HEALTH-Watch By Dr. Osim (EPISODE V)
Our recent past as a nation has easily been marred by events that leave chapters of puckered stories that many would rather wish expunged from the catalogues of history.
At the time when the nation was faced with a call to battle by the EBOLA virus challenging the right-to-life of citizens and the right to existence of the nation, the defenders of the nation’s health frontiers were fighting a different battle—a battle whose very theme is still to be clear to Nigerians.
Surely the country won the acute EBOLA attack but sadly could not stand up to the chronic malady of health workers strikes whose impact in morbidity and mortality if told would easily make the war songs of Ebola sing small.
This imbroglio in the healthcare sector has shifted the nation’s attention from “the problems” to “a problem”—health workforce training, health workforce shortage, health workforce migration, abysmal working conditions of health workers, crippled health systems, etc, etc, etc.
Health workers—”all people engaged in actions whose primary intent is to enhance health” (World Health Report 2006) are endangered species especially in sub-Saharan Africa with Nigeria as true giant.
WHO estimates the global health worker shortfall to be over 4.2 million. That shortage is impairing provision of essential, life-saving interventions such as childhood immunizations, safe pregnancy and childbirth services for mothers, and access to treatment for AIDS, tuberculosis and malaria. As a result, people are suffering and dying needlessly.
In Nigeria the problem is rather skewed in being complicated with a lopsided distribution of health professionals in favour of urban centres. There is an uncomfortable mix of under-utilization and over-utilization of the skills of health professionals depending on the geographic location and professional category/sub-category involved.
The National President, Nigerian Medical Association, Dr. Osahon Enabulele, says there is an acute shortage of doctors, with a shameful doctor to patient ratio of one doctor to 6,400 patients. Other sectors of the healthcare workforce fare even worse.
Fifty-three years after independence, the nation’s health sector still contends with the exodus of doctors to foreign hospitals, dearth of specialists, dilapidated facilities, poor funding and revenue loss to Indian/Israeli hospitals. Name it, from access to quality health care, availability of modern medical equipment, provision of functioning up-to-date health facilities, to availability of manpower, Nigeria is lagging behind in the provision of quality health care for her citizens.
However, rather than discuss the truly cantankerous bale of issues bedevilling our health systems, the health workforce is serving – whether conscionably or unconscionable to deflect attention, distracting from the nations dismay by its actions and or inactions. These strikes give the government ample distraction and breathing space and how thankful they must be to their political lucky stars.
In the next three weeks, HEALTH-Watch will drive a recollection of and reflection on the recurrent spate of strikes embarked upon by deferent clans of the healthcare delivery community. We shall dissect for the purpose of discussion the physical, social, economic, spiritual and other consequences the situation has bestowed upon the good people of Nigeria.
We shall also attempt to appraise using crowd sourced information, the physical toll of this fast becoming EPIDEMIC which has largely remained untold, un-quantified and unsearched.
The HEALTH-Watch team has sent a verbal request to the leadership of Nigerian Medical Association (NMA) Cross-River State to send in their position regarding the recurrent strikes and their epidemicologic assessment of the impact of same. We are by this medium also extending similar request to other healthcare unions to send in lucid explanations for embarking on the just ended strike. HEALTH-Wacth will also welcome public opinions and articles on this issue.
We believe that citizens matter and deserve to know! Therefore HEALTH-Watch is opening up electronic channels to receive and publish comments, complaints and reports about the strike from citizens. This channel shall be made open by 0800hrs Nigerian time on Monday 9th February, 2014. We welcome spirited participation in the opinion polls we shall be conducting during this three weeks. Let’s talk people! Let’s talk frankly and politely.
To set the stage for the BIG discussion in the ensuing three weeks we will be serving this week’s HEALTHFUL-Words and also reviewing the WHO facts on health workforce crisis.
HEALTHFUL-Words (This week’s Health Quote).
The world’s biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5 – extreme poverty.
Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable and why mothers die in childbirth. It is the underlying cause of reduced life expectancy, handicap, disability and starvation.
Poverty is a major contributor to mental illness, stress, suicide, family disintegration and substance abuse. Every year in the developing world 12.2 million children under 5 years die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die because they are poor.
In the time it takes to read this sentence, somewhere in the world a baby has died in its mother’s arms. For that mother, the message that her neighbour’s infant will live is no consolation. It does not stem her grief to know that 8 out of 10 children in the world have been vaccinated against the five major killer diseases of childhood, or that globally since 1980 infant mortality has fallen by 25%, while overall life expectancy has increased by more than 4 years, to about 65 years.
—World health report: The state of world health 1995 (WHO)
10 facts on health workforce crisis
Fact 1: Health workers are people whose main activities enhance health. They include health care providers and people who manage and support delivery systems. Worldwide, there are 59.8 million health workers. Without them, prevention and treatment of disease and advances in health care would not reach those in need.
Fact 2: In 2006, WHO stated that a country with less than 23 doctors, nurses and midwives per 10 000 people is undergoing a critical health worker shortage. This is the case in 57 countries (36 of which are in sub-Saharan Africa).
Fact 3: The global health worker shortfall is over 4.2 million, with 1 million health workers needed for Africa alone.
Fact 4: Sub-Saharan Africa faces the greatest challenges. It has 11% of the world’s population and carries 25% of the global disease burden. Yet the region has only 3% of the global health workforce and accounts for less than 1% of health expenditures worldwide.
Fact 5: In comparison, North America and South America, which together have 14% of the world’s population but only 10% of the global disease burden, employ 37% of the global health workforce and are responsible for over 50% of the global health expenditure.
Fact 6: Many factors have led to the health workforce crisis, including growing economic disparities between countries and upsurges in new and old pandemics. Such pandemics pose special challenges to workers; for example, HIV/AIDS is a ‘triple threat’ to health workers, causing far bigger workloads, psychological stress, and the daily risk of HIV infection.
Fact 7: Training a nurse takes at least three years; training a doctor can take more than six. If action to expand the health workforce is taken now, effects will only begin to be felt years later. Innovative methods (distance learning, task shifting or community health worker programmes) can shorten this delay effect, but there is no “quick fix” to this problem.
Fact 8: Health worker migration is increasing due to disparities in working conditions, wages and career opportunities. One in four doctors and one in 20 nurses trained in Africa later migrate to work in more developed countries. In Africa and some Asian countries, a public sector physician’s monthly wage can be less than US$ 100; in higher resource countries, monthly salaries can exceed US$ 14 000.
Fact 9: WHO estimates that a rapid health workforce scale-up by 2015 would cost US$ 447 million on average per country per year. WHO advocates for 25% of the US$ 12 billion (2004 figure) devoted to international health aid to be spent on the health workforce.
Fact 10: The health workforce issue crosses many sectors – no single entity can successfully address it on its own. The Global Health Workforce Alliance has brought together a coalition of health leaders, civil society and workers to explore solutions to this crisis at the first Global Forum on Human Resources for Health in Kampala, Uganda in March 2008.
And so the curtain is drawn for this week. Until next week, it’s safe to say — Ishamali Azi!!!
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