Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

Human Resources for Health

David Mant⁸  Jan De Maeseneer¹  Drissa Diallo⁴  Mustafa Khogali³  Oathokwa Nkomazana⁷  Nthabiseng Phaladze²  Shabir Moosa⁹  Eman Hassan Mahmoud³  Vincent Mubangizi⁵  Francis Bajunirwe⁵  Chiaka Diakité⁴  Pierre Daou⁶  Wim Peersman¹  Merlin L Willcox⁸ 

[1] Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium;School of Nursing, University of Botswana, Gaborone, Botswana;Ahfad University for Women, Omdurman, Sudan;Department of Traditional Medicine, National Institute for Public Health Research, Bamako, Mali;Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali;School of Medicine, University of Botswana, Gaborone, Botswana;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa

关键词: South Africa;    Botswana;    Uganda;    Mali;    Sudan;    Review;    Primary health care;    Human resources for health;   

Others  :  1225502
DOI  :  10.1186/s12960-015-0073-8

 received in 2014-10-17, accepted in 2015-08-26,  发布年份 2015

【 摘 要 】

Background

The World Health Organization defines a “critical shortage” of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years.

Methods

This study is a review of published and unpublished “grey” literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa.

Results

Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers.

Conclusion

There is an “inverse primary health care law” in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.

【 授权许可】

   
2015 Willcox et al.

【 图 表 】

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