PHA-Exchange> Human resources for health in Africa

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 from Jawad Asghar <jawad at alumni.washington.edu> -----

Human resources for health in Africa
------------------------------------

Better training and firm national policies might manage the
brain drain

BMJ 2005;331:1037-1038 (5 November)
http://bmj.bmjjournals.com/cgi/content/full/331/7524/1037

African countries have a very low density health workforce, com-
pounded by poor skill mix and inadequate investment.[1] Yet
trained healthcare staff continue to migrate from Africa to more
developed countries. The World Health Organization has estimated
that, to meet the ambitious targets of the millennium develop-
ment goals, African health services will need to train and re-
tain an extra one million health workers by 2010.[2]

It is too simplistic and misleading to define or try to resolve
the crisis in human resources for health in Africa by looking
only at overall numbers and density of workers, not least be-
cause these vary from country to country.[3 4] Furthermore, the
poor performance of health services in African countries is of-
ten compounded by shortages of drugs and other essential sup-
plies, broken equipment, and poor logistical support. Africa
needs balanced investment in human resources, infrastructure,
drugs, logistics and other supportive services that will enhance
the capacity to deliver health care.

Seven main principles should guide the debate on developing and
refining African health services. African leaders are be-
ginning to work together on this, supported by the regional of-
fice of the World Health Organization, the New Partnerships for
Africa's Development, and the African Council for Sustainable
Health Development. Each country needs clear policies on human
resources, based on objective analyses of needs and opportuni-
ties and aimed at strengthening the healthcare system in a sus-
tainable way.

Such policies must include strategies for dealing with migration
of health staff to developed countries.[5 6] Mass migration of
health personnel is often a symptom of the "sick system syn-
drome," in which many essential components of healthcare ser-
vices are malfunctioning and mismanaged. Policies on migration
policy must tackle the "pull factors" which induce trained per-
sonnel to seek better living conditions abroad as well as the
"push factors" which make disaffected and frustrated health
workers seek employment elsewhere. The "anchor factors" which
encourage workers to remain in public service are important
too.[7-9] These may include well designed training programmes
that increase workers' skill and competence, boost their morale,
increase their job satisfaction, and improve the performance of
services.

Ghana has developed two training programmes which successfully
combine appropriate curriculums and policies for developing hu-
man resources. With guidance and support from the American Col-
lege of Obstetricians and Gynecologists and the Royal College of
Obstetricians and Gynaecologists, two Ghanaian medical schools
now operate the Ghana Residency Programmes in Obstetrics and Gy-
naecology.[10 11] This programme provides trainees with sound
clinical knowledge and appropriate skills for practising in both
hospital and community settings. The programme has produced a
steady stream of obstetric specialists, practically all of whom
are still working in Ghana. A programme for training midwives in
lifesaving skills, run by the Ghana Registered Midwives Associa-
tion in both the private and public sectors, has successfully
enabled midwives to deal alone with some emergencies and also
stabilise patients before referral for more specialised emer-
gency obstetric care.[12]

Such training might be partially funded by health services in
the countries which welcome health workers from Africa, thereby
providing mutual benefit. And countries such as Nigeria, which
produces more trained health personnel than its health system
can use effectively, might benefit from a programme of managed
emigration.

Africa's health authorities­with financial and technical support
from national, regional, and international partners­need to de-
sign and implement creative policies for managing their human
resources. In turn, development partners, some of which may have
followed only their own globally focused agendas in the past,
must show that they respect the national goals and priorities of
African countries.


Guidelines for developing Africa's response to the crisis in hu-
man resources for health

Strong African leadership to direct debate and discussions

Analysis within countries to establish national and local needs
for health workers

Regional consultations and networking to share relevant lessons

Diagnostic approaches to inform evidence based action: Identify
signs and causes of the "sick system syndrome" Generate informa-
tion about the distribution and flow, both internally and exter-
nally, of health workforces

Development of policies on human resources which are relevant,
affordable, and sustainable and are realistic about migration of
trained staff.

Adoption of and respect for policies on human resources by na-
tional authorities and development partners

Evaluation and review within and between African countries of
relevant experience and innovations



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