Human resources – the most critical component of a health system

Human resources for the health sector are critical, in order to respond effectively to maternal, newborn and child health needs. Childbirth is the most crucial time when women are highly vulnerable to death and long-term disability. Newborn lives are dependent on their mothers’, hence adding to the gravity of the childbirth process. The role of skilled health care personnel at birth therefore being important has become an overwhelming priority for policy and in practice.

A threshold of 23 physicians, nurses and midwives per 10,000 people are necessary to deliver essential health services. However, as reported by Countdown to 2015 (www.countdown2015mnch.org), only 15 out of the 68 developing countries meet this requirement.  Severe shortages in health workers weaken the system and render it ineffective. For example, only 46% of the births in sub-Saharan Africa are attended by skilled health care personnel. This region records the highest maternal mortality ratio at 640 maternal deaths per 100,000 live births.  

Estimates from the High Level Task Force on International Innovative Financing for Health Systems, show that an additional 0.35 million doctors, 1.7 million nurses and midwives, 0.95 million community level health workers, and 0.5 million mid-level health workers and other health personnel, are needed, if the MDGs 4 and 5 are to be achieved by 2015. The Global Strategy for Women’s and Children’s Health emphasised this need, and aims to ensure that 19 million more women give birth with a skilled attendant, by 2015.   

The current crisis of health care workers is due to shortages and an uneven geographical distribution of workers. Several innovative measures have now emerged to address these gaps. Women community health care workers, for example, have been employed in some countries such as Pakistan and Ghana to provide preventive and health promoting care. A recent article Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial showed that the Lady Health Worker programme in Pakistan helped reduce stillbirths and newborn mortality rate. Clinical officers at district hospitals in Malawi and Mozambique, have been trained to undertake emergency obstetric care. Emerging technologies such as mobile phones and portable data compilers are being innovatively used for storing patient data and managing cases through remote staff.

Issues of quantity and distribution are compounded by issues of quality. Heavy workloads; poor management, supervision and support systems; unsatisfactory working environments and conditions; low remuneration; lack of career paths, other incentives and training, compromise the effectiveness of existing health workers. While innovative ways of tackling the crisis have to be tried, systemic improvements are necessary to overcome the issues of quantity, quality and distribution. Increasing the capacity of national institutions to train the required number of health workers, accreditation, curricula revision, regulation, continuing education, posting and retention schemes especially for rural areas, could help overcome health worker shortages.

These efforts should be implemented through country level human resources plans which are coherent with national strategies, and bring together various stakeholders and partners are necessary.