RESUMO
BACKGROUND: Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery. Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population's health needs. The majority of primary health facilities in the country are staffed using perceived needs. The Workload Indicators of Staffing Need (WISN) tool developed by the World Health Organization is used to determine staffing requirements for facilities. METHODS: The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area (PHALGA) and Obio Akpor Local Government Area (OBALGA). Documents were reviewed to obtain information on working conditions and staffing, and interviews conducted with key informants in 12 randomly selected facilities. We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both. We also retrieved workload data from January 1-December 31, 2015 from the national district health information system. RESULTS: Findings showed varying degrees of shortages and inequitable distribution of health workers. Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives. There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85. OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners; and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively. CONCLUSION: Our findings provide evidence for policies that will help Nigeria improve the population's access to quality health services and reduce inequities in distribution of the health workforce. Evidence-based health workforce planning and redistribution using WISN should be institutionalized. Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.
RESUMO
The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by a lack of a public health workforce. In low-income countries, efforts to build public health surveillance and response systems have stalled, due in part, to the lack of epidemiologists and well-trained laboratorians. To strengthen public health systems in Africa, especially for disease surveillance and response, a number of countries have adopted a competency-based approach of training - Field Epidemiology and Laboratory Training Program (FELTP). The Nigeria FELTP was established in October 2008 as an inservice training program in field epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. The first cohort of NFELTP residents began their training on 20th October 2008 and completed their training in December 2010. The program was scaled up in 2011 and it admitted 39 residents in its third cohort. The program has admitted residents in six annual cohorts since its inception admitting a total of 207 residents as of 2014 covering all the States. In addition the program has trained 595 health care workers in short courses. Since its inception, the program has responded to 133 suspected outbreaks ranging from environmental related outbreaks, vaccine preventable diseases, water and food borne, zoonoses, (including suspected viral hemorrhagic fevers) as well as neglected tropical diseases. With its emphasis on one health approach of solving public health issues the program has recruited physicians, veterinarians and laboratorians to work jointly on human, animal and environmental health issues. Residents have worked to identify risk factors of disease at the human animal interface for influenza, brucellosis, tick-borne relapsing fever, rabies, leptospirosis and zoonotic helminthic infections. The program has been involved in polio eradication efforts through its National Stop Transmission of Polio (NSTOP). The commencement of NFELTP was a novel approach to building sustainable epidemiological capacity to strengthen public health systems especially surveillance and response systems in Nigeria. Training and capacity building efforts should be tied to specific system strengthening and not viewed as an end to them. The approach of linking training and service provision may be an innovative approach towards addressing the numerous health challenges.
