Rethinking the Human Resource Crisis in Africa's Health Systems: Evidence across Ten Countries

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from ten countries in the region to explore the dimensions of this shortage. We find wide variation in human resources performance metrics, both within and across countries. Many facilities are barely staffed, and effective staffing levels fall further when adjusted for absenteeism. However, caseloads--while also varying widely within and across countries--are also low in many settings, suggesting that even within countries, deployment rather than shortages, together with barriers to demand, may be the principal challenges. Beyond raw numbers, we observe significant proportions of health workers with very low levels of clinical knowledge on standard maternal and child health conditions. This work demonstrates that countries may need to invest broadly in health workforce deployment, improvements in capacity and performance of the health workforce, and on addressing demand constraints, rather than focusing narrowly on increases in staffing numbers. Key messagesO_LIThis study analyzed health worker surveys from ten countries in Sub-Saharan Africa for a deeper understanding of human resource challenges. C_LIO_LIAverage staffing across facilities is far below the stated staffing norms for each country. C_LIO_LIHalf of health centers and health posts have one or fewer clinical staff assigned to them. C_LIO_LIStaffing is even lower when adjusted for absence, which is highest in small facilities and public facilities. C_LIO_LIMassive within-country variation in caseload suggests that staffing problems may be solved in part by reallocation of clinical staff. C_LIO_LIHealth workers lack basic clinical competencies, caseloads are imbalanced, and there is substantial absence of workers from health facilities. C_LI