The Implications of Shortages of Health Professionals for Maternal Health in Sub-Saharan Africa

Abstract This paper discusses the implications of shortages of midwives, nurses and doctors for maternal health and health services in sub-Saharan Africa, and inequitable distribution of maternal health professionals between geographic areas and health facilities. Shortages of health professionals reduce the number of facilities equipped to offer emergency obstetric care 24 hours a day, and are significantly related to quality of care and maternal mortality rates. Some countries are experiencing depletion of their workforces due to emigration and HIV-related illness. Another feature is the movement from public to private health facilities, and to international health and development organisations. The availability of skilled birth attendants and emergency obstetric care may be reduced due to understaffing, particularly in rural, poor areas. The existing workforce may experience increased workloads and job dissatisfaction, and may have to undertake tasks for which they are not trained. If governments and development partners are serious about reaching the Millennium Development Goal on maternal health, substantial numbers of professionals with midwifery skills will be needed. Shortages of maternal health professionals should be addressed within overall human resources policy. A rethink of health sector reforms and macro-economic development policies is called for, to focus on equity and strengthening the role of the state. Résumé Cet article examine les conséquences du manque de sages-femmes, d'infirmières et de médecins pour les services de santé maternelle et de santé en Afrique sub-saharienne, et la répartition inégale des professionnels de santé maternelle entre zones géographiques et centres de santé. Ces pénuries réduisent le nombre d'installations capables d'offrir des soins obstétriques d'urgence 24 heures sur 24, et influent sur la qualité des soins et les taux de mortalité maternelle. Dans certains pays, la main-d'éuvre est appauvrie par l'émigration et les maladies liées au VIH. Une autre caractéristique est le mouvement du public vers le privé, et vers les organisations internationales de santé et de développement. Ce phénomène peut réduire la disponibilité d'accoucheuses formées et de soins obstétriques d'urgence, particulièrement dans les zones rurales pauvres. Le personnel connaît donc un surcroît de travail, ce qui crée un mécontentement, et doit parfois accomplir des tâches pour lesquels il n'a pas été formé. Si les gouvernements et les partenaires de développement veulent vraiment atteindre l'objectif du Millénaire pour le développement en matière de santé maternelle, il leur faudra former un nombre substantiel de professionnels en obstétrique. Les pénuries de personnel de santé maternelle doivent être corrigées dans le cadre de la politique globale des ressources humaines. Il convient de repenser les réformes du secteur de la santé et les politiques de développement macro-économique, afin de se centrer sur l'équité et renforcer le rôle de l'État. Resumen Este artículo trata de la escasez de obstetrices, enfermeras y médicos en salud materna y servicios de salud general en África sub-Sahariana, y la distribución no equitativa de profesionales de la salud materna entre zonas geográficas y los establecimientos de salud. La escasez de estos profesionales disminuye el número de establecimientos equipados para ofrecer cuidados obstétricos de emergencia las 24 horas del día y está relacionada en gran medida con la calidad de la atención y las tasas de mortalidad materna. Algunos países están experimentando una reducción de su población activa debido a la emigración y las enfermedades relacionadas con el VIH. Otro aspecto es la mudanza del sector público hacia el privado, y a las organizaciones de salud y desarrollo internacional. La disponibilidad de parteras capacitadas y de cuidados obstétricos de emergencia podría reducirse debido a la falta de personal, particularmente en las zonas rurales pobres. La actual población activa podría experimentar mayores cargas de trabajo e insatisfacción en el trabajo, y verse obligada a realizar tareas para las cuales no está capacitada. Si los gobiernos y los colaboradores de desarrollo están verdaderamente comprometidos a lograr el Objetivo de Desarrollo para el Milenio respecto a la salud materna, se necesitarán muchos profesionales con habilidades en obstetricia. La escasez aquí mencionada debe tratarse como parte de la política general de recursos humanos. Para garantizar equidad y fortalecer la función del Estado, será necesario reformular las reformas del sector salud y las políticas de desarrollo macroeconómico.

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