Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000). In recent years migration to foreign countries has declined and the primary challenge for Nigeria is inadequate production and inequitable distribution of health workers. The health workforce is concentrated in urban tertiary health care services delivery in the southern part of the country, particularly in Lagos (HRH Country Profile: Nigeria, WHO GHWA, 2008). This inequity has been attributed to:
- lack of public and private sector coordination;
- favoring indigenous hires;
- commercial pressures in the private sector that lead to poor quality work;
- work environments that contribute to low motivation, less-than-optimal productivity, high attrition - especially from rural areas; and
- lack of planning based on staffing projection needs resulting in an overproduction of some categories of health workers and a lack of others (Federal Republic of Nigeria HRH Strategic Plan 2008-2012).
These challenges are further compounded by the fact that the federal government accepts and regulates 3 systems of health care delivery: orthodox, alternative, and traditional. The absence of a common HRH and data collection system leads to a lack of coordination in collecting HRH information, which means various stakeholders get fragmented information.
Current strategies to manage HRH maldistribution and attrition include:
- use of telemedicine;
- financing/aid arrangements with other countries where significant populations of Nigerian health workers live plus efforts to enable easier transition to Nigeria; and
- actively managing brain drain.
One successful approach is the Midwifery Service Scheme (2009). It mobilizes unemployed and retired but able midwives and newly qualified graduates from Nigerian Schools of Midwifery to rural communities for 1 year of community service.
Key objectives of the current HRH policy include:
- providing a framework for objective analysis;
- implementing and monitoring measures;
- aligning health worker supply with health sector needs;
- applying best practices to HRH management and development to promote equitable distribution and retention of the quality and quantity of HRH to ensure universal access to quality health services;
- institutionalizing performance incentives and management systems that recognize hard work and service in deprived and unpopular locations;
- fostering collaboration among public sector, non-government providers of health services and other HRH stakeholders; and
- strengthening the institutional framework for HRH management practices.
Some states, such as Jigawa, already have begun adopting these national policies based on their needs. National HRH policies are expected to be adopted universally in Nigeria by the end of 2015.
COUNTRY COORDINATION AND FACILITATION (CCF) IN NIGERIA:
Nigeria has developed HRH policy, strategy and plan to ensure the continual availability of an adequate pool of skilled human resources for health. Effective implementation of these strategies and plans needs the active engagement and involvement of all key HRH stakeholders, including a large private sector. Obtaining relevant data for HRH planning and monitoring has also been a challenge from such diverse stakeholders. In November 2011 at the First National Conference on Human Resources for Health, the Federal Ministry of Health formally launched the national HRH forum and steering committee made up of various government ministries, academia, private sector, and regulatory and professional bodies.
With the support of the Alliance, the implementation of the CCF process in Nigeria has resulted in or contributed to the following achievements:
- orientated stakeholder groups to HRH issues and solutions under the CCF process,
- reviewed and validated the comprehensive National Human Resources for Health Policy in consultation with all the key stakeholders, linked to the health sector development plan,
- reviewed and validated a National Human Resources for Health Strategic Plan (2008-2012) to operationalize the Policy,
- convened the first ever national HRH conference attended by various HRH stakeholders from federal and state governments, regulatory bodies, professional associations, academic institutions and private practitioners,
- established the Nigerian National Human Resources for Health Forum and HRH steering committee to co-ordinate efforts of stakeholders in analysis, planning, financing, implementation, monitoring and evaluation,
- conducted stakeholder analysis and expanded existing HRH technical working group to include more stakeholders for HRH co-ordination in Lagos State (in collaboration with PATH2),
- updated and validated HRH situation analysis in Lagos State (in collaboration with PATH2),
- developed an HRH strategic plan for Lagos State based on the National Strategic HRH Framework and national health sector development plan (in collaboration with PATH2),
- shared experiences from Lagos State with other states leading to resolution to establish HRH co-ordination structures in all 36 states and Abuja Federal Capital Authority,
- introduced a new salary scale for health workers and introduction of specialist allowances for specialist physicians.
The National HRH Forum Steering Committee includes members from the following stakeholder groups:
- Federal Ministry of Health; Education; Finance; Labour;
- Federal Civil Service Commission,
- Manpower Development Division/Office of the Head of Civil Service of the Federation,
- National Universities Commission (NUC),
- Tertiary Hospital Service Commission,
- National Primary Health Care Development Authority,
- Representatives from Registration Bodies,
- Representatives from Professional Bodies,
- Representatives of bilateral agencies,
- Representatives of Non-governmental Organizations,
- Representatives of private for profit sector.
HEALTH WORKFORCE DATA
HUMAN RESOURCES FOR HEALTH PLAN
HEALTH SECTOR STRATEGIES / PLANS
COUNTRY CASE STUDIES & OTHER DOCUMENTS
- A Situation Assessment of Human Resources in the Public Health Sector in Nigeria, Chankova S et al. [pdf, 890kb]
- Browse the HRH Global Resource Centre, Capacity Project knowledge gateway
ALLIANCE MEMBERS WORKING IN NIGERIA
- African Council for Sustainable Health Development
- Afro-European Medical and Research Network (AEMRN)
- American Professional eXchange Association (APXA)
- Babcock University, Nigeria
- Center for Public Health, Umuahia Abia State Nigeria
- Centre for Hospital and Health Services Improvement - CHAHSI Nig.
- Clinton Foundation HIV/AIDS Initiative
- Community Health Information Education Forum (CHIEF)
- Deloitte Consulting LLP (Deloitte Consulting)
- Eco Corp PLC, Ikeja, Lagos , Nigeria
- Human Care and Health Development Foundation, Port Harcourt, Nigeria
- Initiatives Inc.
- Institute of Child Health & Primary Care
- Rakiya Rural Approach Network, Kaduna, Nigeria
- University of Benin Teaching Hospital, Nigeria
- University of Buea, Faculty of Health Sciences, Buea, Cameroon