“Doing more with less” is an adage we hear often in development discourse, especially in the current environment of budgetary constraints and the global economic uncertainties that are hitting developing countries hardest.
The notion of doing more with less has particular resonance among health workers globally in the wake of the COVID-19 pandemic and more so in countries of the global south which have always had to do more with less.
A common thread that seems to run through the experiences of health workers through the pandemic is how it affected women in particular. A report by McKinsey on women in healthcare and life sciences in the US, notes that “the COVID-19 pandemic has created a seismic shift in the workforce with a specific impact on women”. The analysis finds that women in healthcare faced increasing pressures and challenges related to burnout and longer work hours in the COVID-19 era which may increase attrition in the future. The report also highlights findings of a survey conducted in February and November 2021 indicating that more than 32% of surveyed nurses may leave their current positions providing direct patient care within the year, seemingly driven by the effect of the pandemic on nursing staff.
During the worst peaks of COVID-19, in some countries, cases overran existing bed and staffing capacity, and the response was simply to shut down routine health services including childhood immunisation, HIV/AIDS, and maternal child care services and divert the primary care staff to COVID-19 care. At the start of the pandemic, many countries did not have the required stock of personal protective equipment with nowhere to find supplies. When the much-needed equipment and supplies started flowing into many of the countries in Africa by late 2020/early 2021, the intensive care units which were previously barely functional were suddenly equipped with ventilators and oxygen but no specialised staff to use them.
While all frontline health workers have had to face the demands of longer working hours and increased exposure to risk of infection, women have consistently been shown to bear a greater burden for childcare and other domestic responsibilities. Parenthood in of itself is often a barrier to women’s professional advancement. The confluence of parental responsibilities and the demands of front-line health care during the pandemic is likely to have set many women back particularly those in nursing with its hierarchical structure and limited management positions in any healthcare organisation.
The COVID-19 pandemic served to expose appalling conditions that health workers in Africa have been working in and are rightfully blamed for contributing to the exodus, particularly of nursing staff to countries with better remuneration and well-resourced health facilities. Furthermore, as other sectors of the economy are limping towards recovery, recruiting more staff and returning to offices and factories, health services across the world have gone from the battlefield to a simmering war with no return to peace in sight.
There is no doubt that this has hit nursing staff hardest, the majority of whom are women. In most countries of sub-Saharan Africa, where health worker shortages are the norm, recovery of this precious resource will not happen without bold leadership and thinking about how the health workforce is managed, rewarded, and retained to withstand future shocks. The situation is made worse by the perennial poaching of health workers by Western countries. According to the WHO, Africa faces the most severe health worker shortages. In addition to the region having the highest disease burden, the health worker density is below WHO’s recommended 2.3 health professionals per 1,000 population in 44 of the continent’s 54 countries.
The narrative about health systems strengthening and resilience in Africa needs to incorporate innovative leadership and management approaches in healthcare that seek to optimise health Human Resources. In Africa for a start, there is a need for up-to date data base on available and practicing health professionals as well as their movements in and out of the workforce. Africa also needs to invest in some of the issues that would attract and retain health workers. Perhaps the hierarchical structure of the health sector is a barrier to adapting to the changing and extremely mobile health workforce. While the push factors causing skilled health workers to leave the profession are mostly known, the pull factors are not so well understood and would certainly require a reconfiguration of the sector and its management. There is no doubt that any recovery of the healthcare sector in Africa will need to focus on strengthening retention efforts and consider the needs of women who make up to 70% of the nursing staff. In contrast, in global health, men head 69% of international health organisations, and 80% of board chairs are men.
In addition to investing in improved functionality and infrastructure, there is a need for a rethink of reward systems beyond finance, particularly those that matter to women. These could include flexible working arrangements to accommodate parenting responsibilities without affecting professional progression. In some countries in Africa, safety of women in the health workforce is one of the areas that needs to be addressed to improve working conditions. For example, when nursing staff work night duty in unsafe areas, would different plans be put in place to safeguard their safety if the leadership were predominantly women? I would like to believe that systematically increasing the number of women in leadership roles in the health sector would begin to address some of these gaps.
About the author
Nana Beth Kgosidintsi is a Health Specialist for the African Development Bank and MBA student at Frankfurt School of Finance & Management. A health and development professional with more than 20 years’ experience in Eastern Western and Southern Africa, Nana Beth has lived and worked in Tunisia, Côte d’Ivoire, Botswana, and South Africa. She believes governments and the private sector must work together to make this possible and attract sustainable investment.