Purpose: The purpose of this survey was to document the distribution of PHC workers and research the factors responsible for fluctuations in their distribution in the Nigerian PHC system.
This was a transverse sectional exploratory survey carried out in Anambra province sou’-east Nigeria utilizing papers reappraisal, IDIs with 5 policy shapers and questionnaire study with 610 wellness workers to arouse information on the geographical distribution of PHC workers and the determiners of fluctuation in the distribution.
More than 60 % of the PHC workers are in urban countries where less than 30 % of the people live. The consequences besides showed that the fluctuations are the consequence of a mix of determinations and indecisivenesss by persons, communities and authoritiess, which in bend are influenced by personal, professional, organisational, economic, political and cultural factors.
A good apprehension of the kineticss and determiners of wellness worker distribution is needed to accomplish an just and efficient distribution. Government should utilize both fiscal and non fiscal inducements to pull wellness professionals to otherwise unattractive locations.
Cardinal words: Primary wellness attention workers, geographical distribution, determiners
The planetary wellness work force deficit is characterized by a deficiency of wellness attention forces, and an uneven distribution of bing workers. An increasing organic structure of grounds suggests that the handiness of wellness workers is a critical factor impacting service coverage[ 1 ]. Consequently, some geographic groups do n’t have equal, or in some instances any, appropriate attention. For illustration, worldwide, far fewer wellness professionals choose to pattern in rural countries[ 2 ].
The quality of wellness services, their efficaciousness, efficiency, handiness and viability depend chiefly on the public presentation of those who deliver them3. Thus fluctuation of size, distribution and composing within a state ‘s wellness attention work force is of great concern as the figure and class of wellness workers available in a state is a cardinal index of that state ‘s capacity to supply bringing of wellness services and interventions4
The geographical distribution of wellness forces refers to their spacial allotment and it determines which services, and in what measure and quality, will be available5. Health workers are distributed unevenly between and within countries6 and this has been a serious longstanding worldwide job as all states, rich and hapless, describe a higher proportion of wellness forces in urban and wealthier areas5. Urban countries are more attractive to wellness attention professionals for their comparative societal, cultural and professional advantages. This instability in distribution of wellness forces can lend to great disparities in health.. States with the lowest comparative demand have the highest Numberss of wellness workers, while those with the greatest load of disease must do make with a much smaller wellness work force.
Variation in distribution of wellness workers are the consequence of a mix of determinations by persons, communities and authoritiess which are in bend influenced by personal, professional, organisational, economic, political, socio-demographic and cultural factors5,7. In many states, female wellness service suppliers are peculiarly scarce in rural countries, a state of affairs that may originate in portion because it is insecure for female workers to populate entirely in some stray areas8. Rural-urban unfairnesss, unequal medical instruction systems, migration, public-to-private encephalon drain and unequal payment inducements are merely some of the factors identified as lending to an unbalanced supply of wellness forces. The migration of wellness attention workers is an issue that arises when analyzing planetary wellness attention systems. Research suggests that the motion of wellness attention professionals closely follows the migration form of all professionals in that the internal motion of the work force to urban countries is common to all countries4. Workforce mobility can make extra instabilities that require better work force planning, attending to issues of wage and other wagess and improved overall direction of the work force.
Nigeria is one of the several major health-staff-exporting states in Africa. For illustration, 432 nurses lawfully emigrated to work in Britain between April 2001-March 2002, compared with 347 between April 2000-March 2001, out of a sum of about 2000 ( lawfully ) emigrating African nurses, a tendency that is perceived by Nigeriaaa‚¬a„?s authorities as a menace to sustainable wellness attention bringing in Africaaa‚¬a„?s most thickly settled state. About 20,000 wellness professionals are estimated to emigrate from Africa annually9. Stillwell et al provided a compendious history of factors act uponing migration of wellness workers from developing states, and how to pull off the complex issues. These factors include hapless wage, deficiency of chances for professional development, inadequate or antiquated medical substructure, limited inducements for overseas based wellness workers to relocate to Nigeria. Other challenges include the fact that some wellness workers are trained to degrees superior to local worlds ( Niyi Awofeso 2004 )
Although the handiness of assorted resources like financess, drugs, stuffs and installations are indispensable for the public presentation of the primary wellness attention system, the handiness and distribution of human resources in the needed quality and measure has a greater impact upon PHC in Nigeria ( Herfon 2007 ) . Yet, their distribution and grounds for such distribution is non good known. Imbalances in geographical distribution of wellness workers raise jobs of equity and efficiency in Nigeria and elsewhere as this determines which services will be available and in what measure and criterions.
