KIRUKU: Let’s get doctors, nurses off the street
Recent estimates showing that the East African Community partner states have less than 44.5 physicians, nurses and midwives per 10,000 people are not just worrying, but sad.
The revelation comes at a time when the region is battling serious health issues like cancer, which is now claiming more lives than malaria and HIV/Aids. The high mortality and maternal deaths in the region are partly due to the acute shortage of nurses and midwives, coupled with poorly equipped health facilities that are also few and far between.
One of the key contributors to the crisis is attrition of the health workforce, contributed by the number of health workers permanently leaving their posts. Attrition of health workers in the region is largely due to retirement, death, dismissal and voluntary resignation by health workers, who leave the public health sector for more lucrative positions. In the recent past, a majority of health workers have been leaving the sector to work in the private sector, where the pay is significantly better.
According to the World Health Organisation (WHO), the current workforce in some of the worst affected Sub-Saharan African countries would need to be scaled up by as much as 140 per cent to attain international health development targets. The problem is so serious that in many instances there is simply not enough human capacity even to absorb, deploy and efficiently manage donor funds offered to improve health in such countries.
With such a critical shortage of health workers, it is impossible for the region to attain health-related targets of the Sustainable Development Goals (SDGs). It is impossible for the region to provide quality healthcare to citizens using just a handful of health workers.
It is no secret that the population of the region has grown tremendously over the past few years to about 150 million people without a corresponding investment in the training of health workers.
The shortage of health workers is not confined to East Africa, but extends to most of Sub-Saharan Africa. The endemic shortage of health workers has been made worse by the burden of the HIV/Aids pandemic. The workload of health workers has dramatically increased, directly affecting service delivery.
The third SDG binds nations to, “Ensure healthy lives and promote wellbeing for all at all ages.” It is obvious that this will be impossible to achieve if the current challenges on human resources in the health sector is not comprehensively addressed. This will involve looking at both numbers and quality of training.
Indeed, poor working conditions in the health sector coupled with low remuneration have led to brain drain as health workers seek greener pastures in other parts of the world. Over the past few months, there has been a major crisis in the health sector in Kenya as doctors staged one of the longest strikes, lasting 100 days, as they demanded better pay. Currently, nurses in Kenya are on strike in their quest for better pay and improved working conditions.
The region must strengthen and harmonise training of health workers from across the partner states by ensuring high standards are maintained in the training of health workers. The ongoing national and regional efforts to strengthen training of health workers by expanding postgraduate training fellowships and award of specialist qualifications in medicine and other health sciences is a positive step towards realization of the SDG health target.
For the region to bridge the health workers’ shortfall, a lot of investment will have to be done in pre-service training, international migration, career changes among health workers, premature retirement, morbidity and premature mortality.
Aggressive retention policies – such as improving the remuneration and working conditions of health workers, addressing unemployment, using telemedicine and encouraging short-term-in-migration from surplus to deficit countries – may serve to partly solve the crisis. Donor support may prove critical in making this a reality.
It is now paramount for the region to employ HIV/Aids preventive measures so as to reduce premature mortality among health workers in the long term. Providing anti-retroviral treatment for health workers who need it, for instance, will enable them to work longer.
Still, corruption is a major impediment to health service delivery in the region. The health sector is considered among the most corrupt dockets in the region, with most donor funding being mismanaged.
Health is a key aspect in regional economic development; a healthy region is a wealthy region. The EAC partner states must therefore solve the health workers’ shortage if meaningful economic development is to be attained.