<!-- Start of picture text --> ! ~~Policy Research<br>Populatlon, Health, and Nuiritlon<br><!-- End of picture text --> WPS 914

- This paper a product of the Population, Health, and Nutrition Division, Population and Human Resources Department -is part of a larger study of African health policy by the Sector Operations and Policy Vice Presidency. Copies of the paper are available **IICe** from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact Otilia Nadora, room S6-065, extension 31(91 (May 1992, 19 pages).

Despite a significant growthl in the total number of trained health workers, the Africa region is still poorly staffed. It was the only World Health Organization region that showed a decline in thle doctor-to-population ratio from 198() to 1986.

Emigration of trained health workers - particularly physicians - exaecrbates the problem. Basic training for hcal.h workers is reasonably well established, but advanced and in-service training have been widely neglected. There remains a serious shortage of senior staff with training in public health and management.

Sub-Saharan Africa has not a single school of public health, and it also lacks adequate regional training centers in public health and management. Planning for health workers has been based largely on simple projections of the number of workers required -without much regard for the economic costs or the availability 'f financial resources.

Most countries in Sub-Saharan Africai halve undertaken structural adjustment programs **that,** together with world cconomic conditions, have led to declining financial allocations to ministrics of health. As spending cuts have been made for such items as drugs, maintenance, and tranisport, the proportion spcnt on health personnel has risen. Therc are now strong pressures on ministries to reduce the number of health workers they employ and to encouraigc more private health scrvices. Vaughan concludes that:

* Health personnel policies must become truly national, taking into account **all** personnel in the country, not just those employed by the ministry of healih.

* Some countries need support to develop policies that will help them make the best use of regional training facilities (in public health and management) in nellC::jy countries. More support should be given to regional centers that offer management training for health workers and to initiatives for improvinig in-service and on-thejob training in manaoement skills.

* Guidelines are urgenitly needed on how to rationalize spending on ,ealth personnel.

* There is an urgent need to update methods lor monitoring health workers and for providing the basic numerical projections needed for planning.

* In-depth studies are nceded on the cost implications of training anid employing various types and nambers of health workers, to give more insight into the options in national health personnel policies.

The Poliey Rcsearch Working Paper Series,dissclm inoatcs the ind ings of sAork tindlcr \i\n the anik. Anobjectiveofthescrics is to get thcsc findings out qcuickly, even if preswmltatiofs are less than fully **polish'ed.** The findings. interpretatlons, and conclusions in thesc p'pcrs do not necessarily represent official Bank policy.

Produced hy the Policy Research Dissemiination Ccnter