A good cognition of the distribution of primary wellness attention workers and the determiners of the fluctuations in such distribution is of import to policy shapers and those who attempt to better the wellness systems for effectual service bringing to enable them formulate wellness policy and program. This paper makes part to the apprehension of the kineticss and finding factors of wellness worker distribution which is imperative to achievement of just and efficient distribution and besides cardinal to accomplishment of the wellness related millenary development ends which otherwise can non be achieved if the vulnerable populations do non hold entree to skilled wellness forces and overall good quality wellness services.
Materials and methods:
The survey was conducted in Anambra province, Nigeria. Anambra province prevarications in the south eastern portion of Nigeria. A good proportion of the province is affected by eroding, which renders most roads really hard to go through particularly during showery seasons. The province comprises 21 LGAs, 235 territories, 330 wards, and 177 communities, with the capital at Awka. The 2005 projected entire population of the province from 1991 nose count is 4,054,924, with 0-59months age group 810,985 and 0-15 Old ages population 1,930,707. There is good media communicating system in the province with 75 % of the province ( largely the rural population ) agrarian. The province has a sum of 33 secondary Health installations dwelling of General Hospitals, Comprehensive Health Centers and Cottage infirmaries distributed across the whole LGAs. These infirmaries are managed by the State authorities through the State Hospitals direction Board of the State Ministry of Health ( SMOH ) . There are besides about 382 Primary Health attention centres and wellness station which are managed by the LGAs. However, the Ministry of Health section of Primary Health Care/Disease Control ( PHC/DC ) is the overall coordinator of PHC activities in the province. Nnamdi Azikiwe Teaching Hospital is the lone third wellness establishment in the province which is owned and managed by the Federal Government through the Federal Ministry of Health. The private sector health care suppliers presence in the province shows that every bit at January 2006 there were 14 mission infirmaries, 186 pregnancies, 600 private infirmaries and clinics, 126 registered pharmaceutical premises and about 1,500 presently licensed medical specialty stores.
Malaria is the taking cause of childhood morbidity and mortality followed by diarrhoea diseases, pneumonia, Measles and malnutrition. The baby and under five mortality is 73 per 1000 live-births and 18 per 1000 live-births severally.
Anambra State Southeast Nigeria was the survey site. Anambra province with capital at Awka has a entire population of 4,182,032 in a land country of 4,416 sq. kilometer, giving an mean denseness of 633 individuals per sq. kilometer. Anambra State has 3 senatorial zones, 21 LGAs and 177 communities.
The survey was a transverse sectional exploratory survey carried out in the 21 LGAs of Anambra province sou’-east Nigeria and PHC workers at the LGA degree
Sampling and sample size computation
An equal sample size for the survey of 610 was based on prevalence of wellness workers in public wellness installations in rural countries of Nigeria. A 95 % assurance degree, and power of 80. This figure was shared proportionate to the figure of wellness workers in the 21 LGAs. In each LGA a list of the wellness workers was drawn and was stratified by class of wellness workers after which the respondents were selected from each stratum by simple random sampling.
Data aggregation: Using pre-tested questionnaires, information on the geographical distribution of PHC workers and the determiners of fluctuation in their distribution were collected from 610 PHC workers. A reappraisal of published and gray literature of paperss from the LGA service committee including information obtained from development spouses was undertaken to understand the current deployment of primary health care workers to urban and rural countries, the chief factors impacting this distribution and general restraints of wellness worker keeping in the province. In add-on, in-depth interviews were conducted with 5 province policy shapers to research their position of factors impacting urban-rural distribution of PHC workers. These interviews were moderated by medical sociologists.
