FRONTESPIZIO - Cooperazione Italiana allo Sviluppo

34 Augusto Cosulich, Vincenzo RacalbutoHuman Resource DevelopmentHuman Resource Development (HRD) is an important component of HS-DP. Ethiopia has one of the lowest ratio of physicians to population in theworld (1 : 35.000). In Oromia Region that is the largest and more populatedregion of the country, the ratio is estimated to be 1 : 55.000. The ratio ofnurses (all cadres) to population is not much better being 1 : 5.000 – 10.000and showing a lot of differences between rural and urban areas.Yet, the health care force is male-dominated. Only about 13 percent of physicians,11 percent of health officers and 39 percent of nurses are female. In addition,the large majority of female health-care workers are located in the urbanareas. As a consequence, rural areas where the need for maternal andchild care is high are mostly served by men.The Government has launched at the beginning of 2004 a new training strategyfor the first 2780 Health Extension Workers, all female, in the frameworkof the new policy of the “Health Extension Package”. Training curricula fornurses has been revised and the old health cadre of “Health Assistant” receiveda special upgrading training.Main constraints in improving the number and quality of health workforceare the following:• lack of a human resource management and development strategy;• maldistribution and internal migration towards urban settings;• lack of polivalent well trained personnel at grassroots level;• lack of adequate teaching institutions and teaching aids;• low female literacy rate and consequent gender unbalance in health workforce;• poor teaching / learning quality in nursing school and career pathway,causing migration to private sector for better remuneration and fuelling“brain drain”;• vastity of the country combined with a poor communication and transportationnetwork;• lack of managerial skills especially at district level.36 per cent of the total budget will be given to 4 beneficiary Regions and tothe central level for HRD and training activities specifically targeted to preserviceand continuing education of mid-level health cadres. A contributionof about 4.5 million Euro will fund training of nurses, midwives, technicians,health assistants and health extension workers.About 0.5 million Euro will be directly managed by the PMU.In addition, another component of the Italian Contribution (1,1 million