Human Resources for Health
Ogun State
SITUATION ANALYSIS
Conducted for:
CapacityPlus Nigeria Project
By
Dr. Saka Mohammed Jimoh (Consultant)
November, 2013
IntraHealth is a global champion for health workers committed to ensuring that more health workers are
present, ready, connected, and safe in health systems around the world. Funded by USAID and
implemented through CapacityPlus, IntraHealth is working in partnership with the Government of Nigeria
and other stakeholders, to foster local solutions to health care challenges by improving health worker
performance, strengthening health systems, harnessing technology, and leveraging partnerships that
empower health workers to better serve communities in need.
This report is funded by USAID; however the views expressed does not
necessarily reflect the views of USAID’s official policies.
This publication was produced by IntraHealth International Nigeria, for
Ogun Sate Government. It was prepared by Dr. Saka M.J
Dr. Saka M. Jimoh October, 2013: Situation Analysis of Human
Resources for Health in Ogun State, Nigeria; IntraHealth International.
ii
Table of Contents
Executive Summary
1.
Section 1.Background information
1.1
Introduction
1.2.1 Geography and Demography
1.2.2 Political Context
1.2.3 Ogun State Health Indicators
Section 2
2.0
Purpose of the Assessment
Section 3
3.0
Methodology and Approach
3.1
Sample
3.2
Assessment Approach
3.3
Data Collection instruments and tools
3.4
Data Collection
3.5
Interview of key Informants
3.6
Data Analysis
Section 4
4.0
Findings section
4.1
Governance / leadership for HRH in the State
4.2
Planning for HRH
4.2.1 Key Gaps on HRH Planning
4.3
Production of HRH
4.3.1 Pre-service Education
4.3.1.1 The trend in development of HRH in the State from independence
4.3.1.2 Health training institutions in the State
4.3.1.3 Accreditation and Regulations
4.3.2 In-service and Continuous Professional Development
4.3.2.1 Key Gaps; HRH Production
4.4
Health Work Force Management
4.4.1 Recruitment
4.4.2 Confirmation of appointment, Promotion and inter cadre transfer
4.4.3 Manpower Development
4.4.4 Job Description
4.4.5 Distribution of Health Workers
4.4.5.1 Gender distribution by Health occupation / cadre
4.4.5.2 Age distribution by occupation / cadre
4.5.0 HRHIS Management
4.6
Cross Cutting
4.6.1 Performance Management and Annual Health Planning Process
4.6.2 Performance Management Monitoring and Evaluation
4.6.3 Monitoring and Evaluation / Supervision Structure
4.6.4 Key Gaps on; Coordination, Performance Appraisal, M&E, Partnership
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5.0
Conclusion and Recommendations
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Annexure
References
49-50
TOR/SOW
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Tool
52-63
TABLES
Table 1. State health status indicator
12
Table 2. State owned health institutions
21
Table 3. Number of entrants and graduates by year 2010-2012
23
Table 4. Students statistics: fresh undergraduate students graduands from 2010/2011 and 2011/2012
academic sessions.
25
Table 5. Key health human resources by cadre
35
Table 6distribution of health workers by category/cadre
37
Table 7. Distribution of health workers by category/cadre
38
Table 8. Gender distribution by health occupation/cadre
39
Table 9. Workers by age group and cadre
40
Table 10. Number and distribution (lga and facility) of midwives under the midwives service scheme
40
iv
ABBREVIATIONS
CHEW
Community Health Extension Worker
CHO
CPD
CSC
PRSD
Community Health officer
Continuous Professional Development
Civil Service Commission
Planning Research and Statistics Department
DPRS
Director of Planning Research and Statistics
ECOWAS
Economic Community of West African States
FBO
Faith Based Organization
FGD
Focal Group Discussion
FMOH
Federal Ministry of Health
HAF
Health Action framework
HOS
HRIS
Head of Service
Human Resource Information Systems
HRM
IMR
Human Resources Management
Infant Mortality Rate
KII
Key Informant Interview
LGA
LGSC
Local Governments Areas
Local Government Service Commission
MNCH
Maternal Neonatal and Child Health
MLGCA
Ministry of Local Government and Chieftaincy Affairs
MSS
MTSS
Midwives Service Scheme
Medium Term Sector Strategy
OGPHECADEB
Ogun State Primary Health Care Development Board
PHC
Primary Health Care
SCSC
State Civil Service Commision
SMOH
SURE-P
State Ministry of Health
State Strategic Health Development Plan
Subsidy Re-investment Program
TWG
Technical Working Group
U5MR
WHO
Under-5 Mortality rate
World Health Organization
SSHDP
v
SECTION ONE: EXECUTIVE SUMMARY
Human Resources for Health is not all about numbers. It involves distribution, quality and
productivity. In essence HRH is concerned with getting the right number of staff, in the right
places, at the right time, doing the right job, with the right motivation, at the right cost.
Within many health care systems worldwide, increased attention is being focused on human
resources management (HRM).
Ogun State is one in the league, yet to adapt and domesticate the National HRH strategic
instruments into a State specific policy and plan; and currently facing considerable challenges
in the effective and efficient management of its health workforce to meet the needs of its
teeming population. Although no objective and comprehensive assessment of the HRH
situation had been conducted before now.
Human resource management systems are under-developed. HR management unit at the State
Ministry of Health is not fully established while none exist at the LGA level. HR functions
are more of ad hoc activities. Personnel data are not readily available at the facility level. No
formal HR department exists. Few evidence of job description at the state level but no
evidence at local governments and private sector to develop and provide job descriptions for
all categories of health workers.
Ogun State includes a wide range of health care workers in both the public and private
sectors, such as public facilities managed by federal, state, and local governments, private
for-profit providers, NGOs, community-based and faith-based organizations, religious and
traditional care givers. The state has one of the largest stocks of human resources for health in
Nigeria comparable only to FCT, Lagos, Edo, Osun and Oyo State.
In 2012, a total of 1416 medical doctors are working in Ogun State an increase of 1.47%
from the 2009 figures. Based on population size1, the current number of medical doctor
equates to a ratio of 37.76 medical doctors per 100,000 members of the population. There is
small increase compared to 2009 figures of 33.84 medical doctors per 100,000 members of
the population. This density is one of the highest in the country comparable to national figure
1
3.75 million population, National Population Commission and Ogun State 2007-2009 Health Bulletin
6
of 38.92 medical doctors for every 100,000 population. Even though these ratios indicate that
Ogun State is substantially better supplied with Medical doctors in the south West Nigeria
than Ondo state, the state compare unfavorably with immediate neighbor states in Lagos, Oyo
and Osun.
The nurses and midwifes combined workforce (3,365) translates into a density of 37.76
nursing and midwifery staff of 100,000 population; this is less than half of National average.
Comparing the data of 2009 with 2012 there is very little change in the total number of health
workers/100,000 population. For all categories of health workers available, the state’s
HW/100,000 population ratio is less than national and neighbouring state in the region. It is
thus very obvious that there is a drastic shortage of skilled health workforce in the state.
HRHSDP is partially captured in SSHDP and State Economic plan for Development 20122015 but conspicuously missing as an entity in Midterm Sector Strategy, no budget line items
in State MoH yearly budget and inadequate budget for HRH. However, the State leadership
in health sector are well disposed to provide and develop HRH SDP, state accepted and is
supported the process of development of HRH strategic implementation Plan. Community
nursing /midwifery is about to commence in the State School of Nursing and midwifery.
Framework for effective practice of community nursing and midwifery in all local
government areas in the state is not yet developed, some health institutions like schools of
Nursing and Midwifery are not accredited for 2013 academic session.
HR information system in the State is partially transformed from paper-based to system
based. There is urgent need for the development of a costed comprehensive Human Resource
for health Strategic implementation plan with full complement of Information System with
clearly defined minimum data sets to be collected on regular basis, processes for routine staff
data collection, processing, storage, retrieval and use for decision-making. Both the
regulatory bodies and the HRH planning divisions of all levels of government and the private
sector need to perform their functions according to such evidence-based needs. The needs
should be reviewed periodically in line with well-determined staffing gaps in both private and
public institutions.
2
Nigeria health work force profile as at December 2012
7
Overall, it is being strongly recommended that an HRH Unit should be established in the
DPRS - MOH and enabled such that it can be the ICT hub for a robust state HRHIS that
would have linkage with
FMOH’s HRH Unit and have nodes in all the major HRH
stakeholder establishments in the state. The comprehensive requisite HRH capacity for
implementing the HRH component of the state’s SSHDP should also be determined.
8
SECTION 1 BACKGROUND
1.1 Introduction
Human Resources for Health is not all about numbers. It involves distribution, quality and
productivity. In essence HRH is concerned with getting the right number of staff, in the right
places, at the right time, doing the right job, with the right motivation, at the right
cost3.Within many health care systems worldwide, increased attention is being focused on
human resources management (HRM). Specifically, human resources are one of three
principles of health system inputs, with the other two major inputs being physical, capital and
consumables4.
There is a global HRH crisis both in developed and developing countries. There are several
reasons for this, but primarily it is as a result of the disparity between production of HRH and
the rising health needs of various populations across the globe. This has resulted in an
inequitable distribution of health professionals among developed and developing countries5.
African countries have a very low density health workforce, compounded by poor skill mix and inadequate
investment (Chen L et al 2004)3. Yet trained healthcare staff continues to migrate from Africa to more developed
3
4
WORLD Health Organization. Working Together For Health, The World Health Report 2006, Geneva
Human Development Report, UNDP, 2001
5
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet 2004;364: 198490.[CrossRef][ISI][Medline]
9
countries. The World Health Organization6, has estimated that, to meet the ambitious targets
of the millennium development goals, African health services will need to train and retain an
extra one million health workers by 2010.
It is therefore appropriate to state that any country that tends to have a low level of human
resources for health (HRH) would not be on tract in reaching the health MDGs. Insufficient
HRH capacity is definitely one of the key barriers to scaling up health services in Nigeria 7.
The impact of the HRH shortage is greater in the developing countries as compared to the
developed countries. This scenario is currently worsened by the diseases such as HIV/AIDS,
TB and Malaria that are exacting greatest toll in these same countries most especially
Nigeria.
Ogun State is one in the league, yet to adapt and domesticate the National HRH strategic
instruments into a State specific policy and plan; and currently facing considerable challenges
in the effective and efficient management of its health workforce to meet the needs of its
teeming population. Although no objective and comprehensive assessment of the HRH
situation had been conducted before now. There is need to conduct situational analysis of as a
critical first step in gaining better insight into the factors that hinder or that could facilitate an
enabling environment for the development of a state specific HRH policy and strategic plan
needed to develop Human resource for health strategic implementation plan in the state.
BACKGROUND INFORMATION
1.2.1 Geography and Demography
Ogun State was created on the 3rd of February, 1976. It was carved out of the old Western
State of Nigeria and named after the Ogun River which runs across it from North to South.
The State is strategically located, bordered to the East by Ondo State, in the North by Oyo
and Osun States, in the South by Lagos State and the Atlantic Ocean and in the West by
Republic of Benin, which makes it an access route to the expansive markets of the Economic
Community of West African States (ECOWAS). Abeokuta, the capital and largest urban
6
World Health Organization. High level forum on the health MDGs. Addressing Africa's health workforce crisis: an avenue for action. 2004.
www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf (accessed 28 March 31, 2011).
Ayenbe, W; Bezzano, J; and Foot, S. An Analytical Framework for Understanding the Political Economy of Sector Policy Arenas – Country Level Testing:
The Health Sector in Nigeria. November 2005 – unpublished
7
10
centre, is about 90 kilometres from Lagos and740 kilometres from Abuja, the Capital of
Nigeria. There are 3.75million (2006 census) with 5.1million (projected figure as at 2012);
the State has a land area of 16, 432sq.km. It is peopled predominantly by the Egbas, Ijebus,
Yewas, Remos and Aworis who belong to the main Yoruba ethnic group. It also has subgroups, namely,Ketu, Ikale, Ilaje, Ohori, Anago and Egun. There are also significant numbers
of Nigerians from other parts of the country as well as foreign nationals. The predominant
languages spoken are Yoruba and Egun with several dialects while English is the official
language8.
1.2.2 Political Context
The State is sub-divided into three (3) Senatorial districts, nine (9) Federal Constituencies and
twenty-six (26) State Constituencies. For local administration, the State has twenty (20) Local
Government Areas and Two Hundred and Thirty Six (236) wards as follows9:
The State has a State Legislative house- the State House of Assembly.10 The administrative
structure is decentralized into Local Government Council and Wards. Wards are the smallest
political and administrative units which constitutes the political voice of communities in the
identification, discussion and prioritization of problems and actions to be taken at LGA level.
There are currently twenty Local Governments Areas (LGAs) and 236 political wards.11
1.2.3 Ogun State Health Indicators
The state figures as obtained from hospital data and the public and private sector. Below are
the health indicators & statistics for Ogun State from 2008 – 2012. These are compared with
national values.
8
Ogun State Health Bulletin
9
Ogun State Health Bulletin
10
Ogun State Strategic Health Development Plan; 2010-2015
11
Ogun State Health Bulletin 2012
11
Table 1
State Health Status Indicator
Indicator
National (×)
Ogun
2008
2009
2010
2011
2012
29/1000
27/1000
24/1000
21/1000
14/1000
13/1000
16/1000
14/1000
10/1000
9/1000
300-1200
295
245
235/
124/
202/100,000
/100,000
/100,000
/100,000
100,000
100,000
Perinatal mortality rate
(/1000 births)
22/1000
25/1000
20/1000
17/1000
23/1000
Still birth rate(/1000 births)
15/1000
21/1000
19/1000
16/1000
21/1000
18/1000
21/1000
20/1000
16/1000
11/1000
3.1%
3.1%
Under – 5 mortality rate
(/1000 live births)
201/100
Neo-natal mortality rate
(/1000 live births)
Maternal mortality ratio
(/100,000 live births)
Infant mortality rate(/1000
live births)
100/1000
HIV prevalence rate (××)
4.4 (2005)
No of poliomyelitis cases
(×××)
374
8.5
4
Incidence of smear positive
TB (/100,000 population)
34
55
34
36
54
New borns with low birth
weight (%)
11.39
7.65
9.2
7.91
2.54
Sources World Health Statistics 2005, 12 National sero-prevalence survey13, WHO, Ogun State SACA14, NARHS15
12
Sources World Health Statistics 2005
13
National sero-prevalence survey
14
Ogun State SACA
15
NARHS
12
2.0 PURPOSE OF THE ASSESSMENT
This assessment focuses on profiling the HRH Situation in Ogun State. The findings from the
assessment will serve as a foundation and guide for future efforts towards the development
and implementation of a well-planned, coordinated and managed HRH management system,
in order to facilitate an improved delivery of healthcare services in Ogun State. The key areas
of focus include an assessment of the Status and Trends in the availability and distribution of
HRH stock, for key health cadres (by geo-political zone, level of health care, and rural/urban
area), attrition rates in HRH stock, retention strategies and plans, HRH production, absorption
and deployment and HRH governance as well as data and information management.
Specifically, the objectives of this particular assessment are:

To assess policies and practices of HRM in the health sector.

To identify both Primary and Secondary data systems that are relevant to HRH
management in the state and assess their capacity;

To use information to produce a summary of the HRH background of the state; its
health workforce statistics and disposition in particular;

To aassess HRH capacity within the state to provide the range of functions needed to
plan, produce, deploy, manage, train, support, and sustain the health workforce;

To identify gaps, opportunities and policy levers in the HRH management systems
that would form the base for a set of recommendations that would guide the
development of a State Specific HRH Strategy and HRH Strategic and
implementation plan
3. 0 Methodology and Approach

Sample

Data collection tool – Research questions guide

Data analysis
3.1 Sample
A qualitative approach was adopted using in-depth interviews with key informants and group
discussions with other relevant stakeholders. Individuals were selected for interviews and
discussions based on their experience with the following HRM functional areas:
13

Workforce Leadership, planning and implementation

Workforce production and management environment and conditions

HRH information systems (HRIS)

Performance Management and Monitoring and Evaluation
A purposeful sampling of a range of HRH stakeholders with more years of experience and
expertise from among the following: Ministry of health and departments (e.g., HR, planning,
monitoring and evaluation, research, clinical programs); Other government agencies with HR
roles and mandates (e.g., ministries of education, finance, and local government and
chieftaincy); Organizations and agencies from outside the public sector (e.g., HR managers in
FBOs, NGOs, private-sector associations, regulatory and health professional bodies);
Training institutions; Development partners and Health workers responded to selected
sections of the matrix of leading question guide as adapted from the HRM
3.2 Assessment Approach
Prior to the interviews and discussions, a rapid health sector stakeholder’s landscaping was
done, to classify stakeholders according to above classifications with the probability of being
selected and proportional to their differential level of HRH interest and involvement.
Additionally, to provide a broader and more diverse range of perspectives of the HRH issues
in the state. This stakeholders’ analysis was done in partnership with the Department of
Planning, Research and Statistics of Ogun State Ministry of Health.
3.3 Data Collection Instrument and Tool
The human resources for Health Action framework (HAF) has been used by stakeholders to
plan and implement human resources for health (HRH) interventions and strategies. The
HRM Assessment Approach supports access to and use of the HRH Action Framework
(http://www.capacityproject.org/framework/) as a means of assessing and analyzing HRM
issues in a comprehensive manner. A matrix of leading questions was adapted from the HRM
Assessment approach and other country specific questionnaires previously used to collect
data on HRH issues. The matrix detailed thematic/functional areas with their technical
elements and strategic niches to which the areas are focus and provided a relevant leading
question that was used to elicit information from suggested stakeholder that were interviewed
in the state. In additional to the matrix of leading question a data extraction HRH situational
14
analysis data framework was use to collect numerical data as a source of additional evidence
to support the qualitative information. Some respondents received the full range of the
leading questions while some sections were administered to some respondents.
3.4 Data Collection
Prior to conducting the interviews, available published and unpublished reports, policies and
strategic documents were reviewed to analyse and organize findings on the key four
functional areas of HRM and M&E as well as the overall health system in Ogun state. The
review helped to gather information on general themes from available literature that will
generate perspectives on the issues of interest and provide evidence upon which to formulate
ideas for further investigation. The matrix of leading questions was use to collect qualitative
information with each interview focusing on one or more of the identified HRM
thematic/functional areas depending upon the expertise and experience of the participant(s).
Some participants were interviewed about a single HRM functional area, whereas others were
interviewed on several areas. Some participants were interviewed more than once and some
participants chose to be interviewed together. The questions were designed to elicit current
situation with regards to HRH and recommend what is needed to develop integrated packages
of CapacityPlus-supported HRH interventions in the states. Probes and follow-up questions
varied by interview and were used to obtain additional information about the specific
activities and intervention areas currently being implemented in the state. Interviews were
conducted in person by the consultant and HRH core team over a month period from
September to October 2013.
Other methods of data collection used in the state includes but not limited the following;I.
II.
Observation
Document reviewed
III.
Questionnaire (Matrix)
IV.
Key Informant Interview (KII)
V.
Focal Group Discussion FGD
VI.
VII.
Group Discussion of Directors, Top Management Committee, Technical officers
Visits of institutions Departments, Ministry Agency and Board
15
VIII.
Attendance of Meetings and presentations. e.g Attendance of Feedback Presentation
(Global fund monitoring) and Attendance at the meeting on MTR/MTSS for health
sector
IX.
X.
Meeting of the core group
Meeting of the TWG
3.5 Interview of Key Informants:
DPRS/MOH was used as the entry point for reaching all the state government stakeholders;
the DPRS provided most of their contact details. Core meetings were held with the Director
of PRS (Dr. Ayinde), Deputy Director PRS, HMIS HoD, HRH designated repeatedly for
continual facilitation of the consultations. All the relevant stakeholders were met and
interviewed. Relevant information was obtained from them through the interviews and
consultations while useful and important data were also sourced from them. List of
documents reviewed.
3.6 Data Analysis
The assessment exercise commenced from September through October 2013 when the data
analysis and report writing took place. The findings from the assessment were presented
according to the four key functional areas and M&E. Tables of data were extracted from the
HRH situational analysis framework to further give evidence to the presentations in the
report.
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4.0 FINDINGS SECTIONS
4.1 GOVERNANCE /LEADERSHIP FOR HUMAN RESOURCES FOR HEALTH IN THE STATE ; -
The State leadership in the health sector are well deposed to provide and develop HRH
strategic development which is partially captured in SSHDP16 and State Economic plan for
Development 2012-201517 but conspicuously missing as an entity in midterm strategy18.
The Human resources for health is unit within the Department of Health Planning, Research
and Statistics of the State Ministry of Health. It is located in New Secretariat. A Director
heads the Department of Health Planning, Research and Statistics, while a Deputy Director
Planning Research and Statistics heads the HRH unit. The head of HMIS unit designated as
the HRH focal person and help in coordinating activity of HRH in the state.
The Department of Planning and Research Statistics is supported other units and partners
with relevance to HRH this include;1. HSDP II;- Capacity Building for Health Workers both National and International
Trainings. Health Systems Strength
2. SUNMaP;- Integrated Supportive Supervision and on Job Trainings, Capacity
Building. On Job capacity Building Monitoring and Evaluation. Holistic health sector
Strengthen and Training of Integrated Supportive Supervision (ISS) teams, for
supportive
supervision of service delivery points staff
ISS/OJCBTWG for
supervision funded by SUNMaP
3. HMIS Unit involve in data collection and capacity building
4. UNFPA ;- training of health workforce in relation to reproductive health
5. Partners’ Committee: Membership drawn from partner agencies with interest in
Human resources for health issues. The main agencies interested so far in the Nigerian
Human resources for health in the state are World Health Organization, UNFPA,
SUNMaP and NPHCDA.
16
Ogun State Strategic Health Development plan
17
Ogun State Government Economic Plan Development 2012-2015
18
Ogun State 2013 -2015 Ministry of Health Mid Term Strategy.
17
6. Intra-sectoral Committee: Members are drawn from all the departments’ partners and
agencies of the State Ministry of Health. The professional regulatory agencies are in
this Committee.
Government stakeholders in the State responsible for HRH include;- HMIS unit in
Department of Planning, Research and Statistics, (State Ministry of Health,) Hospitals
Management Board, Office of Head of Service Ogun State Primary Health Care
Development Board (OGPHECADEB); State Civil Service Commision (SCSC); Local
Government Service Commission (LGSC); Ministry of Education, Training Institutions:
Professional councils and Associations. Others are the Faith Based Organization e.g Catholic
Institution. Partners are WHO, UNFPA, ENR, UNICEF, SUNMAP, PPFN, GLOBAL
FUND, NPHCDA, IHVN, and Private Health Practitioners etc.
Career development and promotion of the health work force is sole responsibility of Bureau
of establishment and training, civil service commission CSC, office of the Head of Service
(HOS) and Local Government Service Commission (LGSC). All the ministries and
department are involved in performance management.
The key gaps in stewardship/ leadership for HRH include; Human resource management systems are under-developed. HR management unit at
the State Ministry of Health is not fully established while none exist at the LGA level.
HR functions are more of ad hoc activities. Personnel data are not readily available at
the facility level.
 No formal HR department exists.
 Few evidence of job description at the state level but no evidence at local
governments and private sector to develop and provide job descriptions for all
categories of health workers.
4.2 PLANNING FOR HUMAN RESOURCES FOR HEALTH
Since neither a State HRH policy nor a state HRH strategic plan has been developed in Ogun
state, the most appropriate extant HRH Implementation Plan/Strategy for the State is the
HRH component of its SSHDP which aimed to plan and implement strategies to address the
18
human resources for health needs in order to enhance its availability as well as ensure equity
and quality of health care.
State’s SSHDP’s HRH priorities as stated below; To develop Human Resources for Health Strategic and implementation plan
 To develop and promote non- discriminatory recruitment polices at the State and LGA
levels
 Reappraise the principles of health workforce recruitments and recruitment at all
levels
4.2.1 Key Gaps on HRH PLANNING;1. Inadequate HR planning at the various levels and this is compounded by the nonavailability of reliable, complete and up to date information on staff for decision
making.
2. There are no standards to guide staffing and their utilization for both the private and
public sector. Whilst worker productivity in the public health sector is very low, many
private sector health practices on the other hand suffer from poor work quality
because of commercial pressures.
3. No HRH specific SIP evidence based
4. Thou State leadership in the health sector are well disposed to provide and develop
HRH SDP
5. State accepted and supported the process of development of HRH strategic
implementation plan
6. HRHSP-IP is partially captured in SSHDP and State Economic plan for Development
2012-2015 but