Descriptive statistics, and non-parametric trials were used to analyse the quantitative informations utilizing SPSS and Epi Info version 6 statistical package while manual content analysis of the qualitative information was done.
Distribution and class of wellness workers in the 21 LGAs
From papers reappraisal, there are a sum of 2122 PHC workers in the Anambra province PHC system ( table 1 ) . Two tierce of the wellness workers 1272 ( 60.0 % ) are in the urban countries and the remainder in rural countries. CHEWS ( both senior and junior ) form the bulk 932 ( 43.9 % ) of the workers in the installations in the assorted LGAs. This is followed by the wellness attenders 554 ( 26.0 % ) . Staff nurse /midwife, Community Health Officers and Medical officers of Health make up 258 ( 12.2 % ) , 127 ( 6.0 % ) , and 19 ( 0.9 % ) of the workers. Environmental Health officers, chief Health Nurses, Rural Health overseer, staff nurse merely and staff accoucheuse merely constitute 170 ( 8.0 % ) , 36 ( 1.7 % ) , 3 ( 0.1 % ) , 8 ( 0.4 % ) and 15 ( 0.7 % ) severally.
Table 1: Distribution and class of wellness workers in the 21 LGAs
Number ( % )
849 ( 40 )
1272 ( 60 )
Category of wellness workers
Medical Military officers of Health
19 ( 0.9 )
Community Health Officers
127 ( 6.0 )
Principal wellness nurse
36 ( 1.7 )
Staff nurse /midwife
258 ( 12.2 )
8 ( 0.4 )
15 ( 0.7 )
Senior Community wellness extension worker ( CHEW )
722 ( 34.0 )
Junior Community wellness extension worker ( CHEW )
210 ( 9.9 )
Environmental wellness officers
170 ( 8.0 )
Rural wellness overseer
3 ( 0.1 )
554 ( 26 )
Most of the wellness workers interviewed were females 547 ( 89.7 % ) and the average age was 45 old ages SD 4.4 old ages. A bulk of the respondents were CHEWS 303 ( 49.7 % ) and the respondents reflect the proportion of wellness workers in the LGAs.
Table 2: Features of respondents
Number ( % )
63 ( 10.3 )
547 ( 89.7 )
Age ( Years ) Mean ( SD )
45 ( 4.8 )
Medical officers of wellness
7 ( 1.14 )
Community wellness officers
57 ( 9.3 )
Principal wellness nurse
9 ( 1.5 )
Staff nurse /midwife
85 ( 13.9 )
0 ( 0 )
2 ( 0.3 )
Senior Community wellness extension worker ( CHEW )
249 ( 40.8 )
54 ( 8.9 )
Environmental wellness officers
48 ( 7.9 )
Rural wellness overseer
3 ( 0.5 )
96 ( 15.7 )
From the IDI with the policy shapers community influences, authorities penchants, personal, organisational and socio cultural factors were the wide classs of deciding factors of wellness worker distribution.
Table 4: Determinants of wellness worker distribution from the position of policy shapers.
– personal penchants
– household influences
Table 5 shows that entree to societal comfortss was a major determiner of wellness worker distribution so besides authorities connexion, matrimonial position and fiscal inducements in that order. Personal penchants, household and community influence were non really strong determiner factors
Table: 5 Determinants of wellness worker distribution from the position of wellness workers
Variable N %
286 ( 46.9 )
Influence of household members
33 ( 5.4 )
398 ( 65.2 )
52 ( 8.5 )
Where installation is located
102 ( 16.7 )
232 ( 38.0 )
Entree to societal comfortss
579 ( 94.9 )
127 ( 20.8 )
523 ( 85.7 )
318 ( 52.1 )
In the class of primary wellness attention workers and respondents, there were really few medical officers of wellness and staff nurses bespeaking the critical deficit in Human resources for wellness. This is besides so because PHCs are the exclusive duty of LGAs with minimum support from the State ministry of wellness and most wellness workers particularly physicians and nurses prefer to work in third establishments which are normally federal or province constitutions. Another ground is that most of the Primary wellness attention Centres are in the rural countries or semi urban countries without the full plant of societal comfortss and frequently lack the academic environment needed for calling development. On the other manus CHEWs were the bulk of the primary wellness workers. This is because these are the group of wellness workers who are really trained to populate and work in the community.
