The health sector human resource crisis in Africa : an issues paper

Key features of this crisis, as detailed in section I of this paper, are as follows: (1) In recent years many countries have suffered from scarcities of almost all cadres of health workers. (2) Production of health workers has not kept pace with need, especially with the ever-increasing burden of disease brought about by HIV/AIDS and resurgent epidemics. (3) Some countries have focused on producing less cost-effective cadres of health workers relative to the disease burden and long-term affordability. In addition, the scope of professional practice by each cadre has been too rigid and inflexible for African health settings. (4) The attrition of civil servants has reached critical rates due to the combined effects of accelerated retrenchment and voluntary retirement/departure, the search for greener pastures locally and abroad, and sickness and death, primarily due to AIDS. (5) Many government health workers are ill-motivated -- poorly paid and equipped, infrequently supervised and informed, and with limited career opportunities. (6) Many medical, technical, and managerial positions are now vacant, and scarce medical personnel are often (mis)used for management tasks. (7) Donor resources for training and HR development, though large in some countries, have been poorly coordinated and have not addressed the underlying cause of poor staff motivation. (8) Urban/rural imbalance in the distribution of health workers, a problem in the past, is worsening. (9) Personnel management systems are highly centralized and weak, and human resource planning and management has not been given the importance it deserves. (10) New structures, practices, and technologies are seriously straining the health sector"s already weak human resource base. (11) Finally, poor morale may be engendering adoptive and counter-productive behavior among health workers. Section II of the paper gathers together a few good practices and mechanisms that have been tried to ease the HR problems in the region. It highlights some opportunities for reform and cites the continuing challenges and risks.