7. Conspicuously missing as an entity in Midterm Sector Strategy.
8. No budget line items in State MoH yearly budget and
9. Inadequate budget for HRH budget for health institutions
19
4.3 PRODUCTION OF HUMAN RESOURCES FOR HEALTH
There are detail strategies, requirement, mechanism and capacities for HRH production and
maintenance within the state. The HRH production covers:
a)
Pre-service education of health workforce,
b)
In-service and continuing education
c)
Health workforce requirements
4.3.1 Pre Service Educations
4.3.1.1The Trend in Development of HRH in the State from Independent
Human Resources for Health Prior to Basic Health Service Scheme (BHSS) Training as
‘Local Health Visitor’ began in Ogun Sate as early as 1949 when girls with Middle II
schooling who were Grade II midwives were trained for the new Rural Health Centers in
Ogun State Western Nigeria. This then evolved into the idea of ‘community nurse’, an
auxiliary health visitor, receiving six months’ or a year’s training in a health auxiliary
training school, based on Grade II Midwifery background.
By 1958, with the assistance of the WHO, training facilities were expanded and some of the
indigene attended the Ibadan Health Auxiliary Training School which then trained all
categories of health personnel such as public health inspectors, community nurses, family
visitors, leprosy inspectors, dispensary attendants, and health overseers, the training school
also organized refresher courses that benefited the first set of health work force in the state. It
is on record that Ogun State produced the first set of medical personnel in Nigeria.
Various categories of health workers existed in the state before the BHSS. See table xxx
With the entry of the BHSS in 1977 which was later changed to Basic Health Services
Scheme Implementation Agency (BHSSIA), it became necessary to streamline the
recruitment, training and utilization of these workers for improved effectiveness and
delivery of health services in the rural communities where the majority of the population live,
giving rise to four cadre
of core ‘polyvalent‘ health workers: the Community Health
Officers, Community Health Supervisors, Community Health Assistants and Community
Health Aides. The Community Health Supervisor was eventually phased out, while the
20
Assistant and Aide were renamed Junior and Senior Community Health Extension Workers
(JCHEW and SCHEW) respectively.
Then then schools of nurses, school of midwifery and medical schools emerged in the state
from 1984. A typical LGA PHC team comprises of the Medical Doctors, Community Health
Officer (CHO), CHEW, Public health nurse/ midwife, Health Information Officer,
Laboratory technician, Medical records officers, Pharmacist/ Technicians, Environmental
health officer and support staff ( ambulance drivers, cleaners, messengers, clerks etc), Policy
makers and Health service managers in the state and local government area ministries of
health. TBA are recognised as part of informal heath workforce in the state.
4.3.1.2 Health Training Institutions in the State
Ogun State has various health training institutions where a plethora of health staff are trained.
The following is the list of the institutions, their location and the cadres produced.
Table 2;- STATE OWNED HEALTH INSTITUTIONS
S/N
1.
2.
3.
Institution
Location
Cadres Produced
Olabisi Onabanjo University
Teaching Hospital.
SagamuIle Isan
Remo
Doctors, Pharmacists,
SpecialistsDoctors, Pharmacists
Abeokuta,
Staff Nurses
Backock University
Schools of Nursing
Ijebu-Ode
Ilaro
4.
Schools of Midwifery
Abeokuta,
Staff Midwives
Ijebu-Ode
5.
College of Health Technology
Ilese Ijebu-Ode
Environmental Health Technologists
Med. Lab Technicians
21
Med. Lab Assistants
Community Health Extensions Workers
Health Information Managers
Public Health Nurses
6.
Reproductive Health Training
Centre
Abeokuta
LSS providers
RH providers
FEDERAL OWNED HEALTH INSTITUTIONS
7.
8.
Federal Medical Centre
Abeokuta
Specialists in O & G
Neuro-Psychiatric Hosp. Aro
Abeokuta
Specialists in Psychiatry
There is no evidence to show that the Ogun state has strategic documents on health workforce
production, rather the state desires to have institutions for the production of adequate health
workforce to meet its needs in addition to Federal established health institutions.
All the health institutions both federal and state owned relies on the health professional
regulatory agencies for guidance and approval for the establishment and sustained
operationalization of its training institutions. It is the responsibility of those regulatory
agencies to undertake setting educational standards; regulation; accreditation; and stipulating
capacities for education in the training institutions. Neither the MOH authorities nor the
institutions themselves undertake these roles. They only try to comply with the rules and
regulations enunciated by the regulatory agencies.
Ogun State has a relatively good number of health training institutions. As at 2013, there
were one (1) accredited medical and dental school, (1) private medical school, two (2)
Federal owned Health Institutions (Nuro-Psychiatric Hospital and Federal Medical Centre), 2
approved schools of nursing, 2 approved schools of midwifery, six institutions in College of
Health Technology located in Ilesa Ijebu Ode. The institutions in the college made up of
school of Environmental Health Technology; School of Medical Laboratory Technician;
22
School of Medical Laboratory Assistants; School for Community Health Extension Workers;
School for Health Information Officer and School for Public Health Nurses.
However there is a poor distribution of these training institutions with majority (75%) of
them being located in the central parts of the State.
Table Number of entrants and graduates by year 2010-2012
Cadre
Cours
e
Durati
on
Number of Entrants
Year Year Year Year
10
11
12
13
Total
input
Number of Graduates
Yea Yea Yea Year
r 10 r 11 r 12
13
Total
outpu
t
Medicine
Dentistry
Pharmacy
School Nurs. Abeokuta
3 yrs
79
55
57
22
32
15
(May
)
School Nurs. Ijebu Ode
School Nursing Ilaro
3 yrs
77
56
57
57
61
14
(May
)
3 yrs
Midwifery
Abeokuta
Midwifery IjebuOde
COLLEGE OF
HEALTH
TECHNOLOGY
51
56
57
-xx
xx-
xx
18
month
46
44
41
55
48
43
18
month
45
36
43
48
43
40
2,762
2,919
728
563
Laboratory
Other (describe)
Total
23
OGUN STATE COLLEGE OF HEALTH TECHNOLOGY;-STUDENTS STATISTICS: FRESH UNDERGRADUATE
STUDENTS ENROLMENT BY GENDER AND DISCIPLINE FROM 2010/2011 AND 2011/2012 ACADEMIC SESSIONS
PROGRAMMES
2010/2011
2011/2012
M
F
TOTAL
M
F
TOTAL
1
Environmental Health
Technology
224
337
561
160
299
459
2
Community Health
10
139
149
10
136
146
3
Health Information
Management(ND)
17
23
40
30
57
87
4
Medical Laboratory
Science
101
152
253
104
194
298
5
Dental Therapy
63
117
180
71
132
203
6
Dental Technology
62
105
167
66
123
189
7
Pharmacy
Technique(Technician)
273
507
780
312
533
845
8
Nutrition and Dietetics
13
31
44
14
57
71
9
Water Resources
Management
15
29
44
15
45
60
10
Public Health Nursing
1
18
19
-
24
24
11
Health Assistant
-
10
10
-
29
29
12
Community Ophtalmic
Techniques(Technician)
-
23
23
-
52
52
13
Computer Science
7
3
10
6
4
10
24
14
Health Information
Management(Tech)
57
106
163
43
82
125
15
Dental Nursing
18
39
57
13
40
53
16
Environmental Health
Techniques(Technician)
32
59
91
28
57
85
17
Junior Community
Health
10
109
119
-
138
138
18
Health Promotion and
Education
16
36
52
16
29
45
GRAND TOTAL
919
1,843
2,762
888
2,031
2,919
Source;- Ogun State College of Health Technology 2013
Table 4- STUDENTS STATISTICS: FRESH UNDERGRADUATE STUDENTS GRADUANDS FROM 2010/2011 AND
2011/2012 ACADEMIC SESSIONS.
PROGRAMMES
2010/2011
2011/2012
1
Environmental Health
Technology
118
53
2
Community Health
42
44
3
Health Information
Management(ND)
-
18
4
Medical Laboratory Science
74
28
5
Dental Therapy
53
32
25
6
Dental Technology
38
35
7
Pharmacy Technique(Technician)
203
173
8
Nutrition and Dietetics
28
7
9
Water Resources Management
23
19
10
Public Health Nursing
13
8
11
Health Assistant
5
5
12
Computer Science
4
2
13
Health Information
Management(Tech)
22
43
14
Dental Nursing
17
7
15
Environmental Health
Techniques(Technician)
19
9
16
Junior Community Health
50
76
17
Health Promotion and Education
19
4
GRAND TOTAL
728
563
While the government of Ogun State is responsible for the provision of all the resources
required (human, financial and material) needed in its training institutions, with oversight
from SMoH. There is no formal linkage between the ministries of health and education at the
state level in this regard.
The College of Health Technology, Ilese runs eighteen programmes based on market demand
and efforts to produce quality health workers for the delivery of efficient health care services,
as well as filling the gaps created through regular turn-over in the health sectors. The
26
programmes run in the school have been streamlined along N.D and H.N.D in accordance
with the National education System veering away from the purely professional training which
has given the school the age-long set-back that had made the school less attractive, stagnant,
because the certificates were terminal and self-limiting. With the award of ND and HND, the
College has come into National reckoning and the graduate are having better career pathways
while also enjoying the prospect of higher education in the universities. Since this repositioning started the College has secured collaboration with Olabisi Onabanjo University
Teaching Hospital, Tai Solarin university of Education, Eye Foundation, Lagos, and
university of Agriculture, Abeokuta. The Students are now better trained because of
improvement in quality and quantity of lecturers and in equipment.
Olabisi Onabanjo University was established in 1986 and in the past twenty seven (27) years
of its operations, it has witnessed active and modest development in the physical environment
along with her University College of Health Sciences.
The Institution obtained accreditation for MBBS in 1990 and has the approval of the Medical
and Dental Council of Nigeria (MDCN) to train Medical Doctors and House Officers. The
hospital along with the College has produced 1,560 medical doctors since 1990, 499 of
whom were graduated between 2010 and 2012. The hospital had over the years from the 90s
obtained accreditation for 13 of its 15 departments for Residency Training from the two
Postgraduate Medical Colleges (West Africa and national Postgraduate Medical College).
Furthermore, the Hospital has been supporting the training of student Nurses and Midwives
in the State Schools of Nursing, Babcock University as well as the Pharmacy Technician,
Health Information Management and Laboratory Technician in-training in the State School of
Health Technology, by making available its resources for their practical exposures.
Manpower; The staff strength rose from about Two Hundred (200) in 1986 to Nine Hundred
and Forty Six (946) as at today, categorized as follows. Consultants 55, Medical Doctors 131,
Nurses 246, Administrative; 183, Technical; 234 (These include all the other paramedical
professions) Junior Staff; 115.
No training school for paramedical personnel (School of Post-Basic Nursing, School of
Radiography, School of Medical Records, etc.), which is part of the Teaching Hospital
responsibility/objectives as contained in the Edict. There is need for the establishment of
training schools such as Post-Basic Nursing School, Medical Records, etc, to complement the
activities of the Teaching Hospital.
27
4.3.1.3 Accreditation and Regulations
All human resources for health in Ogun State are regulated through the agency of
professional regulatory agencies. Each health care cadre of worker is taken care of by a
professional regulatory agency. These professional regulatory agencies are headed by
registrar. The regulatory agency accredits health-training institutions according to certain
defined criteria. Some of these criteria include the number and quality of teachers, the
