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Monday, September 25, 2017

Health Workforce and Governance: The Crisis in Nigeria

All persons involved in activities primarily devoted to enhancing heath in the health workforce is an important block of any functioning health system in any country. In the absence of which clinical and public health services cannot be delivered to the population (World Health Organization, 2006). The health governance-led steering and rule-making functions targeted at achieving national health policy objectives for effective delivery of health services and attainment of universal health coverage (World Health Statistics 2014).

Experts have shown direct links between efficient health system governance and promising health workers outputs, which ultimately have positive effects on overall health outcomes (World Health Organization, 2007). However, poor administration and continued underinvestment in health even with the spread of HIV/AIDS, re-emerging diseases and persistent violent conflicts, have contributed greatly to the fragile health systems in many African states (Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, et al, 2004). While there have been calls for concerted efforts- social, economic, environmental and multisectoral towards health system strengthening in sub-Saharan Africa (Senkubuge F, Modisenyane M, Bishaw T, 2014), human resources' crises in the health sector have continued to be a major challenge (Dovlo D, 2003).

Many African countries' governmnets have reported challenges in training, funding, employment, capacity building and efficient deployment of the health workforce (Dovlo D, 2003). Consequently, the continent has continued to experience a rapidly progressive health workforce migration to high-income settings in search of better opportunities (Dovlo D, 2007).
Crises within the health workforce have been repoted as perhaps the biggest constraint towards global health system develoment and sustenance, particularly in Africa (Dovlo D, 2007).

According to the World health report in 2006, 57 countries were in severe health workforce crises, with 37 of these in Sub-Sahara Africa. A region with only 3% of global health workforce, despite contributing about a quarter to the global disease burden (World Health Organization, 2006).
Nigeria, the most populous country in Africa, possibly contributes even more to these crises in the region. Increasing annual rates of population growth, as observed in Nigeria, has been adjudged a major factor in countries with severe health workforce crises (PacquƩ-Margolis S, Muntifering C, Ng C, Noronha S, 2011). Nigeria requires significant increase in the number of additional health workers to achieve desired population coverage. However, beyond the shortfall in health workforce, the Nigeria health sector has particularly experienced a number of other lingering crises inrecent times.
There are growing concerns locally and internationally over these issues with this linked to the overall poor states of health governance in the country (World Health Organizatio, 2016).  Persistently low and inequitable distribution of health workers remain a major challenge in the Nigerian health sector (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016). Bangdiwala stated that there is a global crisis in health workforce by acute shortages and uneven distribution of health workers in several settings (Bangdiwala SI, Fonn S, Okoye O, Tollman S, 2010). In Nigeria, experts have reported that historically, "brain drain", in the form of migration of health workers to high-income settings, has been a major setback in the country (Ike So, 2007).

Current statistics show that 1 in 4 doctors, and 1 in 20 nurses trained in Africa are currently working in developed countries, with this accounting for a shortfall of over 1.5million health workers in the region (World Health Organization, 2014). In Nigeria, the health workforce density is estimated at 1.95 per 1000 population (World Health Organization, 2016). According to the report of Abimola, this shortfall in Nigeria has been complicated by gross inequity in the distribution of health workforce, as there is no national policy guiding the postings and transfers of health workers-redeployment is often based on discretion of administrative officers with multiple influences and several competing interests (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016).


World Health Organization. The World Health Report 2006—working together for health. Geneva: World Health Organization; 2006.

World Health Organization. Health systems. In: World Health Statistics 2014. Geneva: World Health Organization; 2014. p. 128–40.

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7:23568.

Dovlo D. Wastage in the health workforce: some perspectives from African countries. Hum Resour Health. 2005;3:6.

Dovlo D. Migration of nurses from sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;32(3):1373–88.

PacquƩ-Margolis S, Muntifering C, Ng C, Noronha S, IntraHealth International. Population growth and the global health workforce crisis. Washington: United States Agency for International Development; 2011.

World Health Organization. Nigeria. In: Global Health Workforce Alliance. Geneva: World Health Organization; 2016.

Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL: Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria. Int J Health Plann Manage. Int J Health Plann Manage 2016, Epub ahead of print.

Bangdiwala SI, Fonn S, Okoye O, Tollman S. Workforce resources for health in developing countries. Public Health Rev. 2010;32(1):296–318.

Ike SO. The health workforce crisis: the brain drain scourge. Niger J Med. 2007;16:204–11.

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