Need for human resources in primary care at sub-Saharan Africa.


Why there is an inverse primary-care law in Africa

Many sub-Saharan African countries are trying to develop ambitious plans for universal primary care, but they are failing to deliver them because of human-resource problems. For example, half of the health-workers posts were vacant in Uganda in urban and rural health centers in 2009.

Solidarmed picture of a Mission Hopital in Zimbawe

An analysis carried out by interviewing health workers born sub-Saharan Africa showed the reasons why they had not taken up these vacant posts in their own country. Instead of staying in their own country to deliver primary care, they have migrated to Europe (Belgium, the UK or Austria) or to Southern African countries. Some interesting arguments done by these migrated doctors and nurses are explained in the next lines.

The three main reasons given for choosing not to work in primary care in sub-Saharan Africa were a poor working environment, difficult living experiences, and a poor career path. The professionals explain in stark human terms that there is such an intractable gap between government aspirations and the actual provision of effective primary-care services in sub-Saharan Africa. The fact that there is a shortage of medicines and equipment, an unmanageable workload and no professional support affects the quality of the primary-care.

Many respondents had concerns about personal security in primary-care settings, and also about living conditions for them and their family (“There are no big schools”, said a doctor from Guinea). Another reason for migrating is the lack of opportunities to earn a good salary.

Although these difficulties are not restricted to the primary-care sector, they affect it most acutely, because of the exposure to poor social opportunities, personal insecurity, and the poor working conditions in the deprived areas where the primary services are placed.

Face of Malawi picture of an African hospital

It is known that it is not a new problem. It was in the UK in the 60`s, date when universal health coverage was getting introduced, that there was a failure in providing primary care in the areas where it was more necessary. More recently, in India and China, it is shown that good salaries to doctors is not as important as having good clinical resources (access to diagnostic and treatment facilities, incentive to work) to achieve effective universal health coverage.

It´s a pity to say that the general opinion of the 65 health workers who sit the interview was that effective primary care was not going to happen in most of sub-Saharan Africa. They strongly believe that clinicians are not going to work in the conditions of the actual primary care (which are even getting worse as the need for effective primary care increases). This is why the situation could be called the inverse primary care law.

The experts said that ”The policy discourse on universal health care in Africa has to focus on providing the human resources to staff and deliver primary care effectively” Some solutions could change poor working environments and career paths in primary care, and that will be the point for many health workers to return to its own country. Not only to have medicines or better buildings with medical facilities, but also better connections between villages and cities to have access to complete diagnosis and treatments even in the smallest areas. This kind of improvements would let primary health-workers cure properly, and they would find its place in sub-Saharan Africa.  Until some measures won´t be taken, the poorest areas are condemned to receive poor care or no care at all.

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