Civil society organisations have been playing a crucial role in raising awareness about the health workforce crisis. But the African civil society involvement goes beyond advocacy. The African Medical and Research Foundation /AMREF is implementing training programmes for all categories of the health workforce in Africa.

The health workforce crisis in Africa: a key challenge for the MME partnership

In its 2006 World health report “Working together for Health”, the WHO confirmed the importance of the health workforce crisis in Africa. Out of the 57 countries suffering from a critical shortage of health service providers (doctors, nurses and midwives), 36 are in Africa. This region is also the most affected in relative terms, since an increase of almost 140% of the current health workforce would be needed to make up for the shortage. At the same time, many African countries are confronted with high rates of emigration of their health workers. According to OECD health statistics, the expatriation rate of doctors to the OECD in 2000 was superior to 40% in 11 African countries, reaching as much as 64.5% in Mozambique, 63.2% in Angola, 58.4% in Sierra Leone, 55.3% in Tanzania, or 54.2% in Liberia. No wonder why the Joint Africa-EU Strategy and the subsequent Action Plans have considered actions aiming at mitigating the brain drain in the health sector as a key priority.

Filling the health workforce gap: a two-tier strategy

An eLearning training session in progress for nurses upgrading from Enrolled to Registered Nurses at AMREF Virtual Nursing School, Nairobi, Kenya

While international migration is clearly contributing to the crisis in African countries exhibiting such high emigration rates, it is neither the unique nor the main cause of health workforce shortages in Africa: the OECD points out that no more than 12% of the health workforce shortage of the region can be accounted for by health professionals working in the OECD. Scaling-up training, improving working conditions and addressing geographical imbalances resulting from the internal migration of health professionals from rural to urban areas are therefore essential priorities for source countries.

Recent developments at global level have therefore focused on these two complementary priorities. On the one side, 2010 has seen the adoption of the WHO Global Code of Practice on the International Recruitment of Health Personnel, which promotes principles and practices, on a voluntary basis. In particular, States are called to discourage “active recruitment of health personnel from developing countries facing critical shortages of health workers”. On the other side, the WHO has developed Global Policy Recommendations to support developing countries’ efforts to step-up training and working conditions in order to improve access to health services, particularly in underserved areas.

Designing innovative solutions: when African civil society takes the lead

An eLearning training session in progress for nurses upgrading from Enrolled to Registered Nurses at AMREF Virtual Nursing School, Nairobi, Kenya

At global level, civil society organisations have been playing a crucial role in raising awareness about the health workforce crisis through campaigns such as the “Campaign for Sustainable Health Workforce Financing” of the Health Workforce Advocacy Initiative (HWAI). At regional level, the “15%+ Campaign” of the Africa Public Health Rights Alliance, a member of the HWAI aims at giving reality to the 2001 pledge of African Heads of State to allocate at least 15% of domestic budget resources to health, a commitment reaffirmed during the 15th Summit of the African Union held in Kampala in July 2010 (current Africa average stands at 9.6%).

But the African civil society involvement goes beyond advocacy. The work of the African Medical and Research Foundation /AMREF is a case in point. Founded in 1957 and headquartered in Nairobi, the organisation is implementing training programmes for all categories of the health workforce such as doctors, nurses, community health workers and midwives, clinical officers, laboratory technicians and pharmacists. AMREF’s training takes place in communities, health centres and hospitals in six African countries (Ethiopia, Kenya, South Africa, South Sudan, Tanzania and Uganda), as well as in AMREF’s International Training Centre in Nairobi and satellite training centres in Tanzania, South Sudan and Uganda.

AMREF’s training reach extends beyond its operational areas in East and Southern Africa, not least through the utilisation of distance learning. For instance, the Diploma in Community Health course, which is available through face to face and distance learning, has graduated 535 students from 35 African countries and Europe since its inception in 1987. As commented by Dr. Peter Ngatia, AMREF’s Director for Capacity Building, during the Second Global Forum on Human Resources for Health, held in Bangkok in January 2011: “Scaling up of production of human resources cannot happen unless we invest in the use of technology to train the numbers that are required. The 105 medical schools in Africa do not have the capacity to meet the urgent demand for doctors, nurses and midwives, among many other cadres of health workers”.

Another success story of AMREF is its support to the Nursing Council of Kenya to create a distance-learning curriculum with the objective of upgrading over 20,000 certificate-level nurses to registered nurses in the country. Four computer-based training modules have been developed and are being delivered through more than 100 eLearning centres – reaching nurses in the most remote areas of Kenya. Twenty-five nursing schools are also taking part in the programme. To date, more than 7,000 nurses have enrolled in the programme, using both print and eLearning modules, and the programme is now being replicated in Uganda.

Based on this rich experience, AMREF is advocating for “African solutions to the health worker crisis” and contributing to the continental efforts to resolve the health worker crisis, not least through its participation to the African Platform on Human Resources for Health.