Ethiopia falls among the “low-density / high-mortality” countries.60 Carlo Resti, Yohannes TadesseHuman Resources and health clustersHuman Resources and health clustersSource: WHO, 2004Source: WHO, 2004Challenges and constraints to the development of HRHBuilding up of the health workforce necessary to achieve internationalMDGs targets faces a number of constraints. The most important challengesfor a typical low-income country in Sub-Saharan Africa, as it is the case forEthiopia, are likely to include the following factors:• addressing the proportional representation of staff with a distinct socialand ethnic background in the workforce and addressing the issue of an appropriateskill mix of health personnel;• tackling geographical imbalances in the distribution of health sectorworkforce;• building qualitative and quantitative capacities of medical and paramedicaltraining institutions simplifying entry points in the educationalsystem and career ladder;• addressing the necessity to delegate some key skills (task shifting) tolower health cadres of workers to reach the grass root level in health servicesdelivery;• designing and implementing national HRH policies and ad hoc strategies;• carrying forward good governance for a conducive work environmentand a well conceived and balanced overall policy framework.Obviously, the size and the extent of these main constraints varies across differentlow- and middle income countries, but they will largely determine thepace of any effort to increase health service coverage of the population.
5. Human resources for health (HRH): a crucial element for achieving international MDGs. 61Representing minority groups in the workforce and setting the rightskill mixThe Millennium Declaration call for priority to be given to the poor. Oftenthese groups are under- or not at all represented in the health sector workforceand are not sufficiently taken onboard in establishing priority needs interms of health and acceptable and desirable social services.It has been reported that a major reason for extremely low access to healthservices and coverage of nomadic communities in different areas consists inlinguistic and cultural differences to the health personnel. Similar problemsare also described for minority groups such as the Rom people in EasternEurope or migrant laborers. Thus, it will be necessary to employ personnelwith a specific social, ethnic and cultural background for an effective and efficientdelivery of priority interventions to the poorest and most disadvantaged.In Ethiopia, for instance, health personnel from the highlands, normally havedifficulty in approaching and adapting themselves to pastoralist communitiessuch as those of “emerging regions” like Gambela, Afar, Somali, etc.“Skill mix” refers to the mix of posts, grades or occupation in an organization.It may also refer to the combinations of activities or skills needed foreach job within the organization. Setting the right “skill mix” for a definitecountry situation is a long process that should start with a task analysis. Thatis to know the tasks that different staff have to carry out at different level ofthe organization and the skills needed to perform them. The further step is,within the educational system, being able to plan, recruit, train and retainhealth personnel with the necessary bundle of skills. Especially for low- andmiddle income countries, there have been attempts to go beyond the traditionaldefinitions of skills defined by membership of a profession (medicine,nursing, midwifery and other health related professions). So, due to specificneeds, the range of health care workers has been widened to meet the serviceneeds. Some of them can enter the system after a very basic training in extremelybasic preventive and curative skills, while others receive enhancedtraining on specific key skills, such as generic nurses trained in emergency obstetricsor in primary surgery.Geographical imbalances (uneven distribution of health staff)The size and composition of the workforce will determine if priority interventionscan be delivered effectively and efficiently. Countries such as theUnited Kingdom, Ghana, Mauritania, Ethiopia or Zimbabwe report defi-