Improving the Effectiveness of the Curative Health Services in North Darfur 8.1 Introduction
8.4 Human resources
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According to an interviewee (2-5, 04 January 2011, El Fasher) in the State Ministry of Health:
NGOs in North Darfur State have been making a good effort in curative health service delivery to the poor and conflict-affected people. But the government should remove the obstacles that it puts in front of the NGOs to access the remote areas, and try to benefit from their resources and experiences to build its capacity of the health system. Without the NGOs‟ assistance the government is not able to deliver curative health services to its population. The challenge that is facing the government in the near future is the sustainability of curative health services delivery after the NGOs leave the country.
Therefore, the government should consider now the sustainability of health service delivery issues and try to get help from donors and existing international NGOs to build and improve the capacity of health facilities and infrastructure so as to at least minimize the gap that will happen when the NGOs leave the country. 2
This study has documented the extensive role that NGOs have played in providing curative health services during the period of civil conflict, especially to the remote areas, where government services have not reached communities, and the IDP camps. The main concern is what will happen if and when the international NGOs leave. The interviewees are well aware of this issue and mainly suggest that the government seek to maintain partnerships with the international community.
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According to an interviewee (1-5, 09 January 2011, El Fasher) in the State Ministry of Health:
We have a shortage of front- line health workers, a high level of absenteeism and low productivity. Long-term investment in the State health work force will be required to achieve adequate staffing levels. The number of health workers should be increased according to the WHO‟s recommendation and also there is a need to orientate health worker training and develop career incentives to encourage service in rural and disadvantaged areas to counteract the tendency of health workers to work in cities. There should be health worker management strategies through supportive supervision, improved supply of essential goods and integrated on the job training.
Also the interviewee said that:
The government should stop the migration of health staff by providing a good work environment, which includes raising their salaries. Therefore the government needs to identify the push factors that make the health staff migrate from the public sector to the private sector, including to NGOs and abroad and, solve them. These factors include, low wages, lack of additional training opportunities, poor working and living conditions, and lack of social and retirement benefits.
According to another interviewee (2-6, 23 December 2010, El Fasher) in the State Ministry of Health:
Even when there is a lack of health staff numbers compared with the size of population, the government needs to improve the productivity and performance of existing staff. The main strategies for doing so include training, supervision, performance appraisal, changes to the way in which services are delivered, and implementation of modern quality- improvement methodologies. Every person has a right to access skilled health personnel.
An important ingredient of this commitment is the need for scaling up health worker education and training, not only in terms of technical skills but also in sustainable, continuous quality improvement and capacities.
175 The interviewee also mentioned that:
The effective way to stabilize the existing health staff and bring more of them to rural and remote areas is by the government offering higher salaries and travel be nefits to persuade medical staff to work in the remote areas. To improve the standards of health services they provide, the government needs to integrate these workers more fully into the health system, to motivate them by providing better living and work conditions as well as offering training programs.
The movement of health personnel from the public to the private sector was revealed in Tables 5.7 and 5.9. Added to this, though, as the quotations above indicate, is the tendency for health personnel to be concentrated in urban areas, especially in El Fasher (see Table 5.6).
According to an interviewee (2-7, 17 December 2010, El Fasher) in the State Ministry of Health:
There are considerable regional disparities concerning the availability of health personnel. The rural areas are somewhat deprived in this regard. Therefore, human resource development is needed and should be accompanied by a fair distribution of health personnel among rural areas. There is a need to equip the referral hospitals with qualified health personnel and address shortages of administrative personnel at all levels.
There is a need for effective human resource management policy to solve the problem of lack of staff at health posts and other primary health structures. Impro ving access to quality health services can be possible through increasing the coverage of health facilities, especially in rural areas, addressing the human resources shortness problem and strengthening community based services and community participation.
The interviewees, medical practitioners and public health officials alike, identify much the same range of problems. According to them, North Darfur State has insufficient numbers of health personnel. Their working conditions are inadequate and many cannot be persuaded to serve in remote areas. The interviewees believe that government should take the responsibility to improve matters.
Those in the public sector need more incentives through better pay, improved working conditions and opportunities for additional training. This requires financial resources.
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