Thursday, May 17, 2012

INFOCUS: A Crisis - Africa's Health Human Resources Shortage

Thursday, May 17, 2012
On this second piece of our INFOCUS series, we examine the Health Human Resource crisis on the African continent. The biggest challenge in putting this piece together was getting data to give us an impression of the situation on the ground. We discovered that this challenge to us was in-fact one of the main issues behind this crisis; weak Human Resource for Health Information Systems and generally, Health Information Systems.

In this encounter, we will be looking at specifically, what the situation is collectively on the African continent with respect to Human Resource for Health - the doctors, nurses, laboratory technicians, pharmacists, managers - in all over 20 different cadre types. Again, information for all these levels is not readily available. Most of the little reporting and data that is available looks at Doctors and Nurses and is outdated. More comprehensive information and data is needed. Here is what the Africa Health Workforce Observatory says about the challenge of accessing information on health workers through current HR for Health Information Systems;
The entire system depends on different sources such as health professional regulatory bodies, health facilities staffing, health training institutions, faith based organizations, censuses or surveys, payroll records and other various services in statistics for which the completeness, timeliness and comparability are widely variable with the challenges of combining and compilation of information from multiple sources.
What is the situation?

In the first piece we posted in our INFOCUS series, one of the things we highlighted was the Doctor Patient ratio on the continent. We saw that some countries were performing considerably well than others. In the 2006 Edition of the World Health Report by WHO 57 countries were identified as having a Human Resources for Health crisis. Of these, 36 countries were in Africa. Despite the continued forecasting of relatively good economic performance by many countries on the African continent, there is a still a burden in a number of areas including efficient management of development capital.

But if we can go back to the issue at hand, here are some facts we collected on what is happening on the ground;
  • Though we do not like this Sub-Saharan Africa phrasing, the region faces the greatest challenges. According to WHO, while it has 25% of the global burden of disease, it has only 3% of the world's health workers. 
  • 36 countries in Africa, as aforementioned, are confronting critical Human Resource for Health shortages, meaning they have fewer than 2.3 doctors, nurses and midwives per 1000 people. This figure is the  minimum required to achieve an 80% coverage rate for deliveries by skilled birth attendants or for measles immunization.
  • Things are done differently between one country and another. The core Human Resource for Health development functions are spread across different departments within Ministries of Health and in some cases outside, as noted in a 2012 WHO publication titled "Health workforce governance and leadership capacity in the African Region".
  • There are Health Worker urban and rural imbalances all across the continent. Even for those countries  that meet the 2006 WHO health worker benchmark, a measure of the inequalities in distribution shows that this imbalance is evident and more so in those facing the crisis.
  • And perspectives in dealing with these imbalances are for the most part failing - that is increasing HR for Health demand and supply, forcing health workers to work in rural areas and providing financial incentives for those accepting work in rural areas.
We should not be understood as setting out to be negative on the progress on the continent. The distribution of health workers globally places the African continent at an uneven footing. 3% of the world's health workers, diseases, famine and severe malnutrition and conflict - the burden placed on this small cohort is immense but at the same time, the policy and strategic actions supporting the health sector need to evolve and be deliberate to address the shortages and inherently reduce the burden placed on these workers. 

What is being done to address the Crisis?

There is action being taken to address the crisis. There is leadership and will among countries on the continent, but capacity, financial and human resource are lacking and there are no strong case studies to provide inspiration. A number of regional initiatives are providing the technical, content and strategic leadership in addressing the crisis - more so those under the auspices of the World Health Organization.

From the Africa Health Workforce Observatory (which has seen a number of national entities launched in recent years - at least 4 reported on their website), Country Coordination and Facilitation (CCF) to the Health Metricts Network (HMN) and the processes coming out of the first global forum on human resource for health (Kampala, Uganda 2008).
  • The African Health Workforce Observatory is a cooperative mechanism, through which health workforce stakeholders share experiences, information and evidence to inform and strengthen policy decision-making. 
  • The HMN is the first global partnership dedicated to strengthening national health information systems. HMN operates as a network of global, regional and country partners. As a country-owned and partner-driven platform, it assesses health information systems and sustainably improves them, through the use of the HMN Framework. 
  • The CCF is a strategy that promotes the centrality of the existing HRH committee as a process to bring together all stakeholders, to more effectively harness their contributions and to build coherence, coordination and national relevance of all their actions. 
Although progress is skewed, countries are realizing the need for action. The countries facing a brunt of the crisis have developed action plans and CCF strategies to bring all stakeholders towards a common national framework. More action is needed in 
  • Budgeting and managing financing for health workforce development,
  • Increasing efficiency in collection, interpretation, utilization, monitoring and evaluation of health worker information and Human Resource for Health Information Systems,
  • Implementing better policies that reduce imbalances of health workers between urban and rural settings and,
  • Adopting an immediate continental framework on HR for Health and integrate indicators Peer Review Mechanism.
Our assessment, we feel, is somewhat incomplete without some experiences on the actual actions on the ground. We hope to bring you some of these in the coming days to further complement the message here.

Editorial Team.  

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