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:
Namibia faces a human resource crisis in the public health sector, which is characterised by a shortage of health professionals, high vacancy rates for all categories of staff, high attrition rates (mostly due to resignations), lack of a human resources retention strategy, staff burn‐out (and incomplete implementation of the Employee Assistance Programme) and inadequate capacity at local health academic institutions to produce the required number of needed health workers.
In the public health system, Human Resource Management comes under the Directorate of Human Resources and General Services whereas Human Resource Development is in the Directorate of Policy Planning and Human Resource Development.
The MOHSS has a Long-Term Human Resource (HR) strategic framework forecasting the future needs and supply of required staff in the country for a period of thirty years (1997- 2027). Subsequently, a Medium-Term Human Resources Plan (1997-2007) and Five-year Human Resource Development Plans (2000-2005; 2008-2012) were developed to serve as guidelines for HR planning.
The HRMIS (Human Resource Management Information System) that is currently being changed from paper-based to the electronic system is a valuable tool for accomplishing an efficient management of the workforce within the public sector. (MoHSS, 2008)
There is also no functioning Performance Management System (PMS). Staff appraisal is still being done in a traditional manner, where performance is not necessarily rewarded. Further, incentive packages are not sufficient to encourage staff retention. There is also a need for the development of career incentives to encourage service in rural and disadvantaged areas.
There are three health workers per 1,000 population in Namibia, above the WHO recommendation of 2.5 health workers per 1000 population. Specific health worker-population ratios include 1:2,952 for doctors, 1:704 for registered nurses, 1:10,039 for pharmacists, 1:13,519 for social workers, and 1:28,562 for health inspectors, among others. (MoHSS, July 2010)
However, these numbers ignore a shortage in the public sector which has barely two health workers per 1000 population. Moreover, within the public sector there are chronic shortages of frontline workers including doctors and nurses. The country depends very much on the recruitment of expatriate doctors. (MoHSS, 2008) There is a direct relationship between the ratio of health workers to population and survival of women during childbirth and children in early infancy.
In Namibia, the health worker shortage has been a major impediment to attaining the health MDGs. (WHO, 2010) A process of task shifting is underway to maximise the effectiveness of the available health workforce. (WHO, 2010; WHO Namibia, 2011)
There is inadequate capacity at local health academic institutions to produce the required number of needed health workers. (WHO, 2010) Namibia currently has four educational institutions for the training of health workers: the University of Namibia (UNAM) School of Medicine offers pre-service training for health professionals such as doctors and pharmacists; the UNAM Faculty of Health Sciences offers diplomas and degrees in Nursing Science, Social Work, Radiography, and Premed/Pharmacy; the Polytechnic of Namibia runs B-Tech degrees and diplomas in Environmental Health and Med. Lab.
Technology; and the National Health Training Centre provides pre‐service and in-service training for a range of healthcare workers, including nurses, pharmacist assistants, environmental health assistants, radiographic assistants and medical laboratory technicians. (MoHSS, 2008)
In 2008 over 200 Namibian students were pursuing health-related studies at foreign academic institutions in countries such as Cuba, Russia, Kenya, Ghana, Tanzania and South Africa. (DR. RICHARD N. KAMWI, 2008) In 2008 , 379 students graduated from the National Health Training Centres: 362 Enrolled nurse/midwifes, 10 Pharmacy Assistants, 6 Radiographic Assistants, and 1 Environmental Health Assistant. 113 Registered Nurses also graduated from the University of Namibia. (DR. RICHARD N. KAMWI, 2008)
Salary scales/grades are not correlated to educational levels or years of training. The MoHSS plans to review and adjust of salary grades to harmonise remuneration packages of staff members in same occupational categories and carrying out the same functions. (MoHSS, 2008)
There is limited career movement in the public health sector leading to a high staff turnover. The career ladder is lacking such that many health professionals/sub professionals are condemned to remain in an entry position until retirement or to have not more than one promotion in their whole life. (MoHSS, 2008)
There is a problem with attrition in the public health service with an annual average attrition rate for the health professionals of about 5%. The main reasons for human resource losses from the public health service during the year 2005/2006 were resignations with 51%, followed by retirements 20%, death (17%) and transfer to other sectors (5%).
These very high rates are threatening the sustainability and efficacy of the health system. Cited reasons are out-of-date conditions of service, lack of incentives for working in remote area settings and work overload. (MoHSS, 2008)
‘Human resource management’ was identified as a strategic theme in the MoHSS Strategic Plan 2009-2013, with the following objectives: • Improve conditions of service for health and social services workers • Ensure adequate and appropriate staff complement and strength • Improve staff morale • Create a skilled workforce • Devolve levels of decision making to appropriate levels
‘Adopt and implement Performance Management System at all levels’ is also an objective under the strategic theme of ‘Service Provision’. (MoHSS, February 2009)