Human Resources

Ethiopia is preparing for a major influx of medical doctors within three to four years, as government intends to save a public health system that has been losing doctors and specialists to internal and external migration. Medical schools report enrollment of more than 3,100 students, representing a tenfold increase from 2005, when less than 300 students enrolled. A draft of the country's Human Resource for Health Strategic Plan shows an intended increase in the number of physicians to 1 per 5,000 people by 2020. The plan seems on course, with a report presented to parliament in May 2012 revealing that 2,628 students had been enrolled in 22 universities over the previous nine months. Currently fewer than 200 doctors graduate annually. With the strong emphasis on health personnel numbers, experts have expressed concerns about the quality of medical education, a allegation that the Health Minister acknowledges, adding that government is taking steps to strengthen training of doctors through the Medical Education Partnership Initiative (MEPI), networking with known universities in the United States and offering students incentives to study further.

The Health Service Extension Programme (HSEP) is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs), who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia's community health system. This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. A random sample of 60 female heads-of-household in a remote area of Tigray participated in a structured interview survey. While the introduction of HEWs has been a positive experience for women living at the study site, the frequency of visits, extent of effectively imparted health knowledge and affects of HEWs on other health providers needs to be further explored.

This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision. A qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania. Despite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities. The authors noted that although training of primary health workers is useful, it is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro.

There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the US(59%) or the UK(49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or UK/US practices were less likely to express a sense of professional obligation and/or loyalty to the country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intention to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall.