Health-Workforce Performance Report

This report analyzes the health workforce in Nigeria and identifies critical issues and recommendations for improvement. Findings include the lack of surveillance and governance, inequitable distribution of healthcare workers, and poor workforce quality. Recommendations include implementing residency programs, restructuring the NHIS, and establishing state-level structures for monitoring and licensing healthcare workers.

Running head: HEALTH-WORKFORCE PERFORMANCE REPORT
Health-workforce Performance Report
Name of the Student
Name of the University
Author note

1HEALTH-WORKFORCE PERFORMANCE REPORT
Executive summary
The health workforce of a country comprises largely of suppliers of health services and health
management and support employees. Despite few improvements in the situation of the health
workforce since 1997, Nigeria requires to implement severe workers plans to further improve
more effectively. The aim of this study is to prepare for Nigeria a domestic health workforce
plan taking into account their present environmental condition, information profile and
critical problems. From the data analysis, it was discovered that the most critical problem in
Nigeria is the absence of surveillance, control and systematic approach to governance.
Considering the fact that both public and private educational organisations are actively
working to strengthen the healthcare workforce, lack of proper distribution strategy is causing
severe healthcare inequity across the nation.

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Table of Content
Introduction and rationale: ........................................................................................................4
Environmental scan for Nigeria: ...............................................................................................4
Data profile for health workforce: .............................................................................................4
Critical issues to be addressed: .................................................................................................4
Recommendations: ....................................................................................................................4
Conclusion: ...............................................................................................................................4
Reference: .................................................................................................................................4

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Introduction and rationale
As per the definition of World Health Organisation, IHealth employees are all
individuals involved in activities aimed primarily at protecting and improving health. The
health workforce of a country comprises largely of suppliers of health services and health
management and support employees. It is also evident that numbers and proficiency of health
workers directly influence the public health condition of a region. As per the World Health
Organisation presented report of 2016, one of the most poor health workforces facilitated low
to moderate income nation is Nigeria. A huge amount of healthcare workers are present in
Nigeria as health workforce (HRH) in Africa. At the same time, densities of doctors, nurses,
midwives are too low like the other 57 HRH crisis countries to efficiently deliver essential
health services (Who.int., 2018). As per the report of Global Workforce Alliance, the health
service delivery in Nigeria is full of problematic attributes where inequity, lack of
coordination, lack of planning, poor enforcement, incompetent workers are the major
contributors. As per the World Health Organisation report of 2017, the life expectancy at
birth in Nigeria is 54 years which is even lower than other low to middle income countries
such as Ghana, Rwanda and also lower than some lower income countries like Malawi.
Despite of few improvement in health workforce condition from 1997, Nigeria needs serious
workforce plans to be implemented for further more effective improvement (African Health
Observatory., 2016). The purpose of this report is to prepare a national health workforce plan
for Nigeria considering their current environmental situation, data profile and critical issues.
Environmental scan for Nigeria
According to the World Health Organisation a country's capacity to fulfil its health
objectives mainly relies on the understanding, abilities, motivation and implementation of the

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individuals responsible for the organization and delivery of health services. Recently the
migration to the foreign countries has declined, which can be considered as positive outcome
of economic growth. However, it increases the number of people region wise over than the
existing distribution of the health workers (WHO-Nigeria., 2019). The health workforce
policies are more strongly enforced in the urban tertiary healthcare service deliveries that are
situated in the southern region of Nigeria. The northern part of the nation, especially the rural
and sub-urban areas are suffering from healthcare service iniquity due to poor distribution of
the workforce in those areas of the Nation.
Table: Comparison of health situation of Nigeria with other countries regions and world
Countries/Region Life expectancy
At birth in 2007
Life expectancy
At birth in 2017
U5MR per 1000
live births 2007
U5MR per 1000
live births 2007
Nigeria 49 54 146 100
Ghana 60 63 82 49
Malawi 53 64 103 55
Middle East and
North Africa
72 74 31 23
Sub-Saharan Africa 55 61 116 76
World 70 72 58 39
From the above data comparison it can be clearly visible that though the health
situation of Nigeria Improved from 2007 to 2017, the situation is still worse than even the
other part of the Africa. It can be clearly visible that the under-5 mortality rate (U5MR) is
extremely higher than the world level and even from the other African countries. The poor
life expectancy value also shows that in adulthood, people of Nigeria do not receive adequate
health services and supplies (Adedini et al., 2014). A larger sections of the rural health
workforce that are current operating through distributed small health camp are comprised of a
large number of medical and clinical staffs who does not have proper education about
medical and clinical science. Currently Nigeria does not have any healthcare education policy

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to guarantee the quality of the health workforce by all means. A huge amount of indigenous
local peoples are hired in health workforce, especially in the sub-urban and rural areas of
northern Nigeria.
In 2008 the Federal Republic of Nigeria proposed and published a Human Resource
in Healthcare Plan (HRH Plan 2008 to 2012) aiming the strategic development of healthcare
service within 2012. Due to absence of proper communication, coordination and tangible
framework this government strategy has completely failed to address the healthcare
workforce related issues and workforce quality improvement. At the same time, a good
number of quality workforces are migrating to foreign countries for better career
development (Ayamolowo, 2013). Therefore, health workforce work environment is also
contributing to low productivity and high attrition. Currently, the Federal Government of
Nigeria is planning to implement telemedicine, where lack of financial support, managerial
system and poor workforce quality are weakening the initiations. Additionally, the poor
workforce distribution, lack of quality care and lack of accessibility to proper medication are
causing a huge number of morbidity and co-morbidity especially in rural areas.
Table: Rank of Nigeria in top 10 death causes
Top 10 causes of Mortality in
Nigeria
IHME rank 2007 IHME rank 2017
Malaria 1 4
Diarrheal disease 2 5
HIV/Aids 3 3
Lower Respiratory Infection 4 1
Neonatal Disorders 5 2
Tuberculosis 6 6
Meningitis 7 7
Cirrhosis 8 10
Ischemic heart disease 9 8
Stroke 10 9

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From the above dataset it can be clearly seen that due to above discussed issues in
healthcare environment. The health condition concerning mortality rate, is not improving
considerably. Hence further analysis of health workforce will be required to find the
underlying causes of health workforce deficiency and poor quality.
Data profile for health workforce
As per the national health workforce statistics of Nigeria from 2005 to 2013 total
health workforce of Nigeria including physicians, nurses and midwives is 20.1 per 10,000
people. In the following section the health workforce strength of Nigeria has been presented
compared with the other countries and continental average.
Table: Health Workforce distribution comparison of Nigeria with other countries and Africa
Physicians per
10,000
Nurses and
midwives per
10,000
Dentists per
10,000
Pharmacologist
per 10,000
Nigeria 4.1 16.1 0.2 2.1
Malawi 0.2 3.4 0.1 0.2
Ghana 1.0 9.3 0.1 0.7
Africa 2.4 10.7 0.5 1
Physicians per
10,000 Nurses and
midwives per
10,000
Dentists per 10,000 Pharmacologist per
10,000
0
2
4
6
8
10
12
14
16
18
4.1
16.1
0.2 2.1
0.2
3.4
0.1 0.21
9.3
0.1 0.7
2.4
10.7
0.5 1
Nigeria
Malawi
Ghana
Africa
From the above graphical and tabular analysis it can be clearly found that the number
of healthcare workforce in Nigeria is above than most of the other countries in Africa.
However, the number of dentists is very low compared to the average dentistry workforce of
Africa.

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Table: National Average workforce (Ezeonwu, 2013)
Per 10,000 population
Physicians 4.1
Nurses and midwives 16.1
Dentists 0.2
Pharmacologist 2.1
Psychiatrist 0.5
Physicians Nurses and
midwives Dentists Pharmacologist Psychiatrist
0
2
4
6
8
10
12
14
16
18
Per 10,000 population
From the above analysis of national level workforce, it can be clearly seen that the
number of registered nurses and midwives is higher than the number of practitioners;
however less that the rate needed for developing an efficient workforce. At the same time the
number of psychiatrist is very low, that can be the cause of accelerated mental health problem
rate across the nation.
Table: Certificates of Good Standing Issued (Ezeonwu, 2013)
Year Request and letter issued
2008 624
2009 691
2010 637
2011 749
2012 864
2013 699
2015 654

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2008 2009 2010 2011 2012 2013 2015
0
100
200
300
400
500
600
700
800
900
1000
The table presented above represents the number of certificate issued in a year in
Nigeria for the good performance of the medical practitioners. Hence, the above graphical
presentation it can be clearly found that through the rate of good performance in medical
practitioners was improved within 2008 and 2012, after 2012 the performance is declining
significantly, causing limitations in national healthcare service quality.
Critical issues to be addressed
From the above healthcare environment and workforce analysis several issues has
been found in the healthcare workforce management system in Nigeria that need to be
addressed to improve the healthcare service quality and health situation of people. From the
above workforce analysis in healthcare service, it can be clearly seen that considering the
number of workforce Nigeria has a huge number of currently active healthcare workforce
across the nation. However, having this much of workforce still not solving the healthcare
related issues nationwide that increasing mortality rate, pre-mature death, child-death,
transmittable diseases and others. Because of improper communication, coordination and
tangible framework this government strategy has completely failed to address the healthcare
workforce related issues and workforce quality improvement. At the same time, a good
number of quality workforces are migrating to foreign countries for better career
development. Densities of doctors, nurses, midwives are too low like the other 57 HRH crisis

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countries to efficiently deliver essential health services (1.95 per 1,000). The health
workforce in the southern portion of the nation, especially in Lagos, is focused in the
distribution of urban tertiary health care services. The lack of public and private sector
coordination is another key attribute that is contributing this inequity. Apart from that the
nurses and midwives are not educated enough to treat range of health issues. Lack of
planning, monitoring and governance is causing several ethical dilemmas throughout the
nations. Decreasing performance rate of health practitioners is the most noticeable result of
all this ethical issues.
Lack of monitoring, controlling and systematic governance approach is the most
critical issue in Nigeria. Considering the fact that both public and private educational
organisations are actively working to strengthen the healthcare workforce, lack of proper
distribution strategy is causing severe healthcare inequity across the nation (Uneke et al.,
2014). At the same time, the federal government of Nigeria is currently focusing on solo
investment in healthcare development instead of seeking funding help form other private
international organisations. It is declining the funding and facilitation ability to train
healthcare workforce to the standard level. As a result, lack of educational understanding of
diseases, physiology and treatment is causing significant performance issues while practicing
the medical services.
Recommendations
From the above data analysis and critical findings the following recommendations can
be made for the federal government of Nigeria.
In order to tackle the difficulties of medical training and academic development of
healthcare workforce, presenting residency programs (postgraduate medical training) in

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Nigeria can be structured and upgraded to enable educational and clinical training as
observed in some other nations. It will ensure that residents are awarded Masters or PhDs
together with their corresponding Fellowships to complete their training. In addition , as
suggested by the WHO, a contextually adaptable structure for inter-professional education
and cooperative practice in the health industry needs to be developed in order to promote
further effective collaboration, interaction and teamwork in the delivery of health services
while simultaneously prioritising the holistic development of health workforce that can be r
ready to react to local health requirements (Adebayo et al., 2016).
Some writers have suggested that one fundamental way to solve health professionals '
conflicts and potentially stem industrial disputes is to bring non-financial advantages to the
health workforce that are uniformly distributed. This can be in the form of career
development, the acquisition of unique abilities and other human capacity development
programs. In order to promote universal free health coverage for all Nigerians, the current
NHIS that includes only the formal sector very marginally, needs to be restructured properly
with proper reinforced learning.
In order to create sustainable management, it is essential that the domestic health
system has a strong administrative policy basis that enables objectives and alliances to be
aligned, coordinated and coherent within the health workforce and between different
stakeholders. Priority must be given to the challenge of mutual distrust, tension and
supremacy among the health workforce. Health service delivery should concentrate not on
factional or individual strengths but on teamwork.
There are no state-level structures in the two primary legislative bodies. As part of its
assistance for enhancing systems, the Brain Drain to Brain Gain initiative should work with

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appropriate bodies to establish local structures to facilitate the licensing and monitoring
process of their employees at state level.
Regulatory bodies should be supplied with technical support to establish processes
capable of monitoring health workers ' exits beyond the present dependence on good standing
certificates. Therefore, registers of the exiting health workforce should capture migrant,
retired and deceased health employees and update information on a quarterly basis. In order
to functionalize human resources for health databases and monitoring processes of
government and private sector staff in the country, immediate technical assistance to the
Cross River State Ministry of Health is needed. Such assistance should first take inventory of
what other development partners have accomplished and try to construct on existing
structures to avoid parallel processes being created (Adeloye et al., 2017).
In order to promote human resources for health planning, human resources for health
monitoring and data management systems should be established at state health ministries and
connected to all training organizations. At the same time the service delivery points should be
also strengthen enough with the proactive help from the private sectors. There is an urgent
need for the three nursing colleges to restore accreditation, which has seen a halt in midwives
training. A significant set of initiations should be taken to guarantee that training
organizations retain minimum training requirements in their short term as well as long term
development where the growth of infrastructure and human ability requires extra resources.
Conclusion
It can be said from the above debate and analysis that the health workforce of a
country is largely made up of health service suppliers and health management and support
employees. It has been found that a large number of healthcare workers are present in Nigeria
as health workforce in Africa. However, competency of doctors, nurses, midwives are too

12HEALTH-WORKFORCE PERFORMANCE REPORT
low like the other 57 HRH crisis countries to efficiently deliver essential health services.
According to the Global Workforce Alliance study, the delivery of health services in Nigeria
is full of difficult characteristics where the main contributors are inequity, absence of
coordination, absence of planning, bad implementation, incompetent employees. Good
performance rates in medical practitioners enhanced in 2008 and 2012, resulting in
significant declines in performance after 2012, resulting in constraints in the quality of
national healthcare services. The most critical problem in Nigeria is the lack of surveillance,
control and systematic approach to governance. Considering that both government and
private instructional organizations are actively working to reinforce the healthcare workforce,
the absence of a adequate distribution strategy is causing serious inequity in healthcare across
the country. From the above recommendation it has been found that human resources for
health surveillance and data management systems should be created at state health ministries
and linked to all training organisations and service delivery points, including the private
sector, in order to encourage human resources for health planning.

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References
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