The primary challenge for human resources for health in Djibouti has been a lack of health workers in all categories. Past efforts to improve the situation have focused on the recruitment of health workers from other locations, resulting in 1 nurse per every 10,000 inhabitants; 0.71 midwives per 10,000; 0.42 laboratory technicians per 10,000; 0.59 general practitioners per 10,000; and 0.40 medical specialists per 10,000 (Plan National de Développement Sanitaire de Djibouti 2008-2012, République Dijbouti Ministère de la Santé). Another challenge is the lack of specialist skills among medical practitioners. For example, GPs in 5 districts do not have essential surgical skills such as the ability to perform cesarean sections. Other major obstacles to HRH have been:
- limited opportunity for on-the-job training for nurses, midwives, laboratory, and pharmacy technicians;
- lack of accurate information regarding the type and number of staff;
- lack of clarity and role definition of the different health categories;
- absence of national standards for curriculum development for all health professions;
- proliferation of disease-specific training programs;
- lack of regulations and continuing education for health workers; and
- lack of teaching equipment and educational resources (Health Systems Profile: Djibouti, WHO 2006).
As a result of the current health policy, the MoH has been restructured to make HRH a priority and allow for greater institutional coordination, monitoring, and evaluation of continuing education conducted by the various programs and services of the MoH. In addition, a medical school has been opened, internal training of nurses and midwives has increased, and resources have been invested in the Staff Training Center in the Health Sciences Institute of Health. Compensation for health workers was also increased during this period, particularly in remote rural areas.
The current Five Year National Health Policy (NSDP 2008-2012) includes the following HRH objectives:
- ensuring quantity and quality at all levels;
- strengthening the administrative management of human resources at different levels;
- enhancing performance of initial structures (ISSS and EMD); and
- ensuring efficient training of officers at different levels of the health system.
These objectives will be met using the following strategies:
- creating national guidelines for HRH and a strategy for implementing, monitoring, and evaluating these with the aid of stakeholder groups;
- assessing HRH staffing needs;
- recruiting foreign medical specialists;
- mobilizing external sources of HRH funding;
- creating programs of compulsory service in rural areas and income premiums for work in rural areas;
- redistributing existing staff to poor and suburban areas;
- making use of international expertise in the organization of human resource management and training current personnel in HRH;
- creating a computerized system for HRH;
- developing assessment tools for staff performance, and
- developing negative sanctions for misconduct.
COUNTRY COORDINATION AND FACILITATION (CCF) IN DJIBOUTI:
Djibouti is currently in the planning process for the following steps of the CCF process:
- CCF orientation;
- stakeholder identification and analysis;
- establishment of an HRH committee, technical working groups, and capacity building;
- involving the HRH committee and technical working groups in developing an evidence-based, comprehensive, costed HRH plan; and
- engagement of stakeholders for resource mobilization, implementation, monitoring, and evaluation of the HRH plan.
In 2011 Djibouti reported having donor support complementing a fair level of investment of domestic resources (KD-AGA Progress Report, 2011). Good overall performance was also reported in relation to the country’s HRH information system. Among specific progress indicators the following were viewed as areas for future focus: an institutional mechanism to share data to inform policy-making, in-country and rural retention of health workers, and the costing of its HRH plan.
HEALTH WORKFORCE DATA
- Latest data available at: Eastern Mediterranean Region Observatory on Human Resources Country Data for Djibouti
HUMAN RESOURCES FOR HEALTH PLAN
There is no current HRH strategic plan.