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Analytical summary - Health workforce

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Health workforce management systems are one of the weakest components of human resources for health development, as evidenced by:

  • ill-equipped health workforce departments in ministries of health
  • huge imbalances between rural and urban areas and in skill mix
  • lack of incentives
  • sometimes an adverse working environment.

These issues prevail all over Africa, exacerbated by low economic status throughout the continent. Human resource shortages are compounded by recent decreases in investment in health, freezes in recruitment of health workers, poor remuneration and incentives, and the migration of skilled staff. Effectively, the health workforce in Africa (see figure) is in crisis.

Physician-to-population ratio (per 10 000 population) in the WHO African Region, by country, 2000–2010

The WHO African Region requires approximately half a million more health workers than are currently available. It also requires a mix of workers of different categories, not exclusively doctors and nurses, if the right kinds of skills and competencies are to be available.

This requires revisiting the question of training. African training institutions are weak and numerically insufficient, and increasing funding shortages are aggravating this problem.

Evaluation of present training institutions is needed to assess how to move forward constructively:

  • increasing numbers of effective health workers
  • retaining them in service
  • allowing for flexibility in their approach to learning.

Innovative approaches to education and training, and retention must be identified. Otherwise, the shortfall in workforce numbers and lack of appropriate types of training creates a bottleneck in implementation of national health strategies.

To start countering these problems, there is a need for solid information, reliable research and a firm knowledge base. Similarly, it is essential to have the capacity to monitor and evaluate interventions to ascertain progress and identify problems.

Optimizing the use of the existing health workforce, mitigating the adverse effects of migration, and creating new categories of health worker are among the serious priorities and ways forward and the challenges to equitable and accessible health services delivery. The health ministries cannot meet these requirements alone, and strong engagement with other involved government departments and private partners is needed.

However, technical and financial partnerships focusing on planning for human resources for health are now being forged, and scaling-up initiatives is taking place, in the recognition that without further investment in this area, the Millennium Development Goals cannot be met.