Africa's Health Care Worker Crisis
Leading health authorities have long recognized that one of the greatest obstacles to combating major, preventable diseases in Africa is the shocking lack of trained health workers at almost every level of the health system.
In its World Heath Report 2006, the World Health Organization determined that countries below a threshold of 2.3 doctors, nurses, and midwives for every 1,000 people were “very unlikely” to achieve the United Nations Millennium Development Goals.
Of the 57 countries listed as falling short of this number, over 60 per cent are in sub-Saharan Africa. Indeed, Africa suffers more than 25 per cent of the global burden of disease, but has access to only 3 per cent of the world’s health workers and less than 1 per cent of the world’s financial resources – even with loans and grants from abroad.
Despite widespread acknowledgement of the health worker crisis, progress in meeting health workforce needs remains painfully slow. Yet health services simply cannot function without a sufficient number of skilled, motivated and supported health workers; neither can HIV/AIDS, TB and Malaria treatment and prevention programmes be scaled-up.
Most Severe Impact in Rural Areas
This health worker crisis is particularly acute in rural and hard to reach areas, where 80 per cent of Africa’s population lives. In these areas, health workers often feel extremely isolated, living away from their families, and working in incredibly difficult conditions, with a critical lack of resources. Midwives have to deliver babies on makeshift sack sheets laid on the floor because they have no delivery tables. Without even a bicycle or any form of transport (not to mention heavily cratered and pot holed roads) to do outreach work with communities, health care workers have no choice but to walk considerable distances to visit their patients.
Motivation, understandably, remains low, and if a chance arises for a position in a more urban area, with better facilities and a greatly improved standard of living, the majority will seize that opportunity.
AMREF’s Community-Based Approach
Addressing the crisis from the grassroots upwards AMREF’s strategy concentrates on strengthening health systems in Africa to ensure that they better serve the needs of poor and vulnerable communities. Where there is a severe shortage of health workers in an area, we empower communities to take control of their own health development and help them demand the assistance and services to which they are entitled. We develop health projects in close consultation with communities so that they are relevant to their specific needs - whether they are living in a slum in Nairobi, an internally displaced people’s camp in northern Uganda or a remote rural area in Ethiopia.
AMREF’s key strategy in addressing the health worker shortage is training mid-level and community health workers (CHW).
Every year, AMREF trains more than 10,000 community health workers who have an important role to play in bringing health care closer to the most rural and marginalized communities, where the health resource shortage is at its most severe.
Training health workers closer to people’s homes reduces the time lost in travelling to the nearest health clinic, which is often hours or even days away. It also means that understaffed health clinics are less congested with patients who can be safely treated in their homes.
While CHWs do not have the same abilities as trained doctors or nurses, they are trained to recognize and refer more complicated cases.
Training more health care workers is essential but only part of the solution.
African nations need strong national health plans that ensure there are enough administrative and management staff and that performance and quality of work are closely monitored.
These plans must also guarantee health care worker’s most basic needs are met to keep them motivated including supportive supervision, proper training, strong referral systems, availability of necessary medicines and equipment, safe working environments and above all a decent wage.
Global action in strengthening the health workforce, particularly in Africa is urgently needed.
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