Rural-urban distribution of primary wellness attention workers is biased towards the urban. This is non surprising as most wellness workers prefer to work in urban countries because of entree to societal comfortss, developing chances, better wage and general calling promotion, better educational chances for household members amongst other things. This is in consonant rhyme with the findings from other surveies that the unjust socioeconomic development of rural compared to urban countries presents the chief restraint for accomplishing a balanced distribution of HRH ( Ferrinho et al 2000 ) . A batch of wellness workers desire to work in an academic environment with more co-workers in their field of involvement ( Avraham Astor. et al 2005 ) .
From the in depth interviews with the policy shapers, the organisational environment which includes the direction manner, inducements, calling constructions, salary graduated tables, enlisting, posting and keeping patterns are some of the organisational factors that can act upon the geographical distribution of forces. In hapless states like Nigeria, wage is normally low and working conditions unsatisfactory. Wage, in peculiar, seems to represent the most basic influence on keeping of wellness professionals ( Ferrinho et al 1998 ) Health workers frequently resort to get bying schemes, such as adding private pattern to their public employment, to get the better of unsatisfactory wage and working conditions.
It has been proposed that the low Numberss of wellness workers in rural country has more to make with keeping than with enlisting ( Oreilly M 1997 ) , as heavy work loads and professional isolation act as stimulations to look for better working conditions. Lack of equipment and supplies and of appropriate installations can move as a hindrance for wellness forces to accept places in rural and underserved countries. This was a primary ground cited by medical pupils for non rehearsing in rural Pakistan ( Zaidi A 1996. ) . Lack of transparence and of due procedure in the direction of posters and publicities is besides another ground to avoid working in distant countries where one gets forgotten.
Entree to societal comfortss was the most of import deciding factor in the distribution of wellness workers from the position of wellness workers. Rural countries in Nigeria are frequently characterised by hapless electricity, crude or non-existent comfortss, hapless route webs and substructure, poorness, hapless quality educational or communicating installations, delicate wellness systems and the insufficiency of drinkable H2O. Such inauspicious life conditions create formidable lifestyle challenges for wellness forces and their households ( Anyanwu 2006, Porter 2002, Bird et al 2002 ) . Hence a batch of workers decline from rural posters because of hapless entree to societal comfortss. On the other manus urban countries are by and large more attractive to wellness workers because of the societal advantages including societal comfortss ( Lerberghe et al 2002 ) .
Marital position is another strong determiner of where a wellness worker would prefer to work. Most married female wellness workers tend to populate and work where their hubbies are ( Chaudhury 2003 ) . The single wellness worker besides prefers to work in the urban country as it holds better chances for calling development and better opportunities of run intoing a prospective partner with desirable calling thrust
Conclusion and Policy Deductions:
Several factors other than fiscal inducements find where a wellness worker would work. Non fiscal inducements such as societal comfortss, organisational construction of the work environment, calling chances, personal factors, sociocultural factors amongst others affect the picks wellness workers make. Given the wellness and service effects of hapless entree, the consequences suggest that more attending demands to be paid to widening the spacial information base in primary wellness attention, in order to accomplish more effectual planning of services for deprived populations. Policy shapers need to understand the evident mix of factors that affect geographical distribution of primary wellness attention workers and give these due consideration in policies impacting human resources for wellness. This is of import if the millenary development ends are to be achieved.
The writers have no viing involvements.