Human resource challenges in the delivery of primary health care
The national health policy regards primary health care as the framework to achieve improved health for the population through the carefully articulated PHC components which includes, health education; growth monitoring and nutritional promotion; safe water and sanitation; reproductive health, including family planning; immunization against vaccine preventable diseases; provision of essential drugs; treatment of minor ailment […]
The national health policy regards primary health care as the framework to achieve improved health for the population through the carefully articulated PHC components which includes, health education; growth monitoring and nutritional promotion; safe water and sanitation; reproductive health, including family planning; immunization against vaccine preventable diseases; provision of essential drugs; treatment of minor ailment and disease control, mental and dental care. The policy document requires that a comprehensive health care system delivered through the primary health centres should include maternal and child health care, including family planning services. Since the adoption of the Nigerian National Health Policy in 1988, several health policies have been formulated and adopted in the country.
If effectively executed, most of these policies would have contributed positively to the achievement of an acceptable health status for Nigerians. Unfortunately, this has not been the case and our current national health indicators have remained dreadfully poor. Unless there is a drastic transformation or total change in the performance of our health system at all a level, it is most unlikely that we will achieve any remarkable improvement in the health status of Nigerians and this will in general not exclude the health targets of the millennium development goals (MDGs). There are great disparities in health status and access to health care among different population groups in Nigeria. For example, the under-five mortality rate in rural areas is estimated at 243 per 1,000 live births, compared to 153 per 1,000 in urban areas (DHS 2004). While 59 percent of women in urban areas deliver with a doctor, nurse, or midwife, only 26 percent of women in rural areas are privileged to have that opportunity of delivery under trained skilled and personnel (DHS 2004).
The necessity for this change is most crucial at the primary health care level; the recent move to introduce the MSS is a commendable effort that is expected to reverse the negative trend. It is generally acknowledged that human resources,[ the health workforce], play a major role in producing health outcomes, it is indisputably true no health system can function effectively without an effective workforce. Unfortunately however, several challenges constrain the smooth-functioning and effectiveness of our Primary Health Care workforce in Nigeria.
Attainment of an effective workforce for PHC will require the recruitment of appropriate personnel which must be potentially effective, optimizing the performance of the existing personnel and retaining them in the system. There is at present and to some extent uncontrolled production of the community health practitioners’ cadre. Inevitably workers in this cadre render health services beyond their competence, particularly in areas that have health worker shortages linked to unemployment which is equally very high in this cadre of PHC personnel.
The disparity in the remuneration packages and schemes of service between health workers on federal, state and local government payrolls gives cause for concern as do the low morale, inter-cadre conflicts and poor job-satisfaction among health workers. The continuing migration of health personnel to other countries is equally a major challenge; It is gratifying that the Federal Ministry of Health (FMOH) has recognised that these problems exist. Hence formulate a National Human Resources Health Policy (NHRHP), but it is very worrying that the policy has remained since 2006 and is not being implemented
Most states in Nigeria could not boast of having HR department in their state ministries of health that could be charged with HR mapping and planning, but rather remains to having the stone aged departments of the various health professions which in the end does not promote productivity but professional conflicts and defence of interest.
Training institution for PHC workforce is grossly inadequate considering the population of the service consumer especially the rural areas being the domiciliary point for the delivery of greater part of PHC services, in one of our states with a population of over 10 million people cannot boast of having more than one School of Health Technology not more than one School of Nursing and Midwifery. This is awfully inadequate considering the population ratio and the requirement for the delivery of quality PHC service.
Taking into account our universities and some institutes of higher learning in their efforts to put in place the needed high calibre work force for PHC, one will be made not to believe them as doing anything serious for PHC, but rather self and professional promotion in the pursuance of greener posture for their old boys and alumnus. Today the highest training opportunity for authentic and reliable Primary Health care worker in most of the Nigerian universities is Community Health Officers course [CHO] which is grossly inadequate for effective delivery at higher level of performance, design for opportunities to surpass for Master’s and PhD degrees in Nigeria is limited to the core PHC workers which is a big short fall in the sector.
Real needs are those that require appropriate fulfilment and they may be both felt or unfelt. Demand is generated by felt need, and needs and demands require effective provisions. Effective provisions represent the capacity of the health systems to satisfy the real needs within the technological and other resources of the society. Use is not the same as effective provision although it is easier to measure.
Aminu Danmalam, Director Primary Health Care, Gunduma Health System Board, Dutse, Jigawa State, [email protected]