equipment situation, availability and quality of clinical and practical training. Regulatory
agencies, is responsible for registering new health workers, ensuring that these health workers
have the minimum qualification that is needed for enrolling.
The regulatory agency disciplines erring health workers. Though there are many regulatory
bodies, most of these agencies do not have sufficient funds to perform their functions
especially prosecute erring members and facilities that operate in rural areas. The Ministry /
Department concern also due have challenges in timely release of fund for re accreditation.
Within the State the following agencies, council and board available are:
• Medical & Dental Council of Nigeria;- Director of Hospital Services (State Registrar)
• Pharmacy Council of Nigeria;- Director Pharmaceutical
• Nursing & Midwifery Council of Nigeria,;- Director of Nursing and Hospital Management .
• Environmental Health Officers Registration Council;- located in Ogun SMoH
• Dental Technologists Registration Board of Nigeria;- located in Ogun SMoH
• Dental Therapists Registration Board of Nigeria;- located in Ogun SMoH
• Health Records Officers Registration Board of Nigeria;- Hospital Management Board
• Medical Laboratory Science Council of Nigeria;- Hospital Management Board
• Optometrists Registration Board of Nigeria;-, Hospital Management Board and
• Community Health Practitioners Registration Board of Nigeria;- Public Health (MoH)
28
Accreditation of Medical / dental training school is an exclusive duty of MDCN that follows
a process which involves review and inspection of resources of the training institution. The
Accreditation is also based on type of training Basic or postgraduate
Evidence obtained from Ogun State Department of Hospital Services, the following are the
order:
1. 2010- Medical and Dental Master Register of Nigeria recognize only Obafemi
Awolowo College of Health Sciences Olabisi Onabanjo University Ago-Iwoye to award
MB, Ch.B.
2. However some institutions like Covenant University Ota, Babcock University Ilisan
are also processing Accreditation of their institution.
3. The data of all these institutions are yet to be published by MDCN.
4. There are other institutions providing post Graduate Medical Training in different
Fields e.g Aro Neuropsychiatric Hospital, FMC Abeokuta, OOUTH Sagamu, State
Hospital Ijaye Abeokuta.
5. However, two schools of Nursing/Midwifery lost accreditation which is a great
economic lost to the state.
4.3.2 In Service and Continuous Professional Development
In Ogun state professional bodies such as Nigeria Medical Association (NMA), NAGMDP,
AGMPN, MDA, Nursing and Midwifery and some pharmaceutical companies e.g Glaxo
organised continuing professional development education. SMoH is in final stage of
accreditation of CPD by MDCN. Government of Ogun State encouraged and financed in
service-training. Health workers are sent to ASCON and Federal School of Statistics for
carrier development, it also supported staff for conferences, workshops and seminars. In year
2012 and 2013, Government sponsored staff in Directorate level for International leadership
training courses, some of the staff that benefited were promoted to permanent secretary cadre.
Medical doctors working in the state are encouraged and supported for residency training on
supernumerary or study leave without pay.
29
Ogun Cancer institute a flagship Cancer programme for development of manpower which has
its core a state of the art cancer diagnostic and treatment centre unique in West Africa. It is
noteworthy to state that the State Government has released fund for the opening of the cancer
centre.
Other components of the programme will include: Health education and community
outreaches, cancer prevention programmes, satellite cancer centres, state-wide free screening
programmes, training of cancer specialist personnel, research in cancers in people of African
descent, new drug discovery, tissue bank and a cancer registry
4.3.2.1 KEY GAPS; - HUMAN RESOURCES FOR HEALTH PRODUCTION
1. Training institutions are managed as separate entities although funded by the Ministry
of Education &MOH.
2. There are however no alignment between the student intake, training capacity per
curriculum and actual staff requirements in SMoH at hospital and PHC levels.
3. Enrolment of trainees and production of health manpower in the state health training
institutions are currently not determined by any evidence-based HRH needs.
4. Both the regulatory bodies and the HRH planning divisions of all levels of
government and the private sector need to perform their functions according to such
evidence-based needs. The needs should be reviewed periodically in line with welldetermined staffing gaps in both private and public institutions.
5. Community nursing /midwifery about to commence in the State School of Nursing
and midwifery. There is no framework for effective practice of community nursing
and midwifery in all local government areas in the state
6. Loss of accreditation of schools of Nursing and Midwifery
7. Budgetary allocation for training institutions is inadequate
4.4 HEALTH WORK FORCE MANAGEMENT
4.4.1 Recruitment
Health work force like other workers is managed and coordinated in the civil services
commission and LGA commission. However, establishment and ministry of health may be
giving governor approval to employ; the department of Civil Service Commission will be
part of the process. Though in most cases Civil Service Commission takes lead in the
30
recruitment of all cadres of health workers in the State. While LGA commission coordinated
recruitments of LGA Staff. In some cases State owned Health institutions, like College of
Health Technology, Primary Health Care Development Board may have the authority of
Governor to recruit. The process will follow civil service rules procedure and policy
guidelines. The need and demand forecast for health workers is not done regularly, but
recruitment is irregularly done with expansion of health facilities. Weak system and poor
coordination in workforce situation in the state, it highly preferred by the leadership in the
state that each sector to have power to recruit base on need, for example Ministry of health
should be able to employ and deploy. While recruitment and deployment in private for profit
and private not for profit is not systematic, methods and procedure is not known.
4.4.2 Confirmation of Appointment, Promotion and Inter Cadre Transfer
Evidence as obtained from KII shows that, Department of Administration and Supplies
(DAS) of Ogun state MOH, play a key role in recruitment, confirmation of appointment,
promotion, inter cadre transfer and redeployment of health workforce in Ogun state
For example, in 2010 Department of Administration and Supply requested and obtained the
approval of the Governor to recruit Ninety-four (94) staff consisting of Eighty-two (82)
Junior and Twelve (12) senior staff for the Schools of Nursing and Midwifery in the State to
enhance the accreditation status of the Schools. As part of its statutory functions convened
the meeting of the Junior Staff Committee of the Ministry in June, 2010 to consider eligible
candidates for recruitment into pensionable junior posts in the Ogun State Civil Service while
the recruitment of the Senior Staff was referred to the Civil Service Commission. The
Department of Administration and Supplies also issued Letters of Promotion to One hundred
and twenty three (123) Officers of the Ministry who were successful in the 2009 promotion
exercise conducted by Civil Services Commission. On 24th June, 2010, SMoH received
approval from the Civil Service Commission approving the Confirmation of Appointment of
Nine (9) Senior Staff who were hitherto presented for the exercise on 5th August, 2009 and
letters were issued to them accordingly. While four hundred and thirty-eight (438) senior staff
were presented for confirmation of appointment on 17th June, 2010 and letters confirming
their appointments with the Ogun State Government were issued to them when the approval
of the Civil Service Commission came on 31st December, 2010.
31
In 2011 the Department of Administration and Supplies in the MoH, requested and obtained
approval of the Governor to recruit two hundred and forty five (245) staff consisting of One
hundred and forty-six (146) senior staff and ninety-nine (99) junior staff. It also facilitated the
rehabilitation of forty-seven (47) Primary Health Care Centres, PHCs, across the three
Senatorial Districts of the state with full complement of equipment which included sinking of
boreholes in the PHCs. Letters of Confirmation of Appointment of fifty-seven (57) senior
staff in April, 2011 on the approval of the Civil Service Commission were issued. It also
processed the inter-cadre transfer of two junior officers from the grade of Clerical Officer I,
GL.05 to the grade of Secretarial Assistant GL.06 and Head Gardener GL.03 to Clerical
Assistant GL.03 respectively. Both were approved by the Civil Service Commission.
As part of the statutory functions of Department of Administration and Supplies in Ogun
State MoH issued Letters of Confirmation of Appointment to fifty-seven (57) staff in March,
2012 after it received approval from the Civil Service Commission to do so. The department
requested and obtained approval of the Governor to recruit Ninety-nine (99) staff consisting
of Seventy-five (75) senior and Twenty-four (24) junior staff. Letters of Offer of
Appointment were issued to the twenty-four (24Nos) newly recruited junior staff comprising
of Twelve (12) Drivers and (12) Watchmen. It presented Five (5Nos) officers for
Confirmation of Appointment on 24th July, 2012 and three (3) out of them were also
presented for advancement from the post of Scientific Officer Grade II, GL.08 to Scientific
Officer Grade I, GL.09 having fulfilled the conditions stipulated in the Schemes of Service
for advancement in the cadre. Letters were thereafter issued to them for Confirmation of
Appointment and Advancement respectively on approval from the Civil Service Commission.
Facilitated the Inter-Cadre Transfer of one junior staff from the grade of Head Gardener
GL.03 to the Clerical Officer Cadre as Clerical Assistant, GL.03, just as it facilitated the
processing of the retirement papers of fifteen (15) staff who retired during the year. Letters of
Promotion to the candidates who were successful in the year 2011 promotion exercise. A
total of two hundred and ninety two (292) letters of promotion were issued to successful
officers in the year 2011 promotion exercise. For staff enlist and accountability purpose, the
Ministry ensured that all staff of the Ministry participated in the Bio-metric data capturing
exercise conducted by the State Government for workers on its payroll between July and
August, 2012 and finally it secured an office accommodation for the operation of the newly
32
established Department of State AIDs and STI Control Programme (SASCP) and the
rejuvenated Ogun State Accident Services (OGSAS).
The analysis thus reveals that State Civil Service commission recruited health workers into
the public service while the LGSC recruited for LG. The Tertiary hospitals and Hospital
Services have management boards that are empowered to employ health workers, on the
directive of the Governor of State. The same is true of Federal hospitals. At the local
government level, the Local Government Service Commission also handles the employment
of health workers. Recruitment capacities are established for each category of health worker,
depending on the capacity of the health institution. In general it is easier to fill vacant posts of
non-skilled staff.
4.4.3 Manpower Development – The people who make our healthcare sector work
From the KII, it was shown that recruitment and development of health professionals are a
priority for healthcare sector. Within the period of up to 2013 the achievements of
government include:

