Factors contributing to Africa’s failure in achieving MDG5 by Japheth Mati

ABSTRACT[1]

The latest UN Report on MDGs reveals considerable reductions in maternal mortality in most regions of the world except in the sub-Saharan Africa where, despite progress having accelerated since 2000, very high maternal mortality ratios and low rates of access to universal reproductive health services, still persist. This discussion highlights several challenges that operate both at the regional and country levels. The challenges at the regional level include poverty, food insecurity, persistent violent conflicts, inadequate budgetary allocation to health sector, and heavy disease burden. At the country level are the persistent inequalities in access to health care both between countries and within individual countries. A review of the status of MDG 5 indicators particularly focusing on the known drivers of maternal mortality reductions shows that most SSA countries fall far below the targets, to the extent that they are least likely to achieve this goal by 2015. Successive national surveys show disparities which relate to wealth status and area of residence, both reflecting a lack of equitable distribution of health services. Two key challenges stand in the way of addressing these inequalities- improving human resources for health, and strengthening health systems. A critical cross-cutting determinant for both is the proportion of national budgets allocated to reproductive health services. In addition, donor-dictated policies of budgetary ceilings on certain expenditures, including hiring of health professionals, constitute another obstacle. Finally, SSA countries are particularly adversely affected by the drop in international aid towards reproductive health, and especially the financing of family planning programmes.

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[1] Abstract of an invited presentation at the FIGO World Congress October 7 – 12, 2012

 

The world needs 350 000 additional midwives; what of Kenya?

The State of World’s Midwifery 2011, launched in June 2011 by the United Nations Population Fund (UNFPA), reminds us that the greatest “crisis in human resources for health” exists where the need is greatest, in countries which not only accounted for 58 percent of world’s total births (81 million) in 2009, but also accounted for 91 percent of all maternal mortality, and 80-82 percent of global stillbirths and newborn mortality. More importantly, this report confirms that some 350,000 additional skilled midwives are needed to fully meet the needs of women around the world. Increasing women’s access to quality midwifery services is crucial to the realization of the right of every woman to the best possible health care during pregnancy and childbirth. It should be seen as a key investment that is fundamental to reducing maternal and newborn mortality and morbidity, and attainment of MDG 5.

How does this apply to the situation in Kenya? Commenting on the state of midwifery in Kenya the Report observes, among other concerns, the shortages of staff that exist despite the difficulties of newly graduated midwives to find jobs. The Report concludes that for Kenya to make meaningful progress towards achieving MDG 5 appropriate employment and deployment of skilled midwives is essential. The density of the health care workforce is a known determinant of mortality rates for mothers, infants and children under five[i]. Earlier, in 2006 the World Health Organization had listed Kenya among 36 sub-Saharan African countries that were facing a critical shortage of heath care workers[ii].

 Whereas for many sub-Saharan African countries the shortage of health care workers is largely due to inadequate production, the problem in Kenya is of a different nature. The Nursing Council of Kenya (NCK) has accredited nearly 70 institutions for training of nurses and midwives at different professional levels, which collectively put out about 2,250 nurses annually. Kenya surely does have the capacity to meet its nurse workforce needs.

Clearly, by far the lead contributor to Kenya’s nurse workforce shortage is the lack of resources to hire nurses who have been trained at high cost. Factors such as out-migration (brain drain) are relatively less significant and largely fueled by poor deployment which interferes with effectiveness and job satisfaction among trained staff.

Unemployment for nurses in Kenya was something unknown before 1998 when hiring of new nurses was stopped under World Bank and IMF initiated policies. Up to 1996 all nurses were recruited into public service immediately on completing training. In recent past, recruitment supported by development partners under contractual arrangement has helped increase the staff complement, but most of these have been deployed in specific programmes mainly related to HIV and AIDS.

[i] Anand, S. and T. Barnighausen. 2004. “Human resources and health outcomes: cross-country econometric study.” Lancet364(9445): 1603-9. 

UPDATE November 25, 2011:

Speaking at the 54th Conference of the East, Central and Southern Africa Health Ministers which took place in Mombasa, Kenya, 21-25 November 2011, Vice President Stephen Kalonzo Musyoka announced that the Kenya Government is set to hire about 4,000 nurses and health technicians, including an additional 2,100 community health workers, all at a cost of Sh1 billion[1]. They will be distributed equitably throughout the country’s constituencies, and the money for the recruitment has been provided for in the current financial year.

[1] Daily Nation November 25  2011, http://www.nation.co.ke/News/4000+jobs+lined+up+for+nurses+/-/1056/1278796/-/tc1c29/-/index.html