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Analytical summary - Health workforce

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In Sierra Leone, the public health sector’s human resources for health is led by the Ministry of Health and Sanitation’s Human Resources for Health Department. This department is headed by a qualified and experienced Director who reports directly to the Permanent Secretary. However, there is limited internal capacity to manage human resources for health as a strategic function of the Ministry.[1] Only six of the department's strategic objectives were partially achieved.

With support from WHO, the Ministry’s Human Resources for Health Policy is being reviewed to pave the way for the development of a strategic plan, training plan and human resources for health observatory for planning, management and evaluation. Following the introduction of the Free Health Care Initiative, salaries of health workers in the Ministry have considerably improved. A performance-based funding system has also been introduced to motivate health workers, especially in hard to reach areas.

The total workforce in the public health sector increased from 7164 in 2009 to 8125 in 2010, an increase of 13.4%. The distribution of the different cadres of health workers by region clearly illustrates the inequitable distribution of health personnel across the country. Most of the health workers are concentrated in the Western Area, leaving the other regions with inadequate essential staff.

In addition to the inequitable distribution of personnel, there is also an inadequate number of specialist health workers in the health sector (see tables).[2] The Western Area alone accounts for more than half of the medical officers in the country. The inequitable distribution of the health workforce is further amplified by a similar pattern for nurses and other cadres.

Health workforce distribution by category and region Source: National Health Sector Strategic Plan 2010–2015[2]
National staffing requirement based on workload indicators and staffing needs[2]

Maldistribution may be explained by:

  • inadequate accommodation for key facility staff at all levels
  • lack of motivation to work in remote areas
  • lack of reliable human resources for health information systems.

Training is now more organized due to the availability of the Human Resources for Health Policy, which incorporates a training policy. However, training is constrained by the lack of a training plan and weak capacity in training institutions.[3]

Health workers are trained in the College of Medicine and Allied Health Sciences, the National School of Midwifery, Njala University and the University of Makeni.

Each training institution trains when it has the resources. Each determines its class sizes without the participation of the Ministry of Health and Sanitation. The Ministry has no control over training; it does not have regular meetings with the universities and there is little evidence of dialogue with these institutions, for example with respect to type and number of graduates required by the Government of Sierra Leone.[1]

The following graduated from the College of Medicine and Allied Health Sciences at the end of the 2010–2011 academic year:

  • Diploma in Nursing and Certificate in Nursing (101)
  • Bachelor of Medicine, Bachelor of Surgery (25)
  • Pharmacy Technician (12)
  • Bachelor of Pharmacy (11)
  • Diploma in Ophthalmic Nursing (8)
  • Bachelor of Science in Nursing (6)
  • Medical Laboratory Scientist (4).

Apart from training in midwifery, there are no other post-basic or postgraduate training institutions in Sierra Leone and therefore the country has to access these from abroad. There is no policy in place to guarantee graduates, even those from government training institutions, a job.[1]

The low output of graduates from health training institutions in relation to demand is due to several factors, including under-staffing, poor infrastructure, and inadequate learning and teaching models.

Attracting and retaining health workers remains a key challenge owing to:

  • low staff remuneration
  • lack of incentives, especially for hard to reach areas
  • poor career development
  • cumbersome and bureaucratic recruitment processes that cause inordinate delays.

The Ministry of Health and Sanitation is in the process of reviewing the scheme of service for health workers. This scheme is expected to outline the career path for each category of health professionals.[4] The Government has identified the health manpower needs for the country and is determined to fill the identified gaps.

References

  1. 1.0 1.1 1.2 African Health Workforce Observatory HRH fact sheet Sierra Leone (pdf 28.72kb). Brazzaville, WHO Regional Office for Africa, 2006
  2. 2.0 2.1 2.2 National Health Sector Strategic Plan 2010–2015 (pdf 1.09Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  3. Human resources for health policy in Sierra Leone for the Ministry of Health and Sanitation (pdf 160.31kb). Government of Sierra Leone, Ministry of Health and Sanitation, 2006
  4. Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010