Extending the capacity of Africa’s health services

By John Kiwanuka Ssemakula, 29 May 2002

How?

Give nurses greater responsibilities!

In April 2002, the GMC in the UK announce a pilot scheme to expand nursing roles in attempt to relieve the pressure on over worked general practitioners (GP). Specially trained nurse will be able to prescribe common antibiotics for conditions such as urinary tract infections in women, prescribe treatment for minor injuries such as burns and cuts, minor illnesses such as hay fever or common ear infections, palliative care as well as treatment that promotes a healthy lifestyle such as folic acid in pregnancy.

In addition there are plans to extend nurses roles to taking responsibility for the long term management of patients with chronic illnesses such as asthma, diabetes, heart disease and mental illness provided they follow treatment plans supervised by a doctor.

Nowhere is there greater pressure on health systems than in Sub-Saharan Africa SSA). There is an acute shortage of doctors, with ratios that average around 1 doctor per 10,000 people. Yet on average there are 6 nurses for every doctor in SSA. More nurses are produced than doctors every year and it takes a shorter time to train a nurse.

In many public health programmes you find nurses/primary health workers at the forefront. They are involved in mother and child health, immunization campaigns, nutritional campaigns, health education campaigns. They are a valuable resource, often intimately connected with their communities.

But nurses are still relegated to the traditional role of lowly assistants without any responsibilities. Why? More nurses are produced than doctors every year and it takes a shorter time to train a nurse. Why not set up a program to train nurses to be able to prescribe medicines, treat patients? After all nurses outnumber doctors greatly. And why limit training to nurses, why not train paramedics of all types as well, who could also be recruited in the fight against HIV/AIDS and other diseases.

Training such personnel would not only increase the capacity to battle the spread of HIV/AIDS, it would reduce the demand on the health care system at the same time by spreading out the burden over a larger number of people.

If rich countries such as the UK and US with developed health systems see the need to make better use of a valuable resource such as nurses to relieve the pressure, Africa should follow suit. Many African health systems are based on the inherited British colonial systems, with in built deficiencies. So it makes sense that the solutions they are using will with modification work in Africa.

It makes sense to use all the resources at your disposal, yet time and time again the policies fall short of what is needed. Health policy planners need to take this into account when approaching health policy reform. It is time to discard the old fashioned notions of health systems, if SSA is to be able to deal with its health problems in the new century.