Strengthening human resources in Africa’s public health sector is an urgent need to ensure that trained health professionals are available in the right numbers, evenly distributed geographically across urban and rural communities, and are sufficiently motivated to deliver quality health services, according to Ofure Odibeli and Chimezie Anyakora in an article.
Although Africa’s health system has always been confronted by a grossly understaffed workforce, increasing economic strains and fragmentary health service reforms have resulted in a massive brain drain that further weakens the already fragile health system. But the current shortage of skilled professionals, especially in the African health sector, has continued to be a huge setback on the path to achieving universal health coverage on the continent.
Studies have shown that the disparity in Africa’s health workforce, Nigeria in particular, is significant and multifaceted. Africa has only 3 percent of the global health workforce but bears over 25 percent of the global disease burden, in contrast with the Americas, which has only 10 percent of the global disease burden but 37 per cent of the world’s health workers.
The World Health Organisation (WHO) recommends a minimum density of 4.45 health workers (doctors, nurses, midwives) per 1,000 people. Most African countries fall well below this threshold. More worrisome is the fact that health workers are concentrated in urban areas, leaving rural and remote communities severely underserved, leading to inequitable access to healthcare, especially in primary healthcare. Even in the urban areas, many African health professionals migrate to more conducive nations for better pay and working conditions, exacerbating the workforce shortage at home. This has made the issue of brain drain a major epidemic African governments have no solution to yet.
Also, limited capacity and funding for training institutions result in too few graduates to meet demand. In addition, continuous professional development is also lacking, affecting quality of care. Most sadly, where they are available, community health workers are often underpaid or unpaid, despite being vital to the healthcare delivery system.
The disparity between the percentage of the global disease burden and that of the world’s health workers is not encouraging, as there is also a huge geographic disparity within most African countries. As we know, the distribution of health workers is slanted in favour of urban areas, as most health workers are most unwilling to stay in primary health facilities that are typically unequipped and in rural areas where social amenities are lacking.
Tackling Africa’s public health workforce crisis, we believe, should begin with strengthening human resources in Africa’s public health sector. This should be seen as an urgent need to ensure that trained health professionals are available in the right numbers, evenly distributed geographically across urban and rural communities, and are sufficiently motivated to deliver quality health services. To achieve this will require addressing the various factors that influence the healthcare human resources capacity. Among these is having the political will; strong political commitment and engagement are needed to improve the African health workforce. African governments should fulfil the commitment made by the leaders of the African Union (AU) in April 2001 at Abuja. Here, the heads of state and government of the AU made a commitment to allocate 15 percent of the annual budget to improve the health sector. From records, while Rwanda and South Africa have achieved this commitment, Nigeria still lags. Nigeria’s health budget for 2025 is N2.48 trillion, approximately 5.18 percent of the total N47.9 trillion budget.
African governments need to provide legislation and incentives that will facilitate public-private partnerships. Such public-private initiatives should invest in the training and capacity building of health workers, strengthen and equip healthcare facilities, and provide more incentives for health workers.
To attract and retain trained health professionals, African governments should redesign the remuneration system to prioritise health workers, improve salaries and implement improved welfare and benefits schemes, and extend the working life of healthy health professionals. It is good news that some sub-regional governments are doing this already.
To improve the distribution of human resources to rural communities, African governments should provide financial incentives for health workers in rural areas. Also, there should be prioritisation of access to further training and fast-tracking of promotions and career development opportunities for staff working in underserved areas.
The use of innovative solutions and new technologies in service delivery will increase productivity of health workers, allowing health workers to reach more patients effectively, particularly those in remote areas. This will reduce the burden on the limited human resources available in the healthcare system.
The African healthcare sector needs a strong workforce to handle the huge global burden of diseases on the continent. Addressing the various challenges confronting human resources retention, productivity should therefore be accorded the highest priority for achieving better health outcomes.
Finally, we see Africa facing a critical mismatch between healthcare needs and the availability, distribution and capacity of its health workforce. To address this will require systemic reforms, investment, and internal and external collaboration.
