Abstract
BackgroundGuinea undertook health workforce reform in 2016 following the Ebola outbreak to overcome decades-long shortages and maldistribution of healthcare workers (HCWs). Specifically, over 5000 HCWs were recruited and deployed to rural health districts and with a signed 5-year commitment for rural medical practice. Governance structures were also established to improve the supervision of these HCWs. This study assessed the effects of this programme on local health systems and its influence on HCWs turnover in rural Guinea.MethodsAn exploratory study design using a mixed-method approach was conducted in five rural health districts. Data were collected through semi-structured questionnaires, in-depth interview guides, and documentary reviews.ResultsOf the 611 HCWs officially deployed to the selected districts, 600 (98%) took up duties. Female HCWs (64%), assistant nurses (39%), nurses (26%), and medical doctors (20%) represented the majority. Findings showed that 69% of HCWs were posted in health centres and the remaining in district hospitals and the health office (directorate); the majority of which were medical doctors, nurses, and midwives. The deployment has reportedly enhanced quality and timely data reporting. However, challenges were faced by local health authorities in the posting of HCWs including the unfamiliarity of some with primary healthcare delivery, collaboration conflicts between HCWs, and high feminization of the recruitment. One year after their deployment, 31% of the HCWs were absent from their posts. This included 59% nurses, 29% medical doctors, and 11% midwives. The main reasons for absenteeism were unknown (51%), continuing training (12%), illness (10%), and maternity leave (9%). Findings showed a confusion of roles and responsibilities between national and local actors in the management of HCWs, which was accentuated by a lack of policy documents.ConclusionThe post-Ebola healthcare workers policy appears to have been successfully positive in the redistribution of HCWs, quality improvement of staffing levels in peripheral healthcare facilities, and enhancement of district health office capacities. However, greater attention should be given to the development of policy guidance documents with the full participation of all actors and a clear distinction of their roles and responsibilities for improved implementation and efficacy of this programme.
Highlights
Guinea undertook health workforce reform in 2016 following the Ebola outbreak to overcome decades-long shortages and maldistribution of healthcare workers (HCWs)
In 2013, before the Ebola outbreak, the density of skilled HCWs in Guinea was estimated at 7.3 per 10,000 inhabitants; meaning that nearly only 8000 skilled HCWs were available to cover the 11 million population. This ratio was three times lower compared with the threshold of 23 HCWs per 10,000 inhabitants required by the World Health Organization (WHO) in 2006 [1, 2]
These HCWs play a pivotal role in healthcare delivery in rural and underserved health districts, where they make up 68–71% of the overall workforce [4]
Summary
Guinea undertook health workforce reform in 2016 following the Ebola outbreak to overcome decades-long shortages and maldistribution of healthcare workers (HCWs). The first factor is the low employment capacity of the state, contrasting with the chronic over-supply of health graduates on the labour market—more than 25,000 skilled HCWs trained between 2010 and 2017, while nearly 12,000 job vacancies existed [3, 4, 7] Many of these health graduates stay in the capital, Conakry where access to the formal or informal private sector is easier. A relatively low number of them, stay in rural health districts, where they have been working for years as informal HCWs (e.g. volunteer or contractual workers) in public health facilities with the prospect of being prioritized by state actors in recruitment processes [4] These HCWs play a pivotal role in healthcare delivery in rural and underserved health districts, where they make up 68–71% of the overall (formal and informal) workforce [4]. Factors acting outside the health system such as inadequate living conditions in rural settings negatively influence the presence of HCWs [6]
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