Quintile distribution of health resourcing in Africa

Abstract

Africa has a limited health workforce that tackles the morbidity of complex, variable and highly prevalent diseases, often with limited resourcing. This study assesses health worker resourcing in African regions and countries stratified in quintiles (Q). African countries were categorized according to five regions viz. Northern, Western, Central, Eastern and Southern Africa. Each region was assessed according to the distribution of the (medical) doctor and nurse (and midwife) density, nurse to doctor ratio, and hospital bed density, followed by ranking of the health resources and even distribution across Q i.e. Q1-5, with Q1 reflecting the best resourced, Q2-4 intermediate resourced and Q5 the most under-resourced countries in Africa. The doctor and nurse densities, nurse to doctor ratio, and hospital bed availability in Q1 African countries were all higher compared to Q2-5 African countries, reflecting better health resourcing. Both nurse densities and nurse to doctor ratios were higher in Q2 African countries relative to Q4 and Q5 African countries; with hospital bed availability in Q2 African countries higher compared to Q3-5 African countries, and in Q3 African countries compared to Q5 African countries. The best resourced African countries (Q1) were better geared to provide decent healthcare, particularly those meeting global standard thresholds, whereas the remaining countries (Q2-4), and particularly the most under-resourced (Q5) countries, lagged the best resourced African countries, and face extreme challenges in providing decent healthcare. Health resourcing across Africa requires urgent strengthening to enable better healthcare delivery.

Keywords:

• doctor density
• global health
• hospital bed availability
• human resources for health
• nurse density
• nurse to doctor ratio

PUBLIC INTEREST STATEMENT

Africa is diverse with a high disease burden and limited health resources. Most of the 53 African countries, categorized in five regions, had insufficient doctors, nurses and hospital beds. Some of the best resourced African countries barely met the global health resourcing to deliver health services, and there were intra-regional disparities. Relevant, quality health worker training and skills programs, and task shifting and sharing, can improve health service delivery to benefit patients. Increasing hospital bed capacity by transferring patients to offsite locations will enhance patients’ access to health services. Greater continental and regional healthcare coverage should be pursued and supported by nationally cohesive health systems and the sharing of limited resources to enable partnerships that address the continental challenge for better health resourcing thereby fostering development. Communities should also be empowered to contribute to healthcare. People should value and take ownership of their health and adopt preventative strategies by living healthier.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

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Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Marlon E. Cerf

Marlon Cerf’s global health focus is on health strategy, the socio-economic determinants of health and disease, and health worker resourcing, particularly in low- and middle-income countries. He also has a strong interest in research capacity and sustainable development. This research reports on the limited health resourcing in African regions and countries, and highlights the need for enhancing health resourcing through cohesive continental partnerships, national strategies, relevant quality training and skills programs, and task shifting and sharing, to improve health worker resourcing particularly in the poorest resourced African regions and countries.