Manpower inadequacies, poor infrastructures, rural/urban divide associated with disparity in amenities, and many more were the common phenomena associated with the health sector in time pasted. As some will argue – this writer inclusive- this poor leadership associated quagmire is still confronting our present society. These challenges are more daunting now than ever due largely to increase in population, disease and other health challenges in reverse relationship with the health workforce number and improved infrastructure available.
In response to these challenges, Dr. Olikoye Ransom-Kuti, a Minister of health during the administration of Gen Ibrahim Babangida, sought to address the issue surrounding the health workforce. This approach led to the establishment of Community Health Extension Workers (CHEW) and Community Health Officers’ (CHO) training in the colleges of health technology. The idea was to provide low to mid-level trained health professionals with the skills to provide health care at the community level in response to the unwillingness of the highly trained doctors and nurses to practice in rural communities.
This action provided the opportunity for the larger proportion of the society –at the time representing over 70%- to receive health care services within reach, as most of the trained personnel’s were respected residents of the community they served. With the population of rural Nigeria, contributing over 54% of the total population and a corresponding population growth, the demand for health care professionals is at its peak.
Current statistics show that there are about 35,000 medical doctors currently practising in Nigeria. Although medical schools in Nigeria produce far above the stated figure, others have either moved away from the shores of Nigeria in pursuance of greener pastures or have moved into other fields of endeavour. By the World Health Organisation (WHO) standard, the proportion of doctors to patients that will be classified as sufficient is 1:600. By this, Nigeria will need an additional 237,000 doctors to meet the health needs of the entire population. If Nigeria must meet this standard, at the rate of production of doctors by medical schools and assuming all trained doctors remain in practice, it will take 100 years to meet this need.
In the wisdom of Dr Ransom-Kuti, envisaging this fallout in the future, he pushed for the establishment of the community health extension workers. Sadly, the Community Health Extension Workers have almost become an endangered species, with the number of trained personnel decreasing at an increasing rate. Increasing rivalry in the health sector displayed in the fight for supremacy and relevance among medical doctors and other health professional has contributed to almost complete relegation of the Community Health Extension Workers and Community Health Officers to an obscure state. In the bid to find relevance, some of these trained personnel are converted to cleaners and administrative staff in tertiary and secondary hospitals.
This is largely due to the disregard decision and policy makers at the ministry of health and other agencies place on the health personnel. Most Community Health Extension Workers are not employed by the government and when employed by private individuals, they are converted to domestic staff. With exception of programmes funded by development partners targeted at the community level (where Community Health Extension Workers are employed), most focus on utilising other skilled health professionals.
Over the years Nigeria has suffered from high maternal and infant mortality and morbidity with a large population of rural dwellers representing a large segment of that population. Despite the funds invested in training and retraining of traditional birth attendants and faith-based maternity operators, little positive result has come of that adventure. Having realised the low returns on training aimed at improving maternal health and despite large investments on this cadre of health providers, WHO declassified them as skilled health providers.
While countries like the United Stated of America and United Kingdom are investing and encouraging the training of physician associate -the equivalent of the community health officers in urban centres in the writer’s opinion- Nigeria is eliminating theirs. These nations have realised the need for mid-level health professionals to meet the needs of their ever increasing population. Though Nigeria knows the advantages of these community health workers, she is yet to maximise their use. It is pertinent therefore; to review the role of this key grassroots health workforce if issues of human resource for health must be addressed. Rather than neglect their skill set, more training should be given to enhance their competence to meet the challenges of health care in Nigeria.
Chimankpam Williams Uzoma
