Addressing the Global Health Workforce Crisis

Like the other hospitals we visited during the week, the “theatre” (operating room) at Jinja Regional Referral Hospital was missing necessary instruments, equipment and supplies. Their limited budget could only pay for a small autoclave (machine that sterilizes equipment before and after surgery) that was not big enough to fit some of the larger, over-sized instruments that are often used during surgery. The drug bottles were only 10% full and the rusted surgery beds were ripped and covered with black trash bags.

Outside the theatre I found the MOTH Data Book used to keep record of all the surgeries with simple remarks such as “good,” “fair” and “poor.” The maternity ward—essentially a room with 30 beds and more than 30 patients—was busy as ever and attended by a single nurse with a huge smile.

Time and time again, we met health workers who were over-burdened but never without hope. Overwhelmed by all there is to witness, one can easily feel hopeless that a stronger, more efficient health system would ever be possible. Talking to those health workers though, I felt invigorated and recommitted to the importance of the work that PHR is doing to strengthen health systems and ensuring the right to health.

Throughout the week, I interviewed many health workers who told me about their struggles, their challenges and their hopes. Among them were Nurse Ruth who works at the Infectious Disease Institute at Mekerere University.

I also interviewed Nixon Niyonzima, a 4th year medical student at the Medical School of Mekerere University in Kampala, who works with the PHR affiliated student chapter called Students for Equity in health Care.

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A little over a year ago Time Magazine highlighted people they called “angels”—individuals praised for making a difference in the world of global health. I remember reading the stories of physicians, researchers and scientists and of their contributions and extraordinary efforts. I was, however, saddened that the invaluable work of the professional nurse went unrecognized.

Here in Uganda at the First Forum on Human Resources for Health, where the focus is on the development of a Global Action Plan—a guide to make a lasting impact on the human resources crisis in developing countries—I have had the opportunity to attend a number of sessions that actually acknowledge the essential role of the nurse. In many African countries nurses comprise up to 70% of the health work force: if you don’t include the voice of the nurse a successful HR plan would be hard to come by!

Eager to get first hand input from nurses attending the conference I collaborated with a nurse member of our partnership organization here in Uganda, AGHA. Together we arranged for an impromptu meeting over lunch with nurses interested in sharing their perspectives: what issues need to be addressed in order to retain skilled, motivated nurses able to provide quality, accessible health care.

To my amazement what I had thought would be a handful of nurses turned out to be over 20, all eager to share their personal experiences. They talked about the need to be recognized and respected as “professionals,” to have access to ongoing educational opportunities that led to professional growth; to work in a safe and secure work environment free from harassment and attack; to care for patients in facilities that had electricity and running water; to know that if they suffered from an occupational exposure to HIV or Hepatitis that they could receive confidential and free care.

Their requests were straight forward—but seemingly out of reach. Patrick, Secretariat of the Uganda Nurses Association, shared with me that policies to address many of these issues were in place, but nothing has been implemented. His fear was we would leave the forum with yet another plan—but no action. “How can we be motivated when we are not respected and our voices seem to be ignored?”

As one nurse, Lucy, said “I am proud to be a nurse but I am not happy.” She told stories of having to care for 30-40 critically ill patients on a hospital ward with no supplies, not even a BP cuff that worked, and one O2 tank that frequently was non-operational. Most of those admitted for care died simply because of the lack of adequate equipment and too few nurses to provide care. “I am not going to stop trying to care but it is difficult,” she said.

As I shared the mission of the Health Action AIDS campaign and AGHA with the group and the role that our joint advocacy efforts could play in strengthening their voices, interest peaked, and the energy and enthusiasm of the discussion grew. Participation in the demand for accountability was enticing. Our session ended with 20 new members of PHR and AGHA—a promise to continue the dialogue and pursue the rights that all health professionals, especially nurses, deserve.

Among the many successes of this forum I think we can count the fact that we have a contingent of nurses who perhaps for the first time feel a sense of support and hope. My goal is that sometime in the near future nurses in the forefront of the AIDS battle are given the acknowledgment they have long deserved and are finally recognized among the “angels” for their invaluable contributions to health rights.

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