into clinically prepared graduates, equitable deployment or timely employment. This critical narrative review examines how access can be widened without weakening academic, clinical and professional preparedness. Literature published from 1 January 2000 to 5 June 2026 was identified through accessible scholarly indexes, citation searching and authoritative institutional sources. Evidence was appraised for design quality, measurement validity, geographical coverage, consistency and relevance to the education-to-workforce pathway. The synthesis shows that Ghana’s central challenge is not a simple choice between enrolment growth and quality. It is a coordination problem across admissions, faculty capacity, curriculum delivery, clinical-placement density, preceptor preparation, simulation and digital infrastructure, regulation, transition support and funded employment. Ghanaian studies consistently identify overcrowded placements, variable supervision, weak feedback, uneven educator preparation and theory–practice discontinuities, but most are cross-sectional, qualitative or based on self-reported experience. Consequently, confidence is stronger regarding the presence of system constraints than regarding the causal effect of particular reforms on objective competence or patient outcomes. Access should therefore be defined as effective access: fair entry, supported progression, exposure to sufficient accredited learning opportunities, attainment of demonstrable competence and a realistic transition into appropriately distributed employment. A capacity-linked expansion model is proposed in which admission ceilings are informed by faculty, simulation, placement and labour-market capacity, while equity safeguards prevent quality regulation from excluding applicants from underserved regions or disadvantaged backgrounds. Immediate priorities include national clinical-site accreditation, protected and trained preceptorship, shared simulation hubs, stronger educator development, longitudinal graduate tracking and integrated education–workforce data. Expansion remains necessary, but its public value depends on whether every additional place is accompanied by the learning and employment conditions required for safe, respectful and context-responsive practice.