With a population of more than 8 million, Chad has around 3,600 health workers: 50 percent of these are unskilled, and 35 percent are nurses and midwives. Chad also faces geographical imbalances in the distribution of health professionals, with approximately half working in the capital N’Djamena.

Massive shortages of qualified health workers are recognised by the Chad authorities to be a primary bottleneck for the development of the health sector. Policies have been implemented which prioritise human resource development. However, more coherent policies are needed, particularly to improve motivation and retention.

The easiest option in the short-term for increasing the health workforce is to integrate currently unemployed personnel. In Chad the size of the unemployed health workforce is unknown but it is estimated that in recent years nearly all newly trained health personnel have been integrated into the health service, so there may not be a significant pool of unemployed personnel.

Hiring health personnel with specific skills from other countries with an excess supply is another option. Neighbouring countries such as Niger report similar shortages and job vacancies. Chad has temporarily hired around 100 Cuban health workers, most of whom are physicians. However, this strategy requires good financial and non-financial incentives to attract them to Chad, and is likely to only partially lessen health workforce shortages. Moreover there are only a limited number of countries with a surplus and most countries in sub-Saharan Africa encounter similar problems as Chad.

Investing in training institutions is likely to be the most sustainable approach in the mid-term. However, this would involve collaboration across different ministries and strategic agreement on priority areas for training. It would also take several years for trainees to become qualified.

Improving performance would help tackle the need for additional health workers. In Chad, at least 30 percent of staff time is spent on unproductive activities such as waiting for patients or simply being absent from the service without explanation. A productivity increase would reduce the need for more staff. Introducing performance assessment and offering decent working conditions would be effective approaches. At present there are no policy initiatives in this direction. Policies to improve motivation and retention should be prioritised.

Source(s):
id21 insights health #7, August 2005, Responding to the health workforce crisis Full document.
'An approach for classifying human resources constraints for achieving health-related Millennium Development Goals', Human Resources for Health 2:11, by K. Wyss, 2004

Funded by: Ministry of Health, Chad; Swiss Tropical Institute

id21 Research Highlight: 13 July 2005

Further Information:
Kaspar Wyss
Swiss Centre for International Health
Swiss Tropical Institute
Socinstrasse 57
CH- 4002 Basel
Switzerland

Contact the contributor: kaspar.wyss@unibas.ch

Swiss Centre for International Health, Swiss Tropical Institute

Other related links:
'Responding to the health workforce crisis'

'Stopping the migration of Ghana's health workers'

'Filling the gaps: introducing substitute health workers in Africa'

'The crucial contribution of overseas volunteers'

'Committing donors to building health workforces'

'The Joint Learning Initiative Report: overcoming the crisis'

Eldis/HSRC human resources for health dossier