Numbers and distribution of health workers
The number of staff of the ministry in charge of health, all categories have increased from 8,050 in 2005 to 10,376 agents in 2006, an increase of 22.4%. This change made subsequent to the recent recruitment in the public, did not cover all needs because many health facilities are still closed due to lack of staff. In 2007, in the absence of recent and reliable data on personnel at the Directorate General of Health, the number of health workers obtained from the compilation of Departmental Directorates of Health officials were 7270 (staff in post and really different from the staff for the years 2005 and 2006), these figures did not take into account the agents operating in the private sector, the state personnel in a position to secondment or in service organizations under trusteeship.
The absence of a National Plan for Development of Human Resources for Health (PNDRHS), trained staff in HRM and the lack of consultation between Department and user department recruiter resulted in the recruitment of non-essential personnel to the detriment of nursing staff. Indeed, in 2005 - 2006 on 7721 staff recruited and made available to the MSP for use, only 3.9% of the workforce was made up of doctors, 4.4% for midwives against 18.2% for administrative staff. Registered nurses state represented 21.3% of staff recruited during this period, a total of 78% of qualified health workers, 3.8% of health workers unskilled and 18.2% of administrative staff. The following table shows the actual cons recruited by qualification.
|2004 – 05||2005 - 06|
|Qualified laboratory technicians||54||70||124||1.6|
|Technicians laboratory assistants||0||280||280||3.6|
It should be noted that these data are incomplete and do not reflect accurately the current situation of HRH. For example, the figures for 2007 show a decline in enrollment (from 10,376 in 2006 to 7,270 in 2007) when, in fact, from 2005, the number of staff displays a rather upward trend especially with the resumption of recruitment. HRH The next census will update the figures given above and contribute to a better control of the workforce.
The average ratios "staff / population" for some staff qualifications, calculated for 2007 showed overall there was less of a health worker per 1000 population. These ratios hide huge disparities between departments, especially between rural and urban areas. The cities of Brazzaville, Pointe-Noire alone contain 5,061 staff or 70%. Compared to the qualification, there are 325 physicians 4.5% 484 6.7% midwives, laboratory technicians 135 graduates at 1.9%, 1,615 state-certified nurses (IDE) or 22.2% in two localities mentioned above. Despite this concentration of health personnel in both communities, the average ratios "staff / population" are hardly better. There are fewer physician (0.3) per 1000 inhabitants, less than a midwife (0.46) per 1000 inhabitants, less than a graduate lab (0.14) per 1000 inhabitants and a little more than one nurse (1.69) per 1000 inhabitants.
The findings of the report on world health in 2006, a ratio equal to 2.5 qualified personnel (doctors, nurses and midwives) per 1,000 population is required to hope to achieve coverage rates above 80% for health programs such as vaccinations and support of deliveries by trained personnel or significantly reduce child mortality and maternal mortality. Referring to data from the development work of the health map, the country had in 2006 of about 5027 skilled personnel, consisting of physicians (549) state-certified nurses and health assistants (3776) and midwives ( 702). This corresponds to an overall effective density index equal to 1.34 qualified skilled personnel per 1000 population. It reflects the importance of sufficiently qualified personnel shortage plaguing the country.
Breakdown of staff available for qualification
In general, we find that in 2005, registered nurses state dominated the entire staff of public sector health workers with 1390 or 17.3%, followed by ancillary staff or nursery with 1210 15.0 % technicians and health workers with 13.7% in 1100. As for doctors, their staff represented 6.8%. Pharmacists accounted for only 0.6% with a staff of 36 agents. As against 2006, the technical staff of health represented 21.1% of all current employees while FDI is second with 12.5%. Midwives accounted for 6.1%.
In 2007, state-certified nurses have ranked first in all health personnel working in the public sector (2239 agents) or 30.8% followed by midwives with 8.6% of the total workforce of staff. The role of nurses in the state of integrated health centers and referral hospitals justifies the predominance of such staff.
Physicians accounted for only 5.5% of the staff, nurses assistants (health technicians, nursery assistants ...) 8.3%, medical assistants (health assistants) 4% and laboratory technicians (4.6 %). Some skills are almost nonexistent.
The lack of personnel in certain categories of staff including biomedical engineers and technicians have resulted in the premature death of technical equipment preventive maintenance default negating the efforts of government investment.
It is generally noted that the category pharmacist has always been very poorly represented especially by the lack of accompanying measures attractive, so pharmacies in CSS and most hospitals are they animated under the supervision of CSI in the field near non-existent.
