Wanted: Human Resources for Health Agenda (1)

As we approach the 2019 elections, political parties and candidates have started regaling Nigerians with promises. It is imperative to focus the mind of the contestants to a critical area of the health sector – human resources for health. The personnel, who operate and manage the National Human System is the most important factor in the delivery of quality of health care. S/he coordinates other factors and resources needed to meet the right to health of citizens and residents of Nigeria. Therefore, one of the core questions for political contestants will be on how governance after the elections, will be used to increase the number of available human resources for health, and guarantee that they deliver optimum services in a friendly and enabling environment.

Essentially, how will the political party increase the number of physicians, pharmacists and other health workers in Nigeria to match the national health priorities? The extant numbers of health personnel is not sufficient to meet the demands of healthcare in Nigeria. The National Health Policy 2016 states that there are 65,759 medical doctors amounting to 38.9 per 100,000 Nigerians; 249,566 nurses and midwives being 148 per 100,000 Nigerians; 16,979 Pharmacists at 10 per 100,000 population; 1,286 Radiographers at 0.76 per 100,000 population; 19,225 Medical Laboratory Scientists at 11.3 per 100,000 population while physiotherapists number 2,818 at 1.7 per 100,000 population. Further Community Health Officers (CHOs) are 5,986 at 3.5 per 1000,000 population; Community Health Extension Worker (CHEWs) are 42,938 at 25.3 per 100,000 population while Junior Community Health Extension Workers are 28,458 in number at 16.8 per 100,000 population. These figures are way below international standards on the ratio of health workers to the population. These ratios put a lot of demand and stress on available medical and health personnel.

Experts have posited that the availability of trained medical and health professionals and personnel receiving domestically competitive salaries is one the indicators of availability of functional public health and health care facilities and services. Health facilities need adequate personnel to deliver effective service. The Basic Health Care Provision Fund established by section 11 of the National Health Act sets aside 10% of the Fund for the development of human resources for Primary Health Care. Section 41 of the Act is on the development and provision of human resources in the National Health System. It states: “(1) The National Council on Health shall develop policy and guidelines for, and monitor the provision, distribution, development, management and utilisation of human resources within the National Health System. (2) The policy and guidelines stated in subsection (1) of this section shall amongst other things, facilitate and advance: (a) the adequate distribution of human resources; (b) the provision of appropriately trained staff at all levels of the National Health System to meet the population’s health care needs; and (c) the effective and efficient utilisation, functioning, management and support of human resources within the National Health System”. It further provides in section 43 (d): “The Minister shall make regulations with regard to human resources management within the National Health System in order to: identify shortages of key skills, expertise and competence within the National Health System, and prescribe strategies which are not in conflict with any other existing legislation, for the education and training of health care providers or health workers in the Federation, to make up for any shortfall in respect of any skill; expertise and competence”. These provisions envisage a knowledgeable and dedicated Health Minister and his team who will pilot affairs to achieve appropriate numbers and skills of health personnel.

Another major challenge is the uneven distribution and spread of available health personnel as they are not equitably distributed across the Federation. They are concentrated in the urban areas and there is a wide disparity between the North and South of Nigeria and across geopolitical zones. How will the party achieve equitable spread across the Federation? Three examples of the disparity will be shown. For medical doctors; 9.73%, 4.06%, 8.35%, 19.59%, 14.37% and 43.9% are in the North Central, North East, North West, South East, South South and South West geopolitical zones respectively. For Pharmacists, 19.94%, 3.8%, 7.79%, 11.74%, 12.39% and 44% are in the North Central, North East, North West, South East, South South and South West geopolitical zones respectively. Nurses – 16.4%, 11.65%, 13.52%, 15.29%, 27.75% and 15.35% are in the North Central, North East, North West, South East, South South and South West geopolitical zones respectively.

Would the political party consider incentives for health personnel to work in the rural areas and certain disadvantaged parts of the country? Incidentally, the areas that attract the least health personnel seem to need them the more. Section 42 of the National Health Act states as follows: “The Minister, with the concurrence of the National Council on Health, shall determine guidelines that will enable the State Ministries and Local Governments to implement programmes for the appropriate distribution of health care providers and health workers”. How will the party, through its elected officials, put this into practice?