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Kenya: To Get Enough Health Workers, Let's Think Outside the Box

Peter Ngatia

10 April 2008

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opinion

Nairobi — THE STORY IS TOLD ABOUT AN orthopaedic surgeon, one of very few practising in Kenya in the 1970s, who, though brilliant, had a major weakness for alcoholic beverages that often caused him to fall asleep in the middle of an operation.

Nevertheless, his patients were always wheeled out of the theatre with the operations having been done perfectly.

It turned out that his assistant, an old man called Karuri who had for many years watched the surgeon at work handing him scalpels and forceps and sutures, took over whenever his boss nodded off, doing everything exactly as he had seen the surgeon do countless times.

Not only did Karuri save the lives of those patients, he also filled a critical gap for a service for which there was great demand, but not enough providers.

While this story is certainly not meant to encourage every theatre assistant to grab a scalpel and start slicing up the next patient, it illustrates an innovative and practical solution to the desperate shortage of health workers globally, and Africa in particular.

FOUR MILLION HEALTH WORKERS are needed worldwide to save lives. Africa alone needs one million.

The urgency is fuelled by the HIV epidemic, which not only puts great pressure on already overburdened health systems, but which has taken a heavy toll on health workers, thousands of whom have died or are too ill to work. Faced with this crisis, and with no time or resources to fill this gap any time soon, we must begin to think outside the box.

Task shifting - described as "the rational redistribution of tasks among health workforce teams"- has been touted as an effective and sustainable way of harnessing and focusing on existing financial and human resources to ensure all people have access to healthcare.

At the just-ended First Global Forum on Human Resources for Health, held in Kampala, Uganda, it was agreed that governments should institute policies to enable scaling-up of health workers through approaches like task-shifting.

Though not new, task-shifting is only now receiving recognition as a means to expand the capacities of health systems to provide essential health services.

Examples of successful use of the concept abound. Many midwives are adept at setting up intravenous drips, which they are legally not allowed to do, but which they have had to anyway because there was no one else to do it.

Nor is it unheard of for a midwife or nurse to perform a Caesarian section when presented with obstructed labour and there is no doctor around.

Successful implementation of task-shifting requires training, as well as changes in laws and policies to accommodate such "skilled up" cadres of workers.

Health workers of any cadre must be trained to perform professionally and procedurally if they are to save lives, not endanger them.

In Mozambique and Malawi, nurses and midwives have been trained to set up intravenous drips and perform Caesarian sections, thus saving the lives of thousands of mothers and babies.

In Southern Sudan, the African Medical and Research Foundation (Amref) provides intense three-year training for clinical officers, that equips them to handle anything from surgery, psychiatry and paediatrics, to opthamology, orthopaedics and obstetrics.

There are several reasons for the shortage of health workers in Africa, including lack of training capacity and poor remuneration, discouraging many who would otherwise have entered the profession, and forcing many others to move to countries where they are paid more.

One issue that is rarely ever highlighted, though, is the limited budget allocated to health by most governments.

AFRICAN GOVERNMENTS ARE GUILTY of contributing to the crisis by failing to allocate enough money to train, absorb and retain health workers. In 2001, African Heads of State pledged in Abuja, Nigeria, to spend at least 15 per cent of national budgets on health. So far, only two countries have met that target (Botswana and the Gambia).

Equally guilty is the donor community, which has been paying lip service but not doing enough to correct the situation.

So where do we go from here? The Kampala meeting produced a 12-point agenda urging governments to act immediately on up-scaling and up-skilling their health workforce, increasing budgets to finance development and retention of workers.

In Africa, successful production of adequate health workers will require innovation and committed partnerships between governments, civil society, donors and communities to ensure provision of health services that are accessible, equitable and of good quality.

Dr Ngatia is the director, capacity building, African Medical and Research Foundation.

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