pandemic period and therefore is unknown.

However, SDI data can provide information on counts of medical staff at facilities, including breakdowns by cadre of provider. In particular, the data from Kenya indicate that the average hospital has a total of 34 health workers on staff; approximately three of whom are doctors, four are clinical officers, 16 are nurses, and the remainder are other types of health care workers (such as community health workers or medical assistants) (Table 1). A typical lower-level facility in Kenya has an average of five total medical providers; a doctor is unlikely to be on staff and nurses are the most common type of provider. A typical hospital in Sierra Leone has more than 46 medical staff, the vast majority of whom are nurses (and only about two of whom are doctors). In lower-level facilities in Sierra Leone, health care providers ranking lower than nurses are the most common cadre of staff available. Perhaps as expected, hospitals have more staff than non-hospitals, and more higher-level providers (doctors and clinical officers) than nonhospitals. While it is not possible to comment on whether these provider counts are optimal, these data are crucial for understanding potential areas of human resource constraint or flexibility.

Beyond counts of providers, adequate health worker education and training is required to ensure that appropriate care is administered to patients. Encouragingly, across all countries and levels of facilities, the numbers of providers with post-secondary education or higher is far greater than the numbers of health workers with secondary or primary education (Table 1).

**Table 1** : Total medical staff (cadre and education) by facility type (hospital vs. non-hospital) in Kenya, Sierra Leone, and Tanzania

|||Kenya<br>|Sierr<br>|a Leone<br>|Ta<br>|nzania*<br>|
|---|---|---|---|---|---|---|
||Hospitals|Non-hospitals|Hospitals|Non-hospitals|Hospitals|Non-hospitals|
|**Total medical staff**|34.21|5.20|46.63|6.54|111.47|8.97|
|**Medical staff cadre**|||||||
|_Doctors_|2.55|0.10|1.72|0.01|4.56|0.43|
|_Clinical Officers_<sup>_±_</sup>|4.27|0.83|-|-|5.26|1.26|
|_Nurses_|15.53|2.42|27.05|1.19|17.49|2.67|
|_Other_|11.86|1.85|17.86|5.35|13.06|3.93|
|**Medical staff education**<sup>**++**</sup>|||||||
|_Primary_|0.21|0.04|0.61|0.56|2.34|1.07|
|_Secondary_|1.68|0.55|10.32|1.72|22.28|4.82|
|_Post-secondary_|32.25|4.59|35.07|3.97|15.71|2.40|

*Breakdowns by cadre and education were unavailable for facilities with over 50 medical staff in Tanzania so the counts of doctors, clinical officers, nurses, and other (and counts of staff with different levels of education) are only available for facilities with 50 or fewer medical staff. However, the counts of total medical staff include these larger facilities (Tanzania has 35 facilities with more than 50 medical staff, which increase the averages of total medical staff from 40.37 for hospitals and 8.29 for non-hospitals to the 111.47 and 8.97 reported in the table above). ±Clinical Officers were not a medical staff cadre in Sierra Leone ++Provider education was missing for 1.1% of the sample resulting in the sums of the categories of education equaling less than the total number of medical staff

Importantly, the estimates presented here on the counts of health providers at facilities represent a theoretical maximum of total medical staff available. High rates of provider absenteeism (most of which is excused – such as for trainings and meetings) have been documented repeatedly in previous SDI reports. The estimates presented here assume that, in the case of a pandemic, health care workers could set aside other professional commitments to provide urgent care to patients. These estimates also represent an 10