Here, I’m alone as doctor? Nurse:we are here!!

[Assalamualaikum & salam sejahtera]

In contrast to the previous post which there are many healthcare professional in one area. Now, I want to express my opinion on the problem shortage of doctor in primary health care or primary health center.

The current shortage of healthcare professionals has become a global problems. The major factor contributor to this is brain drain from the rural to urban area, from poorer country to richer countries. World Health Report 2006 suggest that several wealthy countries of the world rely heavily on physicians from other countries.

The report describes the situation of New Zealand and Great Britain, where one third of the active physicians are from abroad, as well as the USA and Canada, whose physician workforces consist of nearly one quarter foreign physicians.  On the other side, some African countries, such as South Africa, Ghana and Angola have lost 20 to 35 % of their physicians to emigration.This situation leaves some of the poorest countries of the world with nearly no physicians. While many wealthy countries have a physician to population ratio of 1 to 500, in Malawi, for instance, this ratio is 1 to 50.000. According to the WHO, a total of 57 countries, mostly in sub-Saharan Africa, but also including Bangladesh, India and Indonesia, face serious health workforce shortages.

That's only one part of the problem, then it comes to second part of the problem which is the demand. At the same time, the demand for health care is rising. In high- and middle-income countries, large populations of ageing people and changing patterns of disease mean a steady growth in the demands on health services. Low-income countries continue to deal with an unfinished agenda of infectious diseases and emerging chronic illness 1. Meeting the commitments to combat disease, reduce child mortality and improve maternal health, as enshrined in the Millennium Development Goals, will involve strengthening health systems so that they are capable of delivering a wide range of health services on a scale much larger than at present.

 

In response to the worldwide health workforce shortage, the WHO  has developed Global Recommendations and Guidelines on Task Shifting.

There the problems. The solution is task-shifting. What is task shifting?

 

Task shifting is the name now given to a process whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications. By reorganizing the workforce in this way, task shifting  can make more efficient use of existing human resources and ease bottlenecks in service delivery. Where further additional human resources are needed, task shifting may also involve the delegation of some clearly delineated tasks to newly created cadres of health workers who receive specific, competency-based training.  Task shifting alone will not put an end to the shortage of health workers but it may offer the only realistic possibility of expanding health workforce capacity fast enough to meet the urgent need for health care services.

Transfer of tasks and skills in Health,Dr AKA Kroo Florent,Medical Association of Ivory Coast presented to the SEMINAR OF THE WORLD MEDICAL ASSOCIATION, Human resources for health & the future of health care Reykjavík, Iceland, 8 & 9 March 2009 that in Ivory Coast, the shortage of health personnel has made the country try to apply the task shifting system. The Ivory Coast suffers from a shortage of health‐care structures in rural areas of the country; under‐equipped and unequally distributed structures with insufficient RHS. The difficulties in accessing care are compounded by precarious and laborious means of evacuation in an emergency. Nurses and midwives are authorized to prescribe a certain number of drugs, for which they are fully accountable (list).

 

Why it is very important to take action on the shortage of health care management?

It is very important to provide sufficient access of health to the citizens. Access of health is affect by many factors. One of them is the availability of health care providers.  it is already proven that to the area with high density of health care provider has higher chances of survival as compare to the area with low density of health workers.

The concept has been spreading rapidly and with intense urgency among providers of HIV prevention, care, and treatment services in many regions of Africa. Studies consistently show that task shifting in the provision of HIV services (such as distributing antiretroviral therapy) and other areas of healthcare can increase access, improve the coverage and quality of health services, and reduce the costs of providing services.

According to the WHO, Indonesia as well as many other countries in Africa has high number of nurses and midwives as compare to the doctor. Thus, this suggests an important opportunity to train nurses and other mid-level providers to offer clinical methods of contraception such as IUDs, implants, and female sterilization. Decades of evidence show that nurses and other mid-level providers can safely deliver these long-acting and permanent methods (LAPMs), although the practice is not yet widespread.

Here are one story of the impact of shortage of doctor in Africa:

“On a busy weekday at a rural family planning clinic in Senegal, a young woman enters the newly built facility. She announces that she is interested in birth control and would like to meet with a healthcare provider. The clinic is staffed by two registered nurses, a community nurse, and a doctor. But the doctor splits his time between this clinic and another one in a more urban area. Today he is at the urban centre.

After a short wait, the woman meets with one of the nurses. Upon learning about all the contraceptive methods for which she is eligible, the woman decides to try an intrauterine device (IUD), because she wants to prevent pregnancy for at least a few years and prefers a nonhormonal method that requires no daily or monthly upkeep. Unfortunately, the nurse says that she is not allowed to insert IUDs. She also tells the woman that the doctor who inserts them will not be back until next week. Discouraged and unwilling to try another method, the woman leaves for her long journey home--unprotected from an unintended pregnancy. Maybe she will be able to return to the clinic next week. Maybe she won't.”

Africa Health, November 2009:
Task shifting is expanding the roles of family planning providers

References:

1.  Africa Health, November 2009: Task shifting is expanding the roles of family planning providers

2. World Health Organization.The world health report 2006: working together for health.

3. SEMINAR OF THE WORLD MEDICAL ASSOCIATION, Human resources for health & the future of health care Reykjavík, Iceland, 8 & 9 March 2009

4.  Task shifting : rational redistribution of tasks among health workforce teams : global recommendations and guidelines.

 

-tHaNk yOu-