Assessing the staffing needs for primary health care centers in Cross River State, Nigeria: a workload indicators of staffing needs study.

BACKGROUND: A major human resources for health challenge for Nigeria is ensuring the availability and retention of adequate competent health workers in the right mix to provide health care particularly at primary health care facilities in remote and rural communities. This study applied the Workload Indicators of Staffing Need (WISN) method to determine the numbers of nurses, midwives, community health officers (CHOs), community health extension workers (CHEWs), and junior community health extension workers (JCHEWs) required to cope with health care service delivery at primary health care facilities in Cross River State; compare workloads of different cadres at selected health facilities, and identify facilities with highest workload pressure. METHODS: Cross River State in Nigeria has 18 local governments, 196 wards, and an estimated population of over three million people. We used the WISN method to estimate the numbers of nurses/midwives, CHOs/CHEWs, and JCHEWs required to cope with the workload in the 196 ward-level primary health care facilities. FINDINGS: Basic services provided by nurses/midwives, and CHOs/CHEWs were typical of the primary health care level. They are antenatal care, routine immunization, child welfare clinic, family planning, treatment of minor ailments, assisted and normal deliveries, postnatal care, emergencies, care of tuberculosis patients, and referrals. Findings show that available nurses/midwives for the 196 PHC facilities were 79, and the calculated requirement was 209, WISN ratio of 0.4 and difference of - 130; the existing number of CHOs/CHEWs was 808, the calculated requirement was 1,258, WISN ratio of 0.6, with a difference of - 450; and the number of existing JCHEWs was 258, the calculated requirement was 203, WISN ratio of 1.3 with a difference of 55. Cross River State had only 40% of required nurses and midwives; and 60% of CHOs/ CHEWs needed to provide health services in the ward-level PHC facilities. CONCLUSION: The findings from this study indicated marked shortages of needed health workforce particularly nurses and midwives at the primary level of care; and overlap in some of the tasks performed by nurses/midwives, CHO/CHEWs, and JCHEWs.

Human resources for health coordination mechanisms: lessons from Bauchi and Cross River states of Nigeria.

BACKGROUND: Addressing the challenges of the health crisis requires collaboration by multiple sectors and stakeholders with a complementary role in a single platform that coordinates policy and programs relating to the health workforce for sustainability. METHODS: Information from purposefully selected stakeholders involved in human resources for health programs in two selected states of Nigeria was collected during a workshop attended by 60 participants drawn from government, multilateral agencies, the private sector, bilateral agencies, academia, professional associations, and regulatory bodies. RESULTS: Lessons learnt from Bauchi and Cross River states HRH platforms included successful joint planning and implementation human resources for health strategies that significantly mobilized resources and improved performance. Human resources for health coordination platforms with strong governance structures are sustainable. CONCLUSION: The coordination platforms require governance structures for inter-sectoral coordination and collaboration. This enhances joint planning, implementation and monitoring of HRH activities.

Estimating frontline health workforce for primary healthcare service delivery in Bauchi State, Nigeria.

BACKGROUND: In Nigeria, adoption of the primary healthcare approach led to the establishment of numerous primary healthcare facilities, and training of new cadres of community health officers (CHOs), community health extension workers (CHEWs) and junior community health extension workers (JCHEWs). These new groups complemented the work of nurses and midwives. METHODS: We conducted a workload indicators of staffing needs study in the 20 local governments of Bauchi State, from March 2016 to September 2018, in all 317 ward-level primary healthcare facilities. RESULTS: Findings show a total of 128 existing nurses/midwives, a calculated requirement of 402 and a shortage of 274 nurses/midwives. Existing CHOs/CHEWs were 735, a calculated requirement was 948 and a shortage of 213 CHOs/CHEWs. The JCHEWs were 477, a calculated requirement of 481, with a shortage of four JCHEWs. CONCLUSION: Results from this study highlight the unequal distribution of health workers; the abundance of some frontline workers in some communities and dire need of others. We emphasize the need to strengthen health workforce planning to deliver essential primary healthcare services, particularly in rural and remote communities with high levels of vulnerability to diseases.

Perspectives of policymakers and health care managers on the retention of health workers in rural and remote settings in Nigeria.

BACKGROUND: Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention. METHODS: We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria. RESULTS: Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building. CONCLUSION: The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations.