Estimating frontline health workforce for primary healthcare service delivery in Bauchi State, Nigeria

Abstract

Background In Nigeria, adoption of the primary healthcare approach led to the establishment of numerous primary healthcare facilities, and training of new cadres of community health officers (CHOs), community health extension workers (CHEWs) and junior community health extension workers (JCHEWs). These new groups complemented the work of nurses and midwives. Methods We conducted a workload indicators of staffing needs study in the 20 local governments of Bauchi State, from March 2016 to September 2018, in all 317 ward-level primary healthcare facilities. Results Findings show a total of 128 existing nurses/midwives, a calculated requirement of 402 and a shortage of 274 nurses/midwives. Existing CHOs/CHEWs were 735, a calculated requirement was 948 and a shortage of 213 CHOs/CHEWs. The JCHEWs were 477, a calculated requirement of 481, with a shortage of four JCHEWs. Conclusion Results from this study highlight the unequal distribution of health workers; the abundance of some frontline workers in some communities and dire need of others. We emphasize the need to strengthen health workforce planning to deliver essential primary healthcare services, particularly in rural and remote communities with high levels of vulnerability to diseases.

A Discrete Choice Experiment on Factors Influencing Attrition and Motivation of Frontline Health Workers in Remote and Rural Areas in Nigeria

“…Despite the 56% ANC attendance, only 21.8% of the women eventually delivered in a health facility while 78% of the deliveries were at home. The unavailability and inadequacy of health workers especially in rural settings have been suggested to be the reason for this trend [10].…”

“…The current situation in Nigeria indicates that health workers are not motivated and this is negatively impacting their performance and e ciency. Several factors, including poor remuneration, inadequate sta ng levels with resultant high workloads, lack of social amenities, poor working environments, inadequate medical supplies and equipment, and delayed salaries and emoluments payment have been documented [8][9][10][11][12][13][14][15][16][17]. Additionally, institutionalized attraction, retention, posting, and motivation mechanisms are absent, especially for primary level facilities often located in rural and remote areas [6,18].…”

Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers

“…The reported barriers to effective implementation of task shifting and sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, the perceived sub-optimal capacity of the beneficiary cadres of task shifting and sharing, and lack of adequate equipment for delivery of needed services. The shortage of health workers, especially at the primary level of care in Nigeria, has been reported, 16,17,[19][20][21][22] and is also suggested to result in high workloads 21,22 and influence attraction and retention of health workers. 19,20,23 Health workers protecting their professional space was also a reported barrier, which has also been reported in Uganda.…”

The health workforce status in the WHO African Region: findings of a cross-sectional study

“…It is important to conduct health labour market analysis periodically at national and subnational levels and use the findings to inform policies on the production, recruitment, retention and deployment of health workers 24 25. Distribution of health workers in service delivery can also be enhanced by applying the workload indicators of staffing needs tool26 that has been used in several countries in Africa to determine staffing needs based workload, rationalising the distribution of health workers and the recruitment of additional health workers to fill the gap 27–31…”