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BERNARD MUTHAKA looks at lasting solutions towards the persistent problem of brain drain
According to the World Health Organisation, a country needs a minimum of 23 doctors, nurses and midwives for every 10,000 people. Kenya has one doctor and 12 nurses and midwives serving 10,000 people.
While factors such as health worker emigration for higher pay and better working environments are partly causing shortage of health workers, lately, attention is shifting to the role played by other cadres of health providers and what they can do to plug the gaps.
According to the World Health Organisation, there is growing evidence that community health workers can address the growing shortage of health workers, particularly in low-income countries, in a concept widely referred to as ‘task-shifting’.
Shortages of skilled health workers are driven by factors such as the rise in demand for health workers in high-income countries, increasing morbidity, mortality and high workload due to the impact of HIV and Aids pandemic.
The pressure is set to go a notch higher, due to the rise of non communicable diseases such as cancer and diabetes.
Add that to the inadequately funded health systems and deteriorating working conditions, especially in hardship areas and one gets the perfect setting for a strong push factor for emigration.
The umbrella term ‘community health worker’ (CHW) embraces a variety of community health aides selected, trained and working in the communities from which they come from.
Health systems researchers propose that there is need to review the role of community health workers in order to determine what tasks can be safely delegated to them.
Kenya’s neighbour Uganda has already adopted task shifting in the provision of Antiretroviral therapy (Arvs). Nurses in Uganda are now undertaking a range of tasks that were formerly the responsibility of doctors, including managing people living with HIV who have opportunistic infections.
They are also diagnosing tuberculosis through sputum tests, determining the clinical stage of people living with HIV and medical eligibility for Arvs.
In turn, tasks that were formerly the responsibility of nurses have been shifted to community health workers, who have training but not professional qualifications.
These tasks include HIV testing, counselling and education on Arvs, monitoring and supporting adherence to Arvs, filling in registers, triage, clinical follow-up, taking weight and vital signs and explaining how to store Arvs.
By creating a range of non-professional types of health care workers, Uganda has been able to expand its human resources for delivering HIV and Aids services.
One of the most important functions the CHW are performing is to act as a bridge between the community and the formal health services.
This goes further to compound WHO proposal that CHWs may be the only feasible and acceptable link between the health sector and the community that can be developed to meet the goal of improved health in the near term.
In Sauri Village in Nyanza, the millennium community has experimented with a CHW programme that was shown to have an impact on accessibility and affordability of health services to rural and poor communities.
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