Wastage in the health workforce: some perspectives from African countries

This paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of "wastage"."Direct" wastage – or avoidable increases in loss of staff through factors such as emigration and death – is on the rise, perhaps as a result of the HIV/AIDS epidemic. "Indirect" wastage – which is the result of losses in output and productivity from health professionals' misapplied skills, absenteeism, poor support and lack of supervision – is also common.HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers, fear of infection, burnout, absenteeism, heavy workloads and stress affect productivity.The paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention, including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain.Africa, unlike the other continents, faces a severe human resources crisis in the health sector. The continent's economic performance has been poor, which has affected the ability of countries in sub-Saharan Africa (with few exceptions) to sustain credible health services and to train, employ and use health workers most efficiently. Economic growth has been low or negative in many countries, with investment in health that has generally been inadequate, both as proportions of GDP and in gross terms. Motivation, incentives and productivity and retention of health workers have been severely affected. Furthermore, over the past two decades the population of countries in t