Maternal health in sub-Saharan Africa: tackling the skills shortage

Sub-Saharan Africa has the worst rate of maternal ill-health in the world. Maternal deaths occur partly because health systems are inadequately staffed to deal effectively with birth complications. How can maternal health human resources be managed better to ensure that all women, especially in poor, rural areas, can access good quality maternal health care?

Maternal death rates vary widely among sub-Saharan African countries, from Mauritius, which has around 24 maternal deaths per 100,000 live births, to Sierra Leone, with around 2,000 maternal deaths per 100,000. Sufficient skilled health providers are critical for the delivery of high quality maternal care, yet in sub-Saharan Africa the proportion of trained health staff to general population is so inadequate that the shortage is considered a crisis.

It is estimated that between one million and 1.4 million more doctors, midwives and nurses are needed in this region to supply the essential health services referred to in the Millennium Development Goals. If universal coverage is to be achieved in the near future for maternal, newborn and child health, the World Health Organization stresses that the large shortages of health professionals with midwifery skills must be filled. The biggest gaps between staff requirements and existing staff numbers are for midwives and nurses.  

A study by the Nuffield Centre for International Health and Development, Leeds, UK, reviews the evidence available to explore the implications of shortages of nurses, midwives and doctors for maternal health and health services in sub-Saharan Africa. It also looks at the unequal distribution of maternal health professionals among regions and among health facilities.

The research found that:

• A shortage of health professionals is significantly related to the quality of maternal care and maternal death rates.
• A shortage of health professionals means that fewer health facilities are able to provide 24 hour emergency obstetric care.
• Health professionals are being lost to emigration and HIV/AIDS, and some leave public health facilities for private facilities or international health and development organisations.
• The understaffing of health facilities, especially in remote rural areas, decreases the availability of skilled birth attendants and emergency obstetric care.
• Due to understaffing, existing staff may have to cope with higher workloads and take on tasks for which they are not trained, resulting in increased job dissatisfaction.

Staff shortages and the poor distribution of maternal health professionals are not new problems in sub-Saharan Africa. However, in the past five years some health systems have lost a significant number of staff to emigration and AIDS. In order for the tide to be stemmed, the study makes the following recommendations:

• The number of health professionals with midwifery skills needs to be increased substantially in sub-Saharan Africa if the Millennium Development Goal on maternal health is to be achieved.
• An overall human resources policy must be developed to address the shortages, misdistribution and migration of maternal health professionals.
• Health sector reforms and macro-economic development policy must be revised to focus on equity, participation of poor people and boosting the role of the state.
• Wealthy countries could help through more flexible development assistance eg. funding recurrent expenditures such as salaries, and by producing sufficient health workers for their own populations.

Source(s):
‘The implications of Shortages of Health Professionals for Maternal Health in Sub-Saharan Africa’, Reproductive Health Matters 14:27, pages 40-50, by Nancy Gerein et al, 2006 Full document.
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 3 November 2006

Further Information:
Nancy Gerein
Nuffield Centre for International Health and Development
Institute of Health Sciences and Public Health Research
Faculty of Medicine and Health
University of Leeds
71-75 Clarendon Road
Leeds LS2 9PL
UK

Tel: + 44 (0)113 343 4858
Fax: + 44 (0)113 343 6997
Contact the contributor: n.gerein@leeds.ac.uk

Nuffield Centre for International Health and Development, University of Leeds, UK

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