Human Resources for Health in Maternal, Neonatal and - HRH ...

It is important to note that these barriers and constraints do not operate in isolation, and often
a combination of factors may affect the delivery of MNRH care and services. For example,
nursing shortages and a lack of drugs and commodities have resulted in the closure of many
of PNG‘s 2000 rural Aid Posts (Duffield 2008). Appendix 4 provides a list of the barriers and
constraints alongside references to documents with useful examples. These are discussed by
category below followed by examples illustrating how these factors interact to affect health
care
Poor coverage and composition
There is a chronic shortage of all cadres of staff in MNRH at community level. This is the
result of poor workforce planning where too few skilled graduates are trained and deployed
as well as high attrition. Poor pay, working conditions and motivation often leads to
migration away from rural and underserved communities to urban centres, to other countries,
to other careers or to better paid positions in well funded programmes or jobs in NGOs or UN
organisations. This affects both the numbers of staff available in the labour force and their
distribution across a geographic area or sector.
Figure 15 outlines the shortages of doctors, nurses and midwives, by WHO region indicating
the numbers of countries in the SEARO and WPRO regions with shortages and the 50% and
119% increase required in the respective regions. Numbers of CHWs are not available.
Figure 15 Estimated critical shortages of doctors, nurses and midwives, by WHO region
WHO region Number of countries In countries with shortages
Total
With
shortages
Total
workforce
Estimated
shortage
Percentage
increase required
Africa 46 36 590 198 817 992 139
South-East Asia 11 6 2 332 054 1 164 001 50
Western Pacific 27 3 27 260 32 560 119
Americas 35 5 93 603 37 886 40
Europe 52 0 NA NA NA
East
Mediterranean
21 7 312 613 306 031 98
World 192 57 3 355 728 2 358 470 70
(WHO 2006)
A ratio of 2.28 doctors, nurse and midwives has been suggested as the optimum number per
1000 people to facilitate the delivery of essential interventions to address the MDGs
(Speybroeck 2006). This proportion has not been applied to other cadres such as CHWs or
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