Recruitment of 153 Medical personnel at the Olabisi Onabanjo University Teaching
Hospital, Sagamu

Recruitment of 30 B. Sc Nursing as Tutors for the School of Nurses and Midwifery

A total of 113 senior staff and 102 junior staff recruited by the State Government’s
Rapid Employment Programme.

Employment of 782 health workers by the Ogun State Hospitals Management Board

Intensive training on malaria diagnosis for Medical Laboratory Scientists from each
LGA in the state. Week-long Malaria retreat was also held for Roll Back Malaria
Managers.

Training of 186 community workers to conduct interpersonal talks on prevention of
HIV/AIDS in 10 LGAs.

Training of Integrated Supportive Supervision (ISS) teams, for supportive
supervision of service delivery points staff . (Supported by SuNMaP).

Training of health workers on diabetes and hypertension by the State Hospitals
Management Board in collaboration with Codix pharmaceutical Company
33
4.4.4 Job description
There is a deliberate effort to formalize the writing of job descriptions, so that health workers
could be made accountable for service outcomes. Presently detailed job descriptions are not
commonly available, but efforts are on-going in the state to create detailed job descriptions.
To get the best out of new workers, orientation is important to explain peculiarities of the
organization. No placement preparations and a formal orientation for new employees are not
commonly arranged. Expect for a very senior cadre like Permanent Secretary and
commissioners.
4.4.5 Distribution of Health Workers
Ogun State includes a wide range of health care workers in both the public and private
sectors, such as public facilities managed by federal, state, and local governments, private
for-profit providers, NGOs, community-based and faith-based organizations, religious and
traditional care givers. The state has one of the largest stocks of human resources for health in
Nigeria comparable only to FCT, Lagos, Edo, Osun and Oyo State.
The total number of skilled health workers in Ogun State is 10,584 (Table 2.1). These
comprise 1416 Medical Doctors and Dentists; 3,356 Nurses and Midwives; 372 Pharmacists;
285 Pharmacists Technicians; 178 Environmental Health Officers; 56 Physiotherapists; 92
Medical Laboratory Scientists; 138 Medical Laboratory Technicians; 61 Health Record
Officers; 1,588 Community Health Extension Workers; 12 Dental Technologists; 50 Health
Educators; 499 VHW/TBA; 2317 Health Attendants/Ward Orderlies; 66 Scientific Officers
and 26 Rural Health Officers19.
In 2012, a total of 1416 medical doctors are working in Ogun State an increase of 1.47%
from the 2009 figures. Based on population size20, the current number of medical doctor
equates to a ratio of 37.76 medical doctors per 100,000 members of the population. There is
small increase compared to 2009 figures of 33.84 medical doctors per 100,000 members of
the population. This density is one of the highest in the country comparable to national figure
19
Ogun State 2012 Health Bulletin
20
3.75 million population, National Population Commission and Ogun State 2007-2009 Health Bulletin
34
of 38.921 medical doctors for every 100,000 population. Even though these ratios indicate that
Ogun State is substantially better supplied with Medical doctors in the south West Nigeria
than Ondo state, the state compare unfavorably with immediate neighbor states in Lagos, Oyo
and Osun.22
The nurses and midwifes combined workforce (3,365) translates into a density of 37.76
nursing and midwifery staff of 100,000 population; this is less than half of National average.
Figures of all health workforces obtained from Ogun State Health Management Board
captured only those in employment of State government, thus an incomplete data (Table 2.3).
It is important to note that the figures as obtained from the health bulletin may be more
details as it include data from private and public institutions. However, it does not reflect
actual health workforce for 2013, which is due to lack of HRH HRIS in the state.
The figures presented in Table 2.1 are for some health professional categories registered by
the State’s professional medical/health regulatory bodies as in 2012. They include health
workers in both the private and public health sectors, and, very likely, health professionals
who are not practicing in the State or may not be practicing health care at all. Comparing the
data of 2009 with 2012 there is very little change in the total number of health
workers/100,000 population. For all categories of health workers available, the state’s
HW/100,000 population ratio is less than national and neighbouring state in the region. It is
thus very obvious that there is a drastic shortage of skilled health workforce in the state.
Table 5 ;- KEY HEALTH HUMAN RESOURCES BY CADRE
S/N
CADRE OF PERSONNEL
STATE
FEDERAL
LOCAL GOVT
PRIVATE
TOTAL
1.
Doctors
327
246
18
825
1416
21
Nigeria health work force profile as at December 2012
22
Nigeria health work force profile as at December 2012
35
2.
Nurses & Midwives ()
1100
663
443
1150
3356
3.
Pharmacists
62
57
13
240
372
4.
Pharmacy Technicians
68
-
138
79
285
5.
Health Planners
15
-
24
-
39
6.
Envr Health Officers
36
-
142
-
178
7.
Physiotherapists
32
20
-
04
56
8.
Medical Lab Scientists
65
8
13
06
92
Medical Lab Technicians
69
-
49
20
138
10
Medical Records Officer
26
28
02
05
61
11.
CHEW
470
-
873
245
1588
12.
Radiographers
22
03
-
08
33
13
Dental Technologists/ Tech
06
06
-
-
12
14
Health Educators
05
-
45
-
50
15
VHW / TBA
-
-
499
-
499
16
Health Attendants / Ward
Orderlies.
340
-
1057
920
2317
17
Scientific officer
57
-
9
-
66
18
Rural Health officers
03
-
23
-
26
TOTAL
2703
1031
3348
3502
10584
9.
Source Ogun State Health Bulletin 2012
36
Health occupational
categories/cadres
Medical Doctors and Dentists
Nurses and Midwives
2007-2009
No
1269
3234
2010- 2012
HW/100,000
Pop.
33.84
86.24
No
HW/1000 Pop.
37.76
89.50
1416
3356
Source Ogun State Health Bulletin 2007-2009 and 200-2012 edition
TABLE 7 DISTRIBUTION OF HEALTH WORKERS BY CATEGORY/CADRE
2009
Health
occupational
categories/cadres
No
Medical Doctors and Dentists
152
Nurses and Midwives
769
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension
Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts
Optometrists
Other
TOTAL
26
58
28
13
5
44
2
_
_
5
_
5
_
_
1
_
1
2
_
HW/
1000
Pop.
0.0
4
0.2
0
2010
No
14
3
71
0
31
38
28
16
5
47
4
_
_
12
_
22
_
_
1
_
_
1
_
HW/
1000
Pop.
0.0
38
0.1
9
2011
No
13
8
60
0
51
38
25
16
9
47
4
_
_
2012
HW/
1000
Pop.
0.0
36
0.1
6
06
_
06
_
_
01
_
_
1
_
No
2013
HW/
1000
Pop.
No
150
0.04
193
689
0.18
784
31
38
36
19
2
44
4
_
_
56
45
29
25
2
57
22
_
_
6
_
6
_
_
1
_
2
2
_
4
_
13
_
_
10
_
1
4
_
HW/
1000
Pop.
0.05
1
0.21
Source- Ogun state health management board accessed September 201323
4.4.5.1 Gender Distribution By Health Occupation/Cadre
Females are predominantly nurses, midwives, medical lab assistant, health records officers,
dental therapist and community health officers (this is probably because MSS/Sure P
23
Ogun state health management board accessed September 2013
37
programme employed only females to the PHC health facilities. Males are predominantly
doctors, dentists, pharmacists, physiotherapists, Dental surgery assistant, and Optometrist.
Women account for only 23.8% of practicing medical doctors compared to 35% of National
figure. The pattern has been maintained over years.
TABLE 8 GENDER DISTRIBUTION BY HEALTH OCCUPATION/CADRE
Occupational categories/cadres
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists /Technologist
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts /Computer Analyst
Optometrists
Other
Total
Total
Female
193
784
56
45
29
25
2
57
22
_
_
4
_
13
_
_
10
_
1
4
46
740
26
36
22
11
1
27
14
_
_
0
_
10
_
_
10
_
_
1
%
Female
23.8
94.4
46
80
75.86
44
50
47.4
63.6
_
_
0
_
76.9
_
_
100
_
_
25
Health Management Board, Hospital Services, Nursing Services and Professional Bodies 2013
4.4.5.2 Age Distribution by Occupation/Cadre
The retirement age for civil servants in the country is 60 years. Health workers in academic
