Equitable distribution of health workforce mandatory

A health post padlocked in daytime.

Not very long-ago, I had worked as a translator for case studies reported to develop qualitative findings for a research entitled ‘Barriers to Effective Policy Implementation and Management of Human Resources for Health in Nepal’. In due course of translating some case studies, key informant interviews and reports on Focus Group Discussions, I learnt many stories that compelled me to have pity over the health situation of the country. In between, my eyes experienced a severe pain when I read a story where a patient was given some pints of dendrite on his eyes against an allergy that he had experienced.

Actually, a patient had rushed to Kimathanka health post located at Kimathanka VDC of Bhot Khola Region of Sankhuwasabha district in search for a treatment against an eye allergy. Since there was neither Auxiliary Health Worker nor Health Assistants, Pemba Sherpa, wife of a Village Health Worker prescribed an ointment as a solution. He hurriedly applied the ointment on his eyes. He thanked her and went his own way. After walking down some yards, he experienced his eyes being glued. He was confused yet tried to recuperate it but no to avail. After few minutes, Chabi Sherpa, Office Assistant found him reeling under this condition on his way to the health post and investigated the situation. As a result, he discovered that the patient was prescribed with dendrite, an adhesive. He hurriedly incised the eyebrows and the patient was sent home.

The Human Resources for Health situation in Nepal has been met with several key challenges particularly related to the shortage and uneven distribution of the health workforces in the country. Despite the need for an appropriate number and distribution of different cadres of health personnel, who are socially responsible, technically competent and are available at the right time and place, as outlined in the National Health Policy 1991, these challenges have prevented policy from translated into practice. Moreover, the National Health Policy has not taken into consideration the epidemiological transitions and demographic developments that have occurred over the last two decades.

According to World Health Report 2006 ‘Working Together for Health, Geneva’, South-East Asia has only 10 percent of the global health workforce while the portion of this continent is home to approximately 25 percent of the world’s population. The World Health Organization has identified Nepal as one of 57 nations with a critical shortage of health workers that creates a huge deficit in the requirements to meet the health related Millennium Development Goals.

The distribution of health workers has been raised as a concern in Nepal, with huge variations between ecological zones (Mountain, Hill and Terai) and mong the 5 development regions of the country. The absence of doctors and qualified health professionals in the most remote areas has been a long-standing issue. These issues are compounded by the movement of high-level health workers, such as doctors and nurses, to private health institutions or overseas, due to high demand for health workers in industrialized countries, as well as attractive incentives that they offer. With the emergence of non-communicable disease due to a changing lifestyle and environment, there is also the need to rethink the current skill mix of health workers.

According to the report ‘Barriers to Effective Policy Implementation and Management of Human Resources for Health in Nepal’ published by SOLID Nepal in partnership with Merlin Nepal, 14 percent of sanctioned positions for all the health workers were vacant with a 38 percent deficit of doctors and a 10 percent deficit of nurses.

The Ministry of Health and Population should increase the current number of sanctioned positions and revise its types taking the shifting disease burden and population growth into consideration. The MoHP should encourage the hiring of health worker at local level through district health system as a part of devolution considering the local needs. The monitoring system should also be improved at the same time.

The research also found that the number of PHCs and hospitals with a complete mix of filled sanctioned posts in PHCs was particularly low in the mountain belt (0%) compared to other belts (80% in the Hill Belt and 50% in the Terai Belt), where the staff had to be locally recruited to fill the gap. The MoHp should create a pool of health staff at the Regional Level who can be transferred to rural health facilities to fill gaps.

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