Abstract
BackgroundTrained healthcare workers are an essential resource for effective health systems. However, healthcare workers’ perspective on healthcare, the challenges they face to provide quality health services, and opportunities to improve motivation and providing adequate care are rarely investigated in resource-constrained settings of sub-Saharan Africa.MethodsAll reachable nurses of Abou Deia, a primarily rural district in the south-eastern part of Chad, were invited to participate. In-depth interviews were conducted to assess current challenges and opportunities faced in daily work, including factors that influence motivation and social wellbeing. Particular emphasis was placed on paediatric care.ResultsEight nurses were interviewed. Main work challenges pertained to overall workload, a lack of training and support regarding a serious case mix to be managed on their own, adverse working conditions, issues related to the local communities, and the impact of postings on nurses’ private life. Poor working conditions and perceived lack of recognition emerged as the main demotivating factors. Motivation to improve nurses’ skills so that they can provide good care, coupled with small, suggested changes in working conditions and health care organisation provide opportunities worth exploring to improve health workers’ satisfaction, motivation and the care they can provide.ConclusionsHealth workers in a predominantly rural district in Chad face a wide variety of challenges, and hence their perspectives need to be taken into account to improve health services interventions that aim at enhancing quality of care. Nurses’ willingness to further develop skills and knowledge, proactive search of solutions to remedy stock-outs of drugs and other medical devices, and motivational factors to improve the quality of care represent important opportunities for improving health services for all.
Highlights
Trained healthcare workers are an essential resource for effective health systems
According to a Multiple Indicator Cluster Survey (MICS) conducted in 2015, 34% of women in Chad delivered with a skilled birth attendant, of which only 22% took place in a health facility
There is one district hospital, which is supported by the Centre de Support en Santé Internationale (CSSI), a local Non-governmental organisation (NGO), which has helped organise and finance additional, much needed staff such as a surgeon, an anaesthesia-nurse, and general nurses
Summary
Trained healthcare workers are an essential resource for effective health systems. In Chad – a country which, despite petroleum exportations, remains very poor, ranking 186th on the human development index [2] – there are only three trained health workers (doctors, nurses, or midwives) per. 10,000 population, while the World Health Organization (WHO)-defined minimum threshold considered necessary to ensure basic maternal and child health care is 23 health workers per 10,000 population [1]. This issue might explain, at least partially, why Chad is among the countries with the highest infant and under-five mortality rates; 72 and 133 per 1000, respectively [3]. Chronic malnutrition concerns approximately 40% of children [5]
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