Ethical Essay On Academic Integrity In Health Workforce Citations In Ethiopia.

Identify features of ethical scholarship and academic integrity for citations in-text. 

Health has been termed as a crucial element which is essential in building sustainable human development, thus creating an association as a human right and an essential factor in stimulating growth of society as a whole.  Health is important in contributing to national development through productive nation building, however to achieve these, there needs to be a healthy work force that drives healthy nation in achieving positive health. Health workforce in health care practice has been essential component in realizing the health of the citizen’s so as to promote growth and development. Shortage in health human resource segment has been eminent in lower and low middle income countries globally according to WHO assessments. In analysing this component, Ethiopia has been no exception in terms of inadequate health force to serve the growing population. It is with this aspect that this report will analyse how workforce component in health care practice in Ethiopia works and give recommendations on mitigation measures using the World Health Organisation guideline framework, (WHO, 2010).

Ethiopia suffers acute shortage of health worker personnel at every level of health care delivery both urban and rural areas. Shortage of human resource is significant in the rural areas where 85% of the population live. They have suffered chronic shortage due to understaffing and inadequate human resource available. The federal ministry of health statistics indicates that health problems affecting the people were largely preventable it accounted for 60%-80% of the country’s health problems. These diseases included malaria, pneumonia and TB, (MoH, 2010).

Majority of the low income earners suffer from acute shortage of health workforce in health care and Ethiopia proofs to be no different. The current workforce in Ethiopia is an  average of 0.7 per 1000 people, which is low according to WHO, recommendations of 2.3 /1000  population. The characteristic of the work force in Ethiopia includes health workers extension and general nurses who dominate the human resource supply chain workforce. Critical shortages are experienced in the fields of physics, dentistry, midwifery and anaesthesiologists. With this view physician are the critical group which is severely understaffed, and there population is drastically reducing in the population currently with a low of 1;42,706 population of people which is the lowest level in  the sub Saharan Africa. The number of health officers, nurses, midwives and health extension workers have shown remarkable improvement over the last years and achieved the status of 1:5000population. There is imbalanced skills distribution in the general workforce along the geographic, gender and health sector in general, (Yumkella, 2006).

Health Workforce Data Profile

In the rural set ups, 83 % of the population are experiencing low staffing levels. This is characterized by the uneven distribution of skilled workers in the health work forces. This segment is skewed on private and non government organizations that serve small segment of the population. The heath workforce also is disrupted by the emigration of health workers to other countries and other sectors. It is for this reason that an urgent need on the development of health work plan to assist in brigading the gap witnessed in the population.

In the year 2009, the HR strategic plan office undertook some studies and drafted the ration of the doctor to population levels. The studies revealed that, there was low coverage of doctor to population levels in the workforce. For example in Addis Abba the capital city, there was a ratio of 1: 36,158 of people. The low production capacity, limited health workforce management, lack of adequate retention and motivation mechanisms were prevalent for these low levels. the impacts these has been the encounter of skill mix which is inadequate, geographical imbalances and mismatch between services of education the encountering of the shortage is attributed to the fact that there are limited number of medical schools in the country, limited capacity for students enrolment, shortage of medical educators and other factors, (Lerberghe, Adams and Ferrinho, 2009).

Health workers in the health care practices are engaged in actions that have primary intent of protecting and improving health of the people. Countries health workforce is aimed at providers of health management to support the workers in the health sector. A health workforce is that which ensures that competent and responsive and productive labour output. In order to achieve this there are measures which are taken to ensure that labour is adequately supplied by the actors in order to improve performance and distribution of existing worker forces.  

Table 1: on data profile of health work force

The shortage experienced by many African countries is likely to have an impact on the eradication and intervention programs of diseases such as malaria and tuberculosis, (Wyss, 2004). The health workforce in Ethiopia has been low and unable to make matching to the growing population and to satisfy needs. In the sub-Saharan region the ratios have been low when compared to population levels, (WHO, 2006). Benchmarking has been done to determine the adequate levels needed for the health workforce. The shortage of human resource has been experienced in Ethiopia with key health sectors being highly affected. The geographical imbalances of the workforce on the attrition rates are increasingly daily are affecting the work force of health in the region. The rate of physician in the Ethiopia is 0.027 per 1000 population. This has been estimated to be 3.5 times lower than the recommended levels, (World Bank, 2004). The shortages in the health sector have been linked to the decreasing number of student enrolment in medical schools, low employment of professional levels and high attrition rates have been factored as possible reasons, (Yankella, 2006).

Health Workforce Plan

The number of doctors, midwives and nurses per 1000 population are far much below the mark of rate of 2.28, (MoH, 2010). The existing numbers and rations are far much below the benchmarks required to achieve normal levels as suggested by Scheffler and others, (2007). The shortfall is quite significant like for the doctors there is 0.52 doctor’s shortfall per 1000 population, which is the required achievement of 80% coverage. This comparison makes Ethiopia not to fair off positively in the ranking score. With this statistics, the ratios of doctors and nurses are unlikely to reach the required levels. a projection by WHO  target approaches , is that number of doctors and midwives is not going to increase any time soon if corrective measures are not undertaken. According to World Bank the suggested levels include 10, 846 for general practitioners and nurses were 8, 635, (Girma et al., 2009). The problem facing Ethiopia for these low levels include low level of production

In the last era, health facilities have not been good enough to attract students, despite the expanded effort in improving the expansion of the schools and infrastructure of the health sector, (Vujicic et al., 2006). Human resource challenges have been attributed to the low deployment and attrition levels of the health care professional in the health care sector cuts in the budgetary allocations have been attributed to the issue affecting the quality  of output, (FMOH, 2005).