posts retire at the age of 65 years. For those professional categories for whom data is
available, the age of most of the staff is below 50 years. Health workers under 30 years are in
the minority, in all cadres, except for health record officers and dental therapist. Important to
note that the age profile pattern looks good but not representative of the health workforce in
the state as the data obtained from different professional bodies may not capture those in
private or federal employment in the state.
38
TABLE 9 WORKERS BY AGE GROUP AND CADRE
Health occupational categories
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts
Optometrists
Other
Total
≤30 Yrs
13
_
1
6
2
1
_
9
17
_
_
_
_
10
_
_
6
_
_
_
31-40
103
_
36
7
17
9
_
27
5
_
_
_
_
_
_
_
11
_
1
3
_
41-50
64
_
17
17
6
10
1
18
_
_
2
_
3
_
_
1
_
_
1
≥51
13
_
1
15
4
5
1
3
_
_
_
2
_
_
_
_
1
_
_
_
Obtained from Professional bodies in Ogun State (NMA, NMCN etc). Accessed Oct 2013
TABLE 1O. NUMBER AND DISTRIBUT ION (LGA AND FACILIT Y) OF MIDWIVES UNDER THE MIDWIVES
SERVICE SCHEME (MSS)
S/N
LGA
MIDWIVES
RESUMPTIO
N DATE
CHEWS
RESUMPTIO
N DATE
PHC FACILITY
1
Ipokia
16
March 2010
to july 2013
8
Oct 2012
Tube Vahwehundo
Odanijaiye Ijofin
2
Ewekoro
16
Dec 2010 to
1st oct 2013
8
Oct 2012
Elere, Obada, Itori, Wasinu
3
Obafemi
Owode
16
Jan 2010 to
July 2013
8
Oct 2012
Owode, Adedero,
Ofada,Mokolik
4
Ijebu East
16
Dec 2010 to
Sept 2013
7
Oct 2012
Ogere,Itele,Ijebu Mushin,&
Owu Ikija
5
Odogbolu
16
Oct 2009
8
Oct 2012
Mobalufon Okunowa Ibefun
Ogbo
39
S/N
LGA
No of HFs
CHEWs
Available
CHEWs
Reqd.
Shortfall
Nur/MW
Availble
Nur/MW
Reqd
Shortfall
6
Ifo
13
Oct 2012 to
July 2013
8
Oct 2013
Coker, Agosi, Oluse Ajuwon
7
Remo
North
16
July Sept
2013
8
Oct 2012
Isara.,Ipare, Oderamo Ajana.
8
Ado
Odo/Ota
15
July 2013
8
Oct 2012
Ota, Ado-odo, Sango, Ijoko
Total
224
63
Overall total 287 health workers were employed to the service of PHC facilitates by FG
40
1
Abk-North
27
34
64
30
41
66
25
2
Ipokia
30
58
60
2
23
45
22
3
Ijebu-Ode
16
62
94
32
22
35
13
4
Ogun Waterside
24
24
60
36
18
40
22
5
Yewa-North
45
67
160\
93
29
44
15
6
Obafemi-Owode
44
34
36
2
29
33
4
7
Sagamu
22
58
68
10
27
37
10
8
Imeko-Afon
15
30
45
15
17
30
13
9
Abk-South
16
36
48
12
22
38
16
10
Ijebu North-East
31
37
87
50
18
44
26
11
Odogbolu
23
43
59
16
16
37
21
12
Yewa-South
24
29
48
19
31
48
17
13
Ifo
26
26
40
14
38
48
10
14
Ikenne
10
29
39
10
24
44
20
15
Odeda
27
34
84
50
39
63
24
16
Ado-Odo/Ota
30
28
99
71
31
102
71
17
Ewekoro
24
32
72
40
34
72
38
18
Remo-North
19
Ijebu-North
0
23
62
87
25
0
18
28
10
41
20
Ijebu-East
Total
0
457
723
1250
527
0
477
854
377
Work Environment and Conditions
There are incentives that are giving to the some of the health workers in Ogun State like staff
quarters for senior workers, provision of official vehicles for some Directors, car loan to any
interested staff, study leave with or without pay, study grants, and so on. Twenty percentages
(20%) of staff basic salary are being paid as 13 month bonus at the end of the year for all
workers in the State.
Only federal health workers staff in the state enjoyed the National Health Insurance Scheme.
Though some staff in rural areas are benefiting from piloted Community Based Health
insurance scheme in 4 LGAs. Information available shows that other levels of health care
workers will soon be introduced to the Scheme. KII shows that pensions for all government
health workers had been poorly managed in the past and most health workers have a more
negative attitude. However, the pension arrangement has been streamlined. The arrangement
is contributory (employer and employees contribute 7 % of the monthly salary. Most of the
staff do not have information on what money is used for. There are other incentives operating
in some LGAs. It is likely that all workers in the States will eventually be offering similar
incentives, to prevent poaching of health workers by neighboring States. Also not all the MSS
or SURE P staffs are benefiting from State in term of accommodation and other allowances.
42
Box 1: HRH Management Challenges;- Evidence from Observation and KII. The most valuable
asset of any health system is the human resources. Even though most of the health workers working
in the state are house in new secretariat building for efficient and effective outcome. Working space is
not enough, staff are crowded in one office, senior and junior staff in same office. However, more
often than not, health workers are sent out to remote areas where: the most basic equipment to do
their work is lacking; Allowance are paid late, if at all for MSS workers; basic drugs and
consumables are not provided; the physical infrastructure of the clinics is falling apart;
accommodation is not provided and transport is not available for some staff working in MSS/SURE P
facilities;
Over the years, recruitment drives at all levels of government have been negatively affected by poor
funding, embargos, and unexpected exits of the health workers. Most of the recruitments have not
been based on evidence-based needs. Poor retention of health staff create extra burden on the existing
staff. These retention problems are induced by poor conditions of service, lack of equipment,
inadequate development of infrastructure at the state and the lower levels of government. Though
there are no delays in staff promotion, however poor placement after training and inadequate
opportunities for professional advancement. Staff distribution is skewed towards urban areas because
the development agenda of governments do not create platforms for equitable distribution of social
amenities. In regular incentives for health workers with particular reference to those that are meant to
attract and retain staff in rural and deprived areas, especially Nurses/Midwives in Midwives Service
Scheme (MSS) programe.
4.5.0
HUMAN RESOURCE FOR HEALTH INFORMATION SYSTEMS MANAGEMENT
Accurate health information is essential for efficient2 running of a healthcare service. HRH
Source: Political Economy of the health sector in Nigeria
information management is critical to the effective and efficient planning and utilization of
the health workforce to meet service delivery targets and to provide qualitative and equitable
health services. Ogun State has embraced the Introduction of the latest version of the
National Health Management Information System (HMIS) software. The state trained M&E
officers to use the system. Forms are also distributed to all health institutions for routine
collection, collation and analysis of health data. The state also released funds to facilitate
collection of statistics data from their local government facilities by monitoring and
evaluation officers, presently there is online registration of private health facilities. Even
though there is health research working group and a health research ethics committee, there is
currently no Human Resources for Health Information Management system in place in the
health sector. However, HRH information and data is collected from different units,
professional bodies and departments by Project Manager Health Systems Development
Project II (HSDP II) in department of planning research and statistics. The information is
published on quarterly basis in Health Bulletin with fund from World Bank health systems
development project II (HSDP II). There is a designated HRH officer in DPRS, yet no data
43
system in the state to enable effective HRH workforce planning and management.
Consequently, most of the HRH management functions such as recruitment, deployment,
retention, motivation and performance assessment are not undertaken in a systematic manner
and decisions regarding them are not reached based on evidence. The only function that is
performed in a seemingly systematic way is promotion but this is done based on information
from APAR form which was apparently designed for serving only that purpose. The
challenge in the management of Human Resources Information in the health sector are as
follow;
There are no institutional structures, facilities, skills and capacity within the SMOH,
SPHCA, HMB, DAS, CSC and Establishment.