The difficult living conditions in rural areas, lack of motivation and the reconciliation of the spouses are responsible for the settlement of health personnel in urban areas. Over 60% of staff recruited in 2006 and assigned to the various rural departments have deserted their posts after receiving their certificates making service, allowing them to piece the payroll of the state, for various reasons ( among others, burdens political, social and environmental difficult). The deficit has resulted in staff, the closure of 302 health facilities including nearly 81.6% are in the public sector.
Breakdown of workforce by gender available by occupation
In 2005, the distribution of health personnel by gender revealed that female staff were in greater numbers: 5075 women was 63.04% against 36.96% or 2,975 men. This could be partly explained by the fact that women are generally a preference for health professions. Also, some specific categories related to both mother - child (midwives, birth assistants) do they contain that women while at a given time of skilled birth attendants or nurses / midwives assistants were trained in paramedical schools to address the lack of midwives particularly in rural areas.
Apart from the categories "female" that naturally attract women, the female was strongly represented in the following categories: nursing assistants with a proportion of 84.2%, and laboratory assistants (56.1%). Conversely, women were poorly represented in the following categories: doctors (22.6%) and pharmacists (18.9%).
Age distribution by occupation
In 2005, health workers throughout consisted of older agents. 7583 agents (or 49.4%) were aged between 40 and 54. As a reminder, age of retirement at the time was set at 55. Certain categories of staff tended to disappear. This was the case of health administrators, assistant administrators of health care, where midwives midwives respectively 66.1%, 85% and 72% of their workforce were over 50 years.
The age distribution of health personnel in 2005 (pyramid of increased type 3) years thaw recruitment presented a number of salient features that are worth noting, before drawing some implications that would result.
- A significant deficit at early ages
A combination of manpower, both sexes, under 30 years indicates that this age group represents only 14% of which 7.9% for females. This is due in large part to the automatic recruitment of graduates in public service since 1985 and since 1991 the introduction of a system of recruiting highly selective and discriminatory.
- An aging workforce
In contrast to the age of 30 which allusion is made above are those aged 40 to 54. These represent about half of health workers (49.4%) about equally divided between men (24.4%) and women (25%). The slight advantage of women at this level might not have existed if mortality does not levy a heavier toll in men than in women. This fact also reflects the aging of health.
- Some implications
The age structure of health staff suggests at least two major implications:
a. First, there would be a break inter-generational caused by a deficit of young people. This would result in a small mixing between old and new generations with the corollary that would derive insufficient benefit the younger generations the experience of their elders. One could, for this purpose, about a bad relay transmitted.
b. Second, in the coming years if we did not make a turnover of health, the deficit already screaming now would only worsen with major consequences for a bad management of a large segment population, which would continue to grow at an accelerated pace. Indeed, if within five (5), ten (10) to fifteen (15) years, consistent recruitment are not made, the absolute number of people working in the health field would respectively less than 4849 , 3644 and 2716 people. Which represent a more than symbolic. To this must be added the effect of mortality, which also affects the health workforce.
Breakdown of staff available by Department by occupation according to 2007 data, the proportional distribution of health personnel in this department due to certain imbalances first, the demographic weight, the absence of incentives for staff operating in rural areas on the other. Compared to the size of each category, there are more midwives (85.7%), doctors (81%), IDE (56.6%) in urban areas.
Here too, the precarious living conditions in the country, including the availability of decent housing, inaccessibility to clean water, electricity and various other existing facilities in urban areas, are the cause of these mass exodus of health personnel Often they have led to shortages in personnel and the closure of many health facilities in rural areas. This situation has highlighted the inaccessibility of populations to health services and quality care and, consequently, the deterioration of their health. Table 3 shows the distribution of health personnel and density index by department staff in 2007.
Numbers of health personnel, private sector
In 2005 there were on the whole territory, 2,849 health workers working exclusively in the private sector of health, including 1766 male officers (61.9%) and 1083 (39.1%) female. In addition it should be noted that many public sector employees also work part time in the private sector. This phenomenon could not be quantified. Ultimately, in 2005 the country had a total stock of about 10,899 health workers in all categories, divided between the public sector (73.9%) and the private sector (26.1%). The distribution of health personnel in the private sector in the departments were as follows:
Like the public sector, the private sector is characterized by an uneven distribution of health personnel. Indeed, Brazzaville account alone 1,464 staff or 51.2%, which represents more than half the staff of the private sector so that we will realize that 33% of the population. If we add to the staff working in the department of Kouilou, whose size is equal to 825 workers or 29%, we realize that only an agent of the private sector in five working in one of eight departments .
This situation could be due to the conditions of installation and operation of medical and paramedical professions that are better in those communities. They are also due to the requirement of profitability which guides the promoters of private health facilities.