The paradoxical surplus of health workers in Africa: The need for research and policy engagement

Abstract

In many countries in Africa, there is a ‘paradoxical surplus’ of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un‐ or underemployed health staff. The emphasis in policy debates about human resources for health at most national and global levels is on staff shortage and the need to train more health workers. In contrast, these ‘surplus’ health workers are both understudied and underacknowledged. Little time is given over to understand the economic, political and social factors that have driven their emergence; the ways in which they seek to make a living; the governance challenges that they raise; nor potential interventions that could be implemented to improve employment rates and leverage their expertise. This short communication reflects on current research findings and calls for improved quantitative and qualitative research to support policy engagement at national, regional and global levels.

From humanitarian crisis to employment crisis: The lives and livelihoods of South Sudanese refugee health workers in Uganda

“…22 Uganda has a paradoxical surplus of qualified and licenced, but unemployed domestic health workers. 16,23 Chronic under-funding of health services and recruitment challenges mean that there is simultaneously a high 26% vacancy rate of health posts 24 and Uganda has only a sixth of the required human resources in position to achieve universal health coverage and the United Nations Sustainable Development Goals. 23 The Refugee Response Plan aims to ensure staffing levels are at 95% of government recommendations in refugee-hosting districts.…”

The workforce crisis in healthcare: Moving the debate to bridge evidence and policy

“…Social care workers 31 and HCW workers 32 in rural/remote areas of mostly high-come countries report shortages despite overall high HCW density; the example of Uganda highlights a paradoxical situation of co-existence of important shortages/low HCW density and overproduction/unemployment in some low-and middle-income countries (LMIC). 33 Studies on new or under-researched groups of HCWs in LMIC countries bringing novel solutions as well as vulnerable groups of HCWs in need of better protection into view. Community health workers (CHWs) 29,34 and refugee or displaced HCWs [35][36][37] show how these groups might help to mitigate HCWF shortages.…”

“…46 Governance gaps and policy failures at macro-and meso-levels are especially visible when looking at the inequitable geographical distribution and mismatches between need, demand and supply of HCWs. [31][32][33] They are also responsible for poor attention to equity measures and persisting gender inequalities, 12,13,30,39,40 as well as for the missing support for new nursing roles 43 and mental health needs of HCWs. 30 On a positive note, identifying poor governance as major problem highlights that change is possible!…”

‘Government don't know me and if I stop, they won't know’: A qualitative study on the lived experiences of volunteer health workers in the Nigerian health system and their implications for the sustainable development goals

“…They are similar to Community Health Workers (CHWs), in that they are drawn from the communities they serve and share the same ethnicity, language, and background 21 but CHEWS undergo more extensive training to enable them to provide maternal and child health care, immunizations, and family planning. 22 It is important to understand their roles in these facilities, documenting their lived experiences, 23 as this information could offer insights into ways to improve staffing in the Nigerian health system and beyond. These lived experiences encompass the personal, subjective, and often multifaceted aspects of their professional journey, including the challenges and rewards they encounter throughout their careers as health sector volunteers.…”