The coordination of HRH in the system is fragmented

There is no specific HRH policy guideline or strategic framework to create the
enabling environment.

Where documentation is available, there are lots of bureaucracy and political tension
for the release of data, information, document and reports.

Available Human Resource for Health Systems (Both Manual and Electronic) are not
maintained well.

HR information system in the State is partially transformed from paper-based to
system based.

Obtaining accurate and up to date information on staff is not very easy manual and
electronic computation is laborious and time-consuming.

There is lack of basic employee data such as, dates of birth, leave taken, appointment
data, staff qualifications, utilization point and so on.

This indicates that there is no effective HR information system or payroll system that
is regularly updated and maintained to provide comprehensive details on employees.

There is the urgent need for the development of a comprehensive Human Resource
Information System with clearly defined minimum data sets to be collected on regular
basis, processes for routine staff data collection, processing, storage, retrieval and use
for decision-making.
44
4.6 CROSS CUTTING
4.6.1 Performance Management and Annual Health Planning Process
The state government declared the resuscitation of the healthcare sector a priority. Hence its
position as number two on this administration’s five point agenda.
Costed annual health planning process start in July every year with a memo from the
Governor Office, Budget and Planning Department. Then the Permanent Secretary in each
ministry including Ministry of Health directs the DPRS to coordinate the process. In Health
sector, DPRS set up Budget and Planning Committee of all the Directors (Public Health,
Hospital Services, Administration & Supplies, Pharmaceutical, Nursing Services, Ogun State
Ambulances Services, State Agency for Control of HIV/AIDs). This expert committee is
chaired by Permanent Secretary.
Each department/Unit/Agency will prepare the activity plan and the cost to achieve it, the
draft costed plan will be collected and collated by the DPRS. The sectorial annual costed
work plan will then be reviewed, harmonized and ensure that it is within the sector seal in a
group work of the budget and planning committee.
Final work plan of activities and budgeting estimates from Ministries, Agencies, Parastatals
and LGAs are collected and forwarded to the Governor Office Budget and planning unit
which also forward it to State Assembly Budget committee for review and defend. The
approval is granted by the State assembly. Some of the challenges and Bottlenecks on
implementation of work plans include Political intervention, inadequate of funds, skills and
intervention with poor reorientation. In addition, inputs from Units Head are not always used
in planning and budgeting, poor feedback on planning processes and work plan and budget is
not internalized in the Ministry.
4.6.2 Performance Management Monitoring and Evaluation
As in all other sector of government annual performance appraisal system for all public sector
workers exists, APA forms are circulated annually to all staffs to complete. Staffs are
appraised based on annual work schedules by line supervisors but this is mostly routine and
has little or no implication on discipline, reward and compensation of health workers.
However, staff promotion is regular and based on recommendation of supervisor. Although
45
compliance with this annual appraisal routine is high, however, staff did not receive
feedbacks, nor did the forms and system for its administration reveal any strategic mechanism
for holding health workers accountable, either individually or collectively for their
achievement or underachievement of targeted results.
The integrated supportive supervision on job capacity building (ISS/OJCB) system in the
health sector of Ogun State is holistic, robust, cross-cutting and not limited to any particular
programme or intervention. The head and “home” for the health sector ISS/OJCB is the
Directorate of Planning Research and Statistics of the State Ministry of Health.
4.6.3 Monitoring and Evaluation/ Supervision Structure
The following exist:
o The State coordinator of the ISS/OJCB system/Chairman of the State ISS/OJCB
Coordinating Committee.
o The State ISS/OJCB Coordinating Committee
o Assistant State ISS/OJCB coordinator and a Desk Officer, ISS/OJCB system
o The State ISS/OJCB Technical Working Group
o The State ISS/OJCB supervisory team
o The LGA ISS/OJCB supervisory teams
The key informant interviewed shown the evidence of DPRS organization structure without
HRH unit.
4.6.4 Key gaps on;- Coordination, Performance Appraisal, M&E, Partnership
Key gaps HRH Coordination
a
Mobilisation, allocation, and utilisation of health resources are fragmented among
different players. Activities of private health sector providers are poorly coordinated.
This affects staff development and utilization.
b Performance appraisal is in place in some areas but is not properly administered
46
5.0 Conclusion
Health workers are at the nexus of health systems and are the cornerstone of quality health
care; yet Ogun State as many other Sate in the country is currently facing health workforce
crises, meaning they are experiencing extreme shortages of doctors, nurses, and midwives
given their population sizes and needs—less than 2.3 doctors, nurses, and midwives per 1,000
population (World Health Organization 2006). Access to quality care is constrained by a
multitude of health workforce issues extending beyond a sheer lack of doctors, nurses, and
midwives. Inequitable geographic distribution of health workers, mismatches between the
population’s needs and the composition of the health workforce, insufficient skills tied to
inadequate education and training capacity, low retention and productivity, and weak human
resources management (HRM) are all well-documented problems affecting the health
workforce and health systems.
The following is a summary of underlining factors that currently undermine effective human
resource planning, management and practices in the state with implications on policy and
HRH strategic implementation plan:
 Weak HR policies and absence of structured HR planning processes
 Weak deployment practices resulting in mal-distribution and poor coverage
 Absence of performance management system leading to under-utilisation and low
productivity
 Poor alignment between intakes into health training institutions and the health worker
requirements of the state this in addition to loss of accreditation of some health
institutions (Nurse and Midwifery).
 Human Resources management is not perceived as critical to effective service
delivery and is handled in isolation from service planning and strategic planning.
Human Resources are managed on an ad hoc basis and follow no policy or regulations
for appointments etc.
47
Recommendations
Based on the above findings and challenges it is recommended that the state should support a
robust development of human resources for health strategic implementation plan (HRHSIP)
State health sector should develop health specific HRH information systems to capture
recruitment for health workers in the state. State Government policy should support health
sector in recruitment of health workers based on the need. And finally creation of an HRH
unit in DPRS is of critical importance and should not be delayed any longer
References
1. National Population Commission and Ogun State 2007-2009 Health Bulletin
2. Nigeria health work force profile as at December 2012
3. WORLD Health Organization. Working Together For Health, The World Health
Report 2006, Geneva
4. Human Development Report, UNDP, 2001
5. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human
resources for health: overcoming the crisis. Lancet 2004;364: 198490.[CrossRef][ISI][Medline]
6. World Health Organization. High level forum on the health MDGs. Addressing
Africa's health workforce crisis: an avenue for action. 2004.
www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf (accessed 28 March
31, 2011).
7. Ayenbe, W; Bezzano, J; and Foot, S. An Analytical Framework for Understanding the
Political Economy of Sector Policy Arenas – Country Level Testing: The Health
Sector in Nigeria. November 2005 – unpublished
8. Ogun State Health Bulletin
9. Ogun State Strategic Health Development Plan; 2010-2015
10. Ogun State Health Bulletin 2012
11. Sources World Health Statistics 2005
12. National sero-prevalence survey
13. Ogun State SACA
14. NARHS
48
15. Ogun State Strategic Health Development plan
16. Ogun State Government Economic Plan Development 2012-2015
17. Ogun State 2013 -2015 Ministry of Health Mid Term Strategy
18. Ogun State College of Health Technology 2013
19. Nigeria health work force profile as at December 2012
20. Ogun State Health Bulletin 2007-2009 and 200-2012 edition
21. Ogun state health management board accessed September 2013
22. Ogun State (NMA, NMCN etc). Accessed Oct 2013
Annexures
I.
TOR/SOW
II. List of person interviewed
III. List of contributing agencies
IV. Draft adapted HRM Assessment Approach
V. List of tables
SCOPE OF WORK FOR HRH STATE STRATEGIC IMPLEMENTATION PLAN
The National Human Resources for Health Policy (NHRHP) 2007 and the draft National HRH
Strategic Plan (2008-2012) sets out the basis for human resource planning, management
and development across the health sector. Ensuring availability and access to a well-skilled
health workforce in areas where they are in most need poses a major challenge for the
health sector. This is further complicated by the uneven distribution of the existing health
workforce, depriving at risk communities from access to critical maternal and neonatal
health care and life saving services. Ongoing health reform in Nigeria places the
strengthening of the health workforce as crucial for accelerating progress towards health
related Millennium Development Goals. In line with the NHRHP and the National Strategic
Health Development Plan (NSHDP) 2010-2015, each state is mandated to adapt and
domesticate the NHRHP to guide HRH developments within the state. Additionally, the
states have integrated HRH priorities, goals, strategies and activities within their respective
2010-2015 State Strategic Health Development Plans (SSHDP) covering the five year period
of the plan.
49
The aim of this assignment is to work with SMOH in the development of state-specific HRH
Strategic and Implementation Plans that are aligned and integrated with the NHRHP, the
Human Resources for Health Priority Area of the SSHDP and the state’s planning and
budgeting cycles (FY January to December) for the state.
Approach
1. The approach will adopt participatory and collaborative techniques to facilitate
stakeholder leadership, engagement and ownership in the planning process and its
outcomes; informed by the principles of the country coordination and facilitation24
(CCF) process and stakeholder leadership group25 (SLG) guidelines and principles.
2. Support the SMOH in each state to develop a draft HRH Strategic and
Implementation Plan (HRHSIP), through an agreed process that is responsive to the
specific context and HRH issues in each state.
3. Support the SMOH to facilitate the establishment and functioning of a mandated
state HRH technical working group (TWG) to develop the HRHSIP.
4. Document the process and support the collation of all related documentation
Tasks
The consultant will carry out the following indicative tasks and support the SMOH to
facilitate the activities of the HRH TWG in collaboration with CapacityPlus Nigeria:
1. Participate in preparatory meetings with CapacityPlus, FMOH and SMOH for briefing
and joint planning for the assignment
2. Document and do a literature review on national and state HR context
3. Conduct a HRH Situation Analysis for each State, which would include the following
activities:
a. Conduct a HRH Situation Analysis and stakeholder mapping for the state.
b. Facilitate preliminary discussions (2-3 meetings) with key stakeholders and
consensus on the development of the HRHSIP for Oyo state, to be based on
the state’s existing SSHDP (Priority Area 3: HRH);
c. SMOH agreement to lead the process of developing the HRHSIP and
identification of a HRH focal person(s)
24
http://www.who.int/workforcealliance/knowledge/resources/CCF_Principles_Processes_web.pdf
25
http://www.capacityplus.org/files/resources/Guidelines_HRH_SLG.pdf
50
d. Work with the assigned SMOH focal person(s) to identify
stakeholders/members for the HRH TWG and draft Terms of Reference for
the TWG if none already exists
4. Develop a refined methodology, Workplan and timeframe for the assignment and
present it to CapacityPlus, FMOH and SMOH leadership for finalization and approval
5. Adapt and apply CapacityPlus’ HRM Assessment Approach26 to produce a standard
template for the situation analysis for the HRHSIP.
6. Work with SMOH mandated HRH technical working group (TWG) to agree and
finalize the structure and format of the HRHSIP and its alignment with the SSHDP
7. Facilitate regular HRH TWG meetings to conduct further problem analysis, identify
HRH issues and challenges, refine the situation analysis and develop strategies,
activities and an M&E framework for the HRHSIP - in line with the agreed structure
and format.
8. Facilitate stakeholder consultations throughout the process to validate HRH TWG
outputs, share information and build consensus and ownership
9. Present key deliverables to SMOH leadership for review and endorsement at predefined stages of the process
10. Provide continuous feedback and monthly progress reports on the process to SMOH,
FMOH and CapacityPlus.
Assessment Tool
HUMAN RESOURCES FOR HEALTH OGUN STATE SITUATION ANALYSIS FRAMEWORK
1.1
N 1 BACKGROUND INFOMATION R PRIOR
Question
1. Does the State have a HRH Strategic Plan or is
the HRH Strategic Plan a component of the
SSHDP (indicate which one)?
2. According to the HRH Strategic Plan and/or
SSHDP, what are the State’s key HRH priorities
and/or challenges?
26
http://www.capacityplus.org/files/resources/hrm-assessment-approach.pdf
51
3. According to stakeholders interviewed, what
are the State’s key HRH priorities and/or
challenges?
4. Does the State have an HRH coordinating
mechanism/structure (provide the name and
composition if one exists)?
5. Does the State have staffing norms/an
establishment of approved and funded posts
for each level (e.g. tertiary, secondary and
primary levels) of the health system?
6. Does the State have a functioning HR
information system (HRIS)?
7. Does the State have a M&E framework/plan for
HRH?
1.2 HRH ACTIVITIES PLANN ED, IMPLEMENTED, NOT IMPLEMENTED AND ONGO ING
For the most recent annual implementation plan period (2012-2013), describe what HRH
activities were planned and have been implemented and who is funding these
Table 1.2 Activities planned and implemented
Activity planned 2012-13
(include all activities
included in the Plan)
Evidence of Implementation
Funding source
Nil
Nil
1.3 HRH STAKEHOLDERS
TABLE 1.3 GOVERNMENT STAKEHOLDERS
Question
Response
1. What government stakeholders in the
State are responsible for HRH?


