Health personnel development in sub-Saharan Africa

Despite a significant growth in the total number of trained health workers, the Africa region is still poorly staffed. It was the only World Health Organization region that showed a decline in the doctor-to-population ratio from 1980-1986. Emigration of trained health workers, particularly physicians, exacerbates the problem. Basic training for health workers is reasonably well established, but advanced and in-service training have been widely neglected. There remains a serious shortage of senior staff with training in public health and management. sub - Saharan Africa has not a single school of public health and it also lacks adequate regional training centers in public health and management. Planning for health workers has been based largly on simple projections of the number of required - without much regard for the economic costs or the availability of financial resources. Most countries in sub-Saharan Africa have undertaken structural adjustment programs that, together with world economic conditions, have led to declining financial allocations to ministries of health. As spending cuts have been made for such items as drugs, maintenance, and transport, the proportion spent on health personnel has risen. There are now strong pressures on ministries to reduce the number of health workers they employ and to encourage more private health services. This paper reviews the health personnel situation and attempts to answer questions which will determine future policy.