During the pandemic, around half of the world’s health workers experienced burnout, while 55 countries face serious shortages of health workers, exacerbated by the poaching of skilled staff by wealthier countries, and a situation that is steadily worsening.
Africa is facing the most pressing challenges, with a projected shortage of 5.3m health workers by 2030, reports Health Policy Watch.
Many countries are struggling to retain health workers, and mitigate their mobility and migration.
This, and other issues, came under the spotlight among delegates at the recent three-day Fifth Global Forum on Human Resources for Health in Geneva.
However, they said, the immediate challenge that needed to be addressed was the burnout, and how to support health workers and deal with the challenges around post-traumatic stress disorder, said Professor James Buchan from the Health Foundation.
“We’ve identified the central role of government in taking forward the agenda to protect and invest (in health workers), which is primarily a government responsibility, but we also recognise many stakeholders are part of the solution, and we need to come at this together,” he added.
He said mobility and migration had also been “a core concern for many years now”.
But because of the pandemic, they have become even more pronounced. “Demand for healthcare workers is up. Supply is constrained.”
Unite in support
Ghana’s Health Minister Kwaku Agyeman Manu appealed to global delegates to support the Africa Health Workforce Investment Charter, spearheaded by his country last year after Covid-19 exposed continental weaknesses.
The charter aims to align and stimulate investments to halve the inequities in access to health staff, especially in countries with the greatest shortages.
“The 5.3m shortage comes amid 30% unemployment or underemployment among graduates,” said Manu. “We are also adversely impacted by unmanaged migration. This is not just an African problem for Africa. The world is interdependent; we must act together.
He said it was time for governments to show leadership in health workforce investments – to align and synergise efforts … in prioritising health workforce investments.”
Ghana itself has managed to increase its workforce by 90 000 despite financial constraints.
Conversely, in Nigeria, however, while the population is expanding geometrically, the healthcare workforce is shrinking drastically: the doctors-to-patient ratio has dropped to 1:10 000 as against the WHO’s recommended 1:1 000.
The mass exodus of skilled medical practitioners is deepening the existing healthcare crisis, with very few medical personnel available to treat citizens.
Leadership reports that Nigeria lost more than 9 000 doctors to the UK, Canada and the US between 2016 and 2018. Additionally, 727 locally-trained doctors moved to the UK alone in just six months, between December 2021 and May 2022.
The data from the Register of the Nursing and Midwifery Council (NMC) of the UK shows that the number of Nigeria-trained nurses increased by 68.4%, from 2 790 in March 2017 to 7 256 in March 2022.
In fact, Nigeria retains a minuscule percentage of the 4 000 doctors produced annually, according to the Medical and Dental Consultants’ Association of Nigeria (MDCAN).
MDCAN president Dr Victor Makanjuola said: “We probably retain just about 30% of those retrained on an annual basis, and are retaining about 30% of about 4 000 produced annually.”
He said Nigeria was already in crisis and it would sink into deeper crisis unless a mechanism was put in place.
He said: “If we retain 30% of 12 000, it’s better than 30% of 4 000. With that we think we can still support the system, not optimally but at least keep the system going.”
Meanwhile, a Bill to halt emigration of medical and dental practitioners until after five years, has passed second reading stage in the Nigerian House of Representatives.
The Bill’s aim is “…to amend the Medical and Dental Practitioners Act, Cap M379, Laws of the Federation of Nigeria 2004 to mandate any Nigerian-trained medical and dental practitioner to practice in Nigeria for …five years before being granted a full licence by the Council … to make quality health services available to Nigeria; and for related matters (HB.2130).”
Added Makanjuola: “No one would, based on patriotism alone, leave a situation where they will be paid 10 times more what they are currently being paid and provided with positive living conditions and decide to stay in a place where you are paid 10 times less, sometimes 50 times less. That’s the challenge, why we are encouraging the government to do its part, while we do our part in increasing the numbers that are produced.”
World Health Organisation (WHO) director-general Dr Tedros Adhanom Ghebreyesus said he would establish “a multi-sectoral advisory group of experts to provide … the evidence for action in support of national health policy and workforce priorities”.
WHO is recommending all countries increase the graduation of health personnel to reach 8% to 12% of the active workforce per annum. This means a country with a total of 5 000 physicians would need to graduate between 400 and 600 physicians annually to maintain and improve capacity in relation to population needs and health system demand.
Leadership article – Concerns As More Medical Practitioners Leave Nigeria (Open access)
See more from MedicalBrief archives:
Global healthcare systems struggling under increasing pressures
SA nursing under threat as UK, Canada lure staff to address crippling shortages
Primary care physicians experience more burnout and anxiety
Anger over Ugandan plans to export doctors
Practitioner burnout contributing to clinical errors — MPS survey