Department of Planning, Research
and Statistics, State Ministry of
Health
HMIS, State Ministry of Health
52

Health Management Board

Office of Head of Service

State Primary Health Care
Development Agency (SPHCDA)

State Civil Service Commision (SCSC)

Ministry of Local Government and
Chieftaincy Affairs (MLGCA)

Local Government Service
Commission (LGSC)

Training Institutions:

Professional councils and
associations:

Others
2. What HR functions and/or decisions are
stakeholders above responsible for?

HR Policy

Workforce planning

Recruitment and deployment

Career development (e.g. promotion)

Pre-service training

In-service training

Performance management

Pay, allowances, incentives
53

HR information systems

Other (e.g. research monitoring and
evaluation, etc.)
3. Which of the stakeholders listed is acting
or could act as the principal HRH ‘focal’
person in the SMOH
TABLE 1.4 OTHER STAKEHOLDERS (PRIVATE SE CTOR AND DONORS)
1. What private (private for profit and not
for profit) health care providers provide
services in the state?
2. Which of the following HRH
functions/areas are donors,
development partners and
implementing partners (e.g. FHI 360,
DFID, Global Fund, EU) supporting in the
State?
 HR Policy

Workforce planning

Recruitment and deployment

Attrition/Retention

Pre-service training

In-service training/continuing
professional development

Performance management

Pay, allowances, incentives

HR information systems

Other (e.g., research monitoring and
evaluation, etc.)
54
1.5 Objective, Methodology and Approach



Key Objectives
Summary of Methodology
Limitations and challenges
55
1
SEON 2
2.1 HEALTH WORKERS SITUA TION 27
This section presents the health workforce in the State and trends of its evolution over recent
years. These data concern the health workers in all sectors (public, semi-public, private for
profit and private not for profit, including faith based organizations sector).
2.1.1
DISTRIBUTION OF HEAL TH WORKERS BY CATEGORY/CA DRE
Distribution of workers by category, and by gender, age, urban/rural, public-private for profit faith based organization
TABLE 2.1 DISTRIBUTION OF HEALTH WORKERS BY CATEGORY/CADRE (SEE DEFINITION OF EACH
OCCUPATIONAL CATEGORY IN ANNEX)
Health occupational categories/cadres
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts
Optometrists
Other
TOTAL
Add Source and year
2009
2010
2011
2012
2013
_
_
_
_
_
2014
Source- Ogun state health management board access September 2013
Please itemize on separate sheet the cadres included under each category
27 Extracted and adapted from WHO (2008) Country Profile Template
56
Remark: If the data exist for more than two data points, create additional columns in the table
below to emphasize better the trends of health workers and ratios in the State.
2.1.2
GENDER DISTRIBUTION BY HEALTH OCCUPATION/CADRE
The analysis can be done on the basis of following questions:
 What are the categories/cadres where women are more/less represented?
 Comment on the gender situation in the labour market in the public and/or private sector?
TABLE 2.2 GENDER DISTRIBUTION BY HEALTH OCCUPATION/CADRE (SEE DEFINITION OF EACH
OCCUPATIONAL CATEGORY IN ANNEX)
Occupational categories/cadres
Total
Female
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists /Technologist
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts /Computer Analyst
Optometrists
Other
Total
%
Female
Add Source and year
*Please itemize on separate sheet the cadres included under each category
57
2.1.3

Age distribution by occupation/cadre
Describe the distribution of workers by age group as per table 2.3 and indicate the
retirement age for State civil servants.
TABLE 2.3 WORKERS BY AGE GROUP AND CADRE
Health occupational categories
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts
Optometrists
Other
Total
Add Source and year
2.1.4

DISTRIBUTION OF HEAL TH WORKERS BY TERTIARY, SECONDARY AND PRIMARY HEALTH
CARE LEVELS
Describe major variations in the distribution of workers by health care level or any other
dimension possible (indicate the best method of determining distribution)
Table 2.4: Service level distribution of workers
Occupational category/cadre
Total Number Tertiary Secondary Primary
level
level
Health
Care/LGA
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
58
Community Health Officers
Community Health Extension Workers
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts / Computer Analyst
Optometrists
Other
Total
Source and year
* Please itemize on a separate sheet the cadres included under each category
2.1.5
DISTRIBUTION OF OCCUPATION/CADRE BY EMPL OYER 2012/ 2013
TABLE 2.5 PUBLIC/PRIVATE FOR PROFIT/FAITH BASED ORGANIZATION/PRIVATE NOT FOR PROFIT
DISTRIBUTION OF HEALTH WORKERS (SEE DEFINITION OF EACH OCCUPATIONAL CATEGORY IN
ANNEX)
Occupational category/cadre
Total
%
%
% Faith
%private
Number
Public
Private
based
not-for –
sector
sector
organization
profit
Medical Doctors and Dentists
Nurses and Midwives
Medical Lab Scientists
Medical Lab Technicians
Medical Lab Assistants
Physiotherapists
Radiographers
Pharmacists
Health Records Officers s
Community Health Officers
Community Health Extension
Workers (CHEWS)
Dental Technologists
Environmental Health Officer
Dental Therapists
Dental Nurses
Dental Health Tech.
Dental Surgery Ass
Chart. Chemists
Public Analysts
Optometrists
Other
59
Total
Add Source and year
* Please itemize on separate sheet the cadres included under each category
60

HRH Production
This section details the strategies, requirements, mechanisms and capacities for HRH
production and maintenance, and covers:
a)
Pre-service education of health workforce,
b)
In-service and continuing education
c)
Health workforce requirements
The issues to be covered in this section are existing policies & strategic documents on
production, supply basic training requirements for each category of health professionals (type
of educational institutions) requirements for specialization and further training (duration, type
of educational institutions); bonding arrangements linked to education; setting educational
standards, regulation, accreditation; capacities for education; number and distribution of
educational institutions and teaching cadres; evaluation and relevance of the training programs,
etc.).
3.1.1





PRE-SERVICE EDUCATION
In this subsection describe who is responsible for pre-service education, links between the
two ministries of Health and Education, and mechanism of co-ordination concerning the
quantity and quality of training in the health training institutions.
Indicate the number of Health Training Institutions in the State as shown in table 3.1.
Indicate where possible which institutions are accredited by the relevant professional body
e.g. Medical & Dental Council, Nursing & Midwifery Council (NMCN), etc.
How the number of workers to educate is defined? Does the State Ministry of Health have
direct control over the production of the training institutions? If not, who decides?
Are there any education policies? Please describe if there are any changes in education
systems, i.e changes in nursing education, emerging new professional categories, etc
3.1.2
IN-SERVICE AND CONTINUING PROFESSIONAL DEVE LOPMENT/EDUCATION
In this subsection, describe





How the in-service training is provided in the public and private sector?
How it is organized, coordinated, planned and monitored?
How often curricula are reviewed, by which mechanism?
Describe the difficulties and challenges faced by training institutions
Partnerships between public, not for profit and Private for profit health training institutions
and the main issues
 Accreditation mechanisms
3.1.3

HEALTH WORKFORCE REQ UIREMENTS
If this information is available, indicate in the table the number required for the next 5 next
years by occupation/cadre (table 3.3.)
SECTION 4
61
4.1 PLANNING PROCESS


Describe the annual health planning process in the State, how LGA plans and budgets are
developed and feed into State annual health plans, what are the key stages of the planning
process and when do these occur throughout the year, what SMOH and government officials
and stakeholders are involved.
Describe how planning for HRH is conducted within the overall annual health planning and
SSHDP processes
62