Achieving the health Millennium Development Goals in Africa requires training a dynamic and skilled health workforce. Most African countries suffer from considerable underfunding of the health sector, along with critical health workforce shortages, poor distribution and inadequate performance. Health sectors in Africa face serious challenges in producing, employing, incentivizing, motivating and managing results-based performance. Globally, Africa ranks the lowest in the availability of health personnel. In 2006, 36 of the 57 countries with critical shortages in health workers per population were in Sub-Saharan Africa. With 12% of the world’s population and 25% of the world’s burden of diseases, Africa has only 3% of the world’s health workforce. The problem is more acute in rural areas, which fail to attract and retain even the minimum number of motivated and skilled health workers. In 2006 roughly 1.5 million additional health workers were required in Africa to meet the minimum density of 2.28 health workers per 1,000 people needed to provide essential care.
Salary is considered the most important factor for retaining health workers in Africa. For example, when Ghana increased wages for its public health workforce the attrition rate dropped by 1.5% a year among younger workers. However, this is not the only factor. Health workers with a rural background are more likely to work in rural settings, as seen in Ethiopia and Rwanda. In schools designed to train health professionals, admission policies that seek to increase the number of students with a rural background can be successful. Similarly, placing schools outside of capital cities encourages rural deployment in the Democratic Republic of Congo and Mozambique.
Using information and communications technology (ICT) to support distance learning has had a positive impact not only on educating but also on motivating and retaining rural health workers in Tanzania. Malawi has implemented an innovative program about human resources for health (HRH), including skills substitution, to enhance the training, deployment and retention of health workers. The program is credited with saving 13,000 lives, largely through greater coverage of reproductive, maternal, newborn and child health interventions. Some African countries have linked pay to performance to deliver more value for the money available (results-based financing in Rwanda) and improve outputs, service quality and outcomes.
Under the Harmonization for Health in Africa HRH Community of Practice, the Bank is helping African countries deal with HRH issues:
- It has brought private investment to East Africa through a public-private partnership to establish regional centres of excellence in medical education, biomedical engineering and social sciences postgraduate education and research.
- It is coordinating health development partners through the Harmonization for Health in Africa and various communities of practice (HRH, health, financing).