Bridging the gap: Strengthening health systems through a resilient and equitable health workforce in Africa

The health workforce is one of the key building blocks of health system strengthening. Properly trained health workers, including doctors, nurses, and community health workers, are essential for effective health care delivery.

By 2030, the global health workforce is expected to face significant shortages, particularly in low- and lower-middle-income countries, with a shortfall close to 10 million. Africa faces acute shortages, with many countries having fewer than 2.3 health workers per 1,000 population, impacting health care delivery, especially in maternal and child health services. Countries like Nigeria, Mauritania, Togo, and Angola struggle to meet the World Health Organization's recommendations for skilled health workers (Figure 1).

Figure 1: Distribution of health workforce in selected countries

^{Source: Data are from the 2022 Global Health Workforce statistics.}

To achieve the World Bank’s goal to reach 1.5 billion people with quality health services by 2030, it will be key to address health worker shortages through targeted funding, expertise, and partnerships. Addressing this shortage is essential for resilient health systems and access to quality care, especially in African countries facing unmet health demands and COVID-19 recovery. Four solutions are proposed.

1.      International collaboration and support for developing a national health workforce strategy

The Global Strategy on Human Resources for Health: Workforce 2030 emphasizes the importance of global and regional partnerships in enhancing health workforce development, especially in low- and middle-income countries. These partnerships are crucial for providing guidance on workforce planning, labor market analyses, and cost-effective strategies to increase the availability of health workers.

By collaborating with international organizations, donors, and development partners, the strategy aims to mobilize the necessary technical and financial support to strengthen health workforce initiatives, particularly for health security in developing countries. For instance, in 2023, Kenya benefited from a strategic partnership with the World Health Organization by conducting the comprehensive Kenya’s Health Labour Market Analysis 2023. This analysis reviewed the current and future needs of the health care workforce, identifying trends, challenges, and areas for improvement in workforce distribution, spending, and job quality, and made recommendations for effective workforce planning and policy development. More recently, the World Bank highlighted the importance of strategic and financial planning and the inclusion of various stakeholders in health workforce security development.

2.      Strengthening health workforce training and education

The COVID-19 pandemic highlighted the need for a sufficient number of well-trained health workers equipped with the necessary skills to address emerging diseases. Education curricula for health workers should align with the specific health needs of the population, ensuring that future health professionals are well-prepared.

Policymakers should prioritize investing in faculty development and infrastructure to maintain educational standards. Given that non-specialist health care workers are often the primary point of contact for initial diagnoses in many African health care settings, governments should focus on training initiatives to enhance the skills of primary health workers and provide continuous training opportunities. This approach ensures that frontline providers can accurately identify and manage prevalent health issues at the community level.

A recent study by the World Bank indicated significant variations in diagnostic accuracy among health care providers across African countries, with Tanzania having the highest accuracy at 69% and Nigeria the lowest at 40%. Among provider types, doctors and clinical officers had the highest accuracy (67%), followed by nurses (55%) and other medical staff (36%).

3.      Encouraging retention with incentives and support

Retention of high-skilled health workers in Africa is essential and should be a key component of national health plans. These plans should focus on offering competitive salaries, career development, benefits packages, and a good working environment. Deploying health workers to underserved areas with incentives can ensure that resources are available where they are most needed.

For example, the World Bank is currently engaged in policy dialogue with the Togolese government on reforms aimed at establishing a resilient and equitable health workforce in underserved areas. Proposed financial incentives include relocation grants, transportation, housing, and communication allowances, life insurance coverage for families, tuition assistance for children, and risk premiums for those working in conflict zones.

4.      Optimizing health information infrastructure and building an evidence base

Developing a robust health information system is vital for health system strengthening. Existing systems like DHIS2 primarily focus on health outcomes rather than the health workforce. National health information systems need to be revised and made interoperable to integrate health workforce aspects. Enhancing human resource and payroll data in health sectors through a national system with biometric identification will enable real-time tracking of health workers' distribution, qualifications, and performance.

In Kenya, the government successfully integrated information on health outcomes and human resources, allowing for the sharing and analysis of health workforce deployment in relation to HIV services. Regular health workforce surveys could complement administrative and payroll data to further investigate the impact of workforce management interventions.

Looking ahead, the World Bank is proactively addressing health workforce issues through several key initiatives aimed at building resilient and sustainable health systems. One of the major goals is to expand health services to 1.5 billion people by 2030. This ambitious target highlights the critical importance of forging strong partnerships with non-government organizations, the private sector, and civil society. To ensure the effectiveness of these investments, it is essential to tie health personnel efforts to pay-for-performance models and maintain a strong focus on health security.

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