PMNCH/Africa Public Health Alliance press release: African health financing

Human resources

A key component of strengthening health systems

Sufficient, well distributed, skilled and motivated health personnel are required to improve health outcomes on the African continent.

While the WHO recommends a minimum of 2.3 doctors per 1000 people to achieve 80% skilled attendance at delivery, Sub-Saharan Africa is grossly understaffed at 1.15 health workers per 1000. This shortage of health workers is compounded by issues of quality, motivation and distribution. There are 61 countries with a critical shortage of healthcare workers – 41 of them in Africa. Niger only has one health worker for every 6,000 people, Sierra Leone has one for every 5,000. By comparison, in the UK there is one health worker for every 119 people

The United Nations Secretary General’s Global Strategy for Women’s and Children’s Health notes that an additional 2.5 to 3.5 million health workers will be needed to achieve millennium development goals 4 and 5 in the 49 low income countries (33 of which are in Africa). A recently published Save the Children report entitled Missing Midwives notes that a global shortage of 350 000 midwives contributes to poor health outcomes for many women and children. A report entitled The State of the World’s Midwifery – developed by 21 partners – will be launched in June 2011 at the International Confederation of Midwives Triennial Congress and will provide an overview of the state of midwifery in countries.

Some countries in the region have focused on health workforce, as a means of improving their health outcomes. In Ethiopia where 85% of the population lives in rural areas and has traditionally been underserved, the Ministry implemented a Health Extension Programme aiming to train 30,000 new Health Extension Workers (HEWs) to work at local health posts and to provide a package of essential interventions to meet needs at this level.

While 18 African countries that committed to the Global Strategy in September 2010 accounted over US$8.5 billion, 11 of these countries made specific commitments related to increasing and improving their health workforce, for instance Rwanda committed to train five times more midwives (increasing the current ratio from 1/100,000 to 1/20,000).