Staff shortages in the health sector

Which skills are needed to boost health systems in the countries with an especially high incidence of HIV/AIDS or infant mortality?
Each government sets its own priorities according to its plans but in all countries health services have to be affordable, sustainable and of a high quality. Health-sector reform typically includes restructuring and decentralisation, focused staff training and funding of institutions and services. Apart from medical knowledge, expertise in management, financial processes and quality control is needed.

Which category suffers from shortages most?
There are too few doctors, nurses, midwives and well-trained hospital managers. Huge disparities exist between cities and rural areas. The rich normally benefit more from government programmes than do the poor, who are often excluded from even the most basic services, as the World Development Report 2004 showed. Work conditions are often so dismal in public health care that many doctors have to top up their meagre salaries by working in private practice.

How should poor countries respond to these challenges?
They should implement pro-poor policies in their health sector which benefit the disadvantaged people. Health ministries should account for all types of funding in their budgets, including contributions from donor governments, the international community and private charities. Parallel structures do not help. Coherent budget management at central and local levels enables those in charge to make use of resources more transparently and efficiently. Some health risks should be handled by government-run insurance schemes to save poor families from financial ruin due to illness. Further training can boost staff motivation, but involving them in decision-making, better salaries and support for staff in rural areas would also make sense. To make processes transparent and enable broad participation, monitoring, evaluation and access to such information are important.

Which InWEnt programme do you consider particularly successful?
The e-learning courses on important topics such as health funding, pharmaceutical management, HIV/AIDS and health as a human right are definitely best practice. E-learning allows health professionals to aquire new skills and knowledge while remaining at their workplaces. These courses are accompanied and supported by experienced tutors. Another crucial feature of e-learning is that it offers the opportunity to discuss topics with colleagues and specialists online. The courses are problem-oriented and enable by their combination of online and face-to-face learning the transfer of knewly aquired skills into practice. We offer our HIV/AIDS e-learning programme in four languages – Chinese, English, Russian and Vietnamese. The courses are relevant to medical as well as non-medical staff. E-learning communication is especially well-suited to build networks – which, in turn, supports effective, multisectoral approaches to prevent and combat epidemics like HIV/AIDS.

Questions by Hans Dembowski.