Health workers are all people engaged in actions whose primary intent is to protect and improve health. A country’s health workforce consists broadly of health service providers and health management and support workers. This includes:
- private as well as public sector health workers
- unpaid and paid workers
- lay and professional cadres.
Overall, there is a strong positive correlation between health workforce density and service coverage and health outcomes.
A “well-performing” health workforce is one that is available, competent, responsive and productive. To achieve this, actions are needed to manage dynamic labour markets that address entry into and exits from the health workforce, and improve the distribution and performance of existing health workers. These actions address the following:
- How countries plan and, if needed, scale-up their workforce asking questions that include: What strategic information is required to monitor the availability, distribution and performance of health workers? What are the regulatory mechanisms needed to maintain quality of education/training and practice? In countries with critical shortages of health workers, how can they scale-up numbers and skills of health workers in ways that are relatively rapid and sustainable? Which stakeholders and sectors need to be engaged (e.g. training institutions, professional groups, civil service commissions, finance ministries)?
- How countries design training programmes so that they facilitate integration across service delivery and disease control programmes.
- How countries finance scaling-up of education programmes and of numbers of health workers in a realistic and sustainable manner and in different contexts.
- How countries organize their health workers for effective service delivery, at different levels of the system (primary, secondary, tertiary), and monitor and improve their performance.
- How countries retain an effective workforce, within dynamic local and international labour markets.
This section of the health system profile is structured as follows:
In the Gambia, the Human Resources Unit comes under the Directorate of Planning and Information. A Human Resources for Health Policy, 2004 and a matching Human Resources for Health Strategic Plan, 2005─2009, have been elaborated to serve as a guide in dealing with human resources for health issues that continuously impact on the health system performance. Human resources for health distribution in the Ministry of Health and Social Welfare is guided by staffing norms and standards where feasible.
The norms provide guides as to cadre, the numbers and services provided at any facility, as well as bed capacity. Inadequate numbers of trained personnel lead to distribution problems, resulting in hospitals being allocated around 75% trained staff. The numbers of trained personnel on April 2011 are shown in the table. According to the Human resources for health country profile 2009 most of the public and private health workers (66%) are within the Greater Banjul area.
Although there is no unified appraisal system in place, some facilities and institutions in the sector have developed appraisal tools, which they use to guide promotion and training opportunities. A standard appraisal system should be designed and distributed by the Personnel Management Office.
At the moment, training of health care workers is shared by the Ministry of Health and Social Welfare and the Ministry of Higher Education Research Science and Technology. The University of the Gambia offers degree programmes in nursing, medicine and public health, while the health training institutions award diplomas, particularly in nursing and midwifery.
In addition, Leeds Metropolitan University in the United Kingdom, in collaboration with the University of the Gambia, also provides an off-site Master of Science degree in Public Health (Health Promotion) for health professionals and other development workers. This programme has been welcomed by health professionals who do not have the opportunity of postgraduate training due to resource constraint. The health sector now has a good number of graduates in public health, which should translate into better management of services.
Health workers, especially nurses, have migrated to the United Kingdom and United States of America in recent years. Internally, some public health sector workers, particularly trained nurses, have migrated to the private sector. It may be necessary for the Ministry of Health and Social Welfare to offer some of these staff flexible working hours to fill the gaps in service delivery.
In view of the importance of human resources for health in quality service delivery there is a need to update the human resources for health database for better planning and coordination.