This health force work plan aims at improving the primary health services in the rural set ups through innovative community based approach based which focuses on the prevention, healthy living and offering curative services. In this plan, development of health extension workers will be achieved, this workforce is aimed at delivering health care to the outreach of the village levels. The program will also focus on the scaling up of health officers to provide clinical services and to play leadership roles in the health centre and to play crucial roles at the zonal level and the regional level and at the district hospitals. The plan also will aim at increasing the number of workers in the health sector, as the current number is escalating highly due to rising demand for health care services, this will create access to primary health care services, (Hailemichael, Jira, Girma and Tushune, 2010). Overall the plans aimed at improving the staff at all the level include the nurses, midwives and support workers such as the technicians, pharmacists and other medical staffs.

The steps to be undertaken in implementing the work force plan entails a road map for several avenues in which the problem can be addressed and analyzed.;

In developing the labour market, the environment for nurturing should be positive and conducive. Development of labour work force can be achieved through creation of jobs in the health sector, through expansion of jobs to offer diverse health care services. It can be enhanced through motivating the largely youthful population engage in training of health related courses in a bid to ensure that jobs are created for them. Sponsoring the unemployed to join medical institutions is an avenue which helps in ensuring that work force is achieved in the long and will be able to reduce the current shortage experienced in Ethiopia.

Promoting and encouraging women to participate in economic activities of the population is essential in achieving the incorporation of women and gender in the sphere of health work force. This can be enhanced through policy change and behaviour change of giving opportunity women in leaderships in health care practice. Employing women in the health care practice will greatly contribute to gender equality. Gender equality globally has been achieved through passage of rules which favour inspiration of women in the leadership and practice levels in health care.

In order to make health care access and delivery to improve there is need to invest on education of the younger generation whom are passionate on medical and to motivate others to join health care practice. This can be done by increasing the number of public universities which are teaching the medical courses and colleges offering medical skills in the country. This can also be coupled with increasing enrolment of students joining these institutions. In order to achieve quality delivery there is need to improve the technical capacity of the institutions and equipped them with adequate resources which are geared towards improving service output of students and ensuring quality is achieved. Need for improved mechanism of competency testing among the students is essential to be put in place. This may necessitate change in curricular to suit the needs of the 21^st century. The shift may need to incorporate problem solving, creativity, competencies and improve on communication in a bid to solve the changing health care needs of the populations.

The health service delivery needs enhanced services that reaches the population in a swift manner that attracts the people for the need to access these services with urgency it deserves. Use of ICT can be utilised in areas such as tele education, telemedicine and electronic management. Health aided technology are the one likely to be built on the as a strategy to incorporate health access and delivery. In Ethiopia more than half of the health facilities are connected to electricity hence the use of technology will be enhance with these availability.

Previously spending in health care has been growing over the years. The need to further improve health care allocation is to ensure that health care resources are able to be accessible to the general public and population. According to the WHO, these allocations need to be raised to a minimum of 5% of GDP. With this increment there is need for improving the access to enable to improve the work force output. Enough financial resource will enable hiring of adequate staff and personnel in effecting service delivery in the health care practice. On the part of the general population improving on health care spending by the population is essential in that it reduces burdening the public in accessing health care, (Vergut et al., 2015).

In ensuring efficient data organisation and systems there is need for adoption of a health information system which will be aimed at improving financial management through improved evidence, enhancing integration and co-ordination. The data information system is designed to make health service delivery to be smooth. Data information system ensures that health information and work force planning are coordinated well in a manner that enhances quality output. The system will be aided with the use of ICT incorporation in a symbiotic relationship meant to enhance service delivery and efficient work force output.

Regulatory measure is needed to be put in place to ensure that work force is maintained and to avoid work force migration. Improvement of health related and regulatory systems ensures safety in health services delivery, products and practices. The relevant regulatory authority needs to be put in place to ensure that health work force is well catered for in terms of remuneration and healthy working conditions. Providing conducive environment to the workers will minimise they suppress the need to migrate for greener pastures outside Ethiopia. This mitigation measure will serve to maintain workforce labour and ensure service delivery to the people is achieved.

Health care workforce is an essential pillar of global health systems and it is achieved in through developing partnerships between different institutions in the resource limited context and rich resources context, to leverage on the unique expertise it has. These partnerships could be achieved through building alliance with nongovernmental institutional, higher learning institutions like providing education and learning skills in the field of health workforce. These relationship s must be equitable and must build collaboration to enhance equity and access to health care through adequate human resource planning and delivery, (Rabin, Mayanja & Rastegar, 2016).

There is need for building capacity in health work force and health systems which are aimed at detecting and responding to public health care risks. For this to be realised there is need for investment in building core capacities and skills development for health workers. For these reason there is need for training the health care workforce in emergency care in both acute and protracted situations and ensuing adequate protection is given to health care faculties. Assesment skills can be offered to the staff on time to time basis and refreshment courses offered in this way they will be able to respond swift and faster to health care needs.

Conclusion

The current shortage in human resource in health sector service delivery, often threatens the scaling of health care delivery services thus affecting diagnosis and management of various diseases and saving lives.  Health work force has experiencing low rate of work force entry compared to the rising population levels.  Countries in the low income and lower middle income are experiencing high shortage in the labour workforce Ethiopia included. This report has provided relevant recommendations which are aimed at mitigating the shortage. Thus with effective implementation, the workforce can ensure health for all is achieved.  

References 

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