One major barrier to accessing health care services in the country is the shortage of manpower to provide essential and sometimes basic healthcare services where they are needed.
The situation is worse in the rural areas as health workers are poorly distributed and in favor of urban and tertiary health care facilities. In the Federal Capital Territory (FCT) for instance, doctors, pharmacists, nurses and medical laboratory scientists are mostly found in public hospitals in Asokoro, Garki and Maitama, and not places like Pyakasa or other remote villages around the FCT.
Some factors that contribute to the dearth of human resources for health include inadequate training institutions to train some specialties, inadequate trained staff and the movement of trained personal to other countries, and embargo on employment in some states, among others.
A study conducted by the Nigerian Polling Organisation, NOI Polls, last year revealed that about eight out of every 10 medical doctors in Nigeria are currently seeking work opportunities abroad. Many pharmacists and other health professional in the country on graduation go to other countries, including African countries like Rwanda, to seek employment.
Recently, president of the Nigerian Optometric Association (NOA), Dr Echendu Damian, lamented that many optometrists are going to Saudi Arabia, United Kingdom and other countries in droves to practice. He added that there is dearth of optometrists (eye specialists) in public hospitals and local government areas thereby leading to poor access to eye care for rural dwellers.
The target to achieve the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) may not be possible when there are not enough health workers to do the job, said Dr Emmanuel Abanida, Senior Technical Adviser, Development Research and Project Centre (dRPC) PACFaH@Scaleproject.
He said that the United Nations has estimated that for Nigeria to be able to achieve the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC), it needs about 450,000 health workers per year for the next ten years, adding that right now the country is only doing about 45,000 health workers per annum, which is very low.
“It is estimated by the World Health Organisation (WHO) that 65% of Nigerians lack access to health care services. Also, 70% of the rural populace has no access to all healthcare services in Nigeria. With a population of over 170 million, Nigeria needs about 237, 000 medical doctors, but currently has only 35, 0000 doctors. As at 2017, Nigeria was second in terms of inadequate number of nurses and midwives in Africa with only 152, 000 closely followed by Ethiopia,” he said.
He said this underscores the need to shift task from over-burdened health workers to those that are less burdened but capable of doing it without necessarily causing harm.
Task shifting and Task sharing is recommended by the World Health Organization (WHO) as a measure to ensure equitable distribution of quality essential health care services in human resources for health constrained regions of the World.
WHO describes task shifting as “the rational redistribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of the available human resources for health.”
“Task sharing means allowing a wider range of cadres to offer certain services, when this can be done safely and effectively as a means of rapidly expanding access and improving health care,” it said.
These measures are temporary and are not designed to take away tasks from any professional groups but rather to make the best use of the cadres of staff currently employed and deployed to health facilities.
Task shifting has been used in a number of countries to address the human resource shortages that militate against the provision of critical services like HIV testing and treatment.
In 2014, the Federal Government launched the Task shifting and Task sharing policy (TSTS) to address the gaps of inadequate availability and inequitable distribution of qualified highly skilled health workers in the country.
However, since its introduction, the policy has faced challenges which also affected its adoption by some states in the country.
Findings reveal that twenty states have adopted and implemented the policy. While Lagos is currently in the process of adopting the policy, some states such as Benue, Cross River, Imo, Ogun and Oyo have established technical working group on Task Shifting Policy implementation.
The Task-shifting and sharing policy also provides room for the training of community health workers (most of whom have not been trained to manage most of the life-threatening complications of pregnancy and childbirth) to provide skilled and quality care which they can do without causing harm.
Yohanna, 46, said he has been accessing HIV services in the last one year provided by community health workers in a primary healthcare centre in his village in Gwagwalada Area Council.
He told Daily Trust that before then, he couldn’t access proper care as doctors and laboratory scientists were hardly ever available at the facility.
Bridget Odo, a mother of five said her Intra Uterine Device (a family planning contraceptive) was inserted for her by a community health worker in the primary healthcare centre at Obolo-Afor in Nsukka, Enugu State.
“I learnt that the staff there have been trained to do it when doctors and nurses are not around,” she said.
Yahaya Adamu Barde, a Community Health Extension Worker, (CHEW) at Comprehensive Primary Healthcare Centre Gwagwalada, told Daily Trust that he was trained on adult HIV treatment under the task shifting and task sharing policy.
He said shifting tasks from some health workers to others has helped in manpower development, increased clinic activities to 100 percent, and reduced waiting time and work load on medical doctors and other health workers.
Director, Reproductive Health Division of the Federal Ministry of Health, Dr Kayode Afolabi said the policy identified specific tasks such as maternal, newborn and child health, HIV/AIDS, malaria, laboratory services and drugs administrations among others.
Comrade Akor Okechukwu, National President of the National Association of Community Health Practitioners of Nigeria (NACHPN), said many success stories have been recorded from the policy in most facilities in rural areas, especially in family planning issues and Infant Welfare Clinic (IYC).
Dr Halima Mukaddas, a former Commissioner for Health in Bauchi State and Executive Director Women, Children and Youth, a non -governmental organization, said it has now given community health workers the mandate to carry out some of the necessary tasks needed to save the lives of women in the grassroots, “Like conducting normal deliveries and even administering some drugs that are necessary to prevent postpartum Herrmorrage and family planning services.”
Challenges of implementing the policy
Dr Emmanuel Meribole, Director Health Planning, Research and Statistics of the Federal Ministry of Health, said funds constitute a major problem to the implementation of the policy.
He said initially, there was unpreparedness on the part of the ministry as there was no monitoring mechanism in place. In addition, the Standard of Practice (SOP) developed was not conclusive and developed two years after the policy.
Findings also reveal that frequent changes of policymakers at state level such as commissioners of health also affected the adaptation of the policy in states.
According to Meribole, another challenge is the resistance to the policy in some states for fear of job security. While noting that the ministry and partners have done fairly well in implementing the policy, he said the gaps are still wide and needed to be addressed by capturing it in the current policy review.