Addressing the crisis of inadequate human resources in Africa’s public health sector

The deficit in skilled professionals and the entire health workforce in Africa continues to be a massive set back on the pathway to achieving universal health coverage on the continent. Although Africa’s health system has always been confronted by a grossly understaffed workforce, increasing economic strains and fragmentary health service reforms have resulted in a massive brain drain, which further weakens the already fragile health system.

According to the World Health Organisation (WHO), 57 countries globally have less than 23 health workers per 10,000 people, with sub-Saharan Africa accounting for 63 percent of these countries.

The disparity in Africa’s health workforce

The consequence of a complex set of factors on Africa’s health workforce has led to a continent that is struggling to handle about 25 percent of the global burden of disease with only 3 percent of the world’s health workforce. This is a huge contrast from the Americas, which shoulders only 10 percent of the global disease burden but has 37 percent of the world’s health workers.

This disparity in Africa’s health workforce does not occur on a continental level alone, as there is also a huge geographic disparity within most African countries. Distribution of health workers is skewed in favour of urban areas to the disadvantage of rural areas, as most health professionals are reluctant to stay in primary health facilities that are typically unequipped and in rural areas where social amenities are lacking.

Also, staff in these deprived and rural communities are often forgotten in terms of incentives, promotions, and career-related scholarships.

Strengthening human resources in Africa’s public health sector is an urgent need to ensure that trained health professionals are available in the right numbers, evenly distributed geographically across urban and rural communities, and are sufficiently motivated to deliver quality health services

Causes and challenges

Several direct and indirect factors have perpetuated the reality of the gross inadequacies in Africa’s health workforce. Some of these factors are poor levels of compensation/benefits with epileptic payment of salaries; poor and degraded health infrastructure; restricted opportunities for career development; increased migration of health workers in search of greener pastures; low health budget and inefficient management of financial resources; inadequate training capacity in public health training institutions; erratic health sector leadership and poor commitment of leadership to addressing human resources challenges in the healthcare sector; use of primitive practices and technology which limit productivity and increase the burden on health workers; amongst other factors.

Strategies to strengthen human resources in Africa’s public health sector

Human resource is the most crucial resource in any work environment and the healthcare delivery sector is particularly labour intensive. The performance of Africa’s health system and indeed health systems globally is therefore strongly linked to the availability, skill, and dedication of the health workers the system can attract and retain.

Strengthening human resources in Africa’s public health sector is an urgent need to ensure that trained health professionals are available in the right numbers, evenly distributed geographically across urban and rural communities, and are sufficiently motivated to deliver quality health services. Achieving this will require addressing the multidimensional factors that influence the healthcare human resources capacity.

These strategies will include:

Providing effective political leadership: Strong political commitment and engagement is needed to improve the health workforce in Africa. African governments should fulfil the commitment made by the leaders of the African Union (AU) in April 2001 at Abuja where the heads of state and government of the AU made a commitment to allocate 15% of their annual budget to improve the health sector. While countries like Rwanda and South Africa have lived up to this commitment, others like Nigeria still lag behind; in Nigeria, the health budget for 2022 is 4.3% of the entire budget.

Facilitating public-private partnerships (PPP): African governments need to provide legislature and incentives that will facilitate public-private partnerships. Such public-private initiatives should invest in the training and capacity building of health workers, strengthening and equipping healthcare facilities, and providing more incentives for health workers.

Implementing enhanced health sector salary scheme: To attract and retain trained health professionals, African governments should redesign the remuneration system to prioritise health workers; improve salaries and implement improved welfare and benefits schemes, and extend the working life of healthy health professionals.

Establishment of a ‘Deprived Area Incentive Scheme’: To improve the distribution of human resources to rural communities, African governments should provide financial incentives for health workers in rural areas. Also, there should be prioritisation of access to further training and fast-tracking of promotions and career development opportunities for staff working in under-served areas.

Adoption of technology to improve productivity and reduce the burden on health workers: The use of innovative solutions and new technologies in service delivery will increase productivity of health workers, allowing them to reach more patients effectively, particularly those in remote areas. This will reduce the immense burden on the limited human resources available in healthcare.

The healthcare sector in Africa needs a strong workforce to handle the huge global burden of diseases on the continent. Addressing the various challenges confronting human resources retention and productivity should therefore be accorded the highest priority for achieving better health outcomes.

Anyakora is the CEO of Bloom Public Health and a public health expert.

Odibeli is a pharmacist and the Research and Communications Coordinator at Bloom Public Health.