The Life of Health Students and Professionals in Developing Countries: A Snapshot

Mesrak BelatchewThere are 57 countries that fail to meet the World Health Organization’s recommended minimum threshold of 2.3 health workers per 1,000 people. Everyone agrees on the fact that the health workforce crisis is beyond the numbers. The increased migration of health workers and the lack of trained health providers in rural and remote areas are manifestations of the inherent lack of capacity of the health and education systems in developing countries to adequately recruit, train, and support their health workers.

Typically, students that join health science institutions have strong records of academic achievement. Their personal aspirations coupled with the high expectations of their families, teachers, and their communities increase their desire to achieve more. They dream of getting more education and training to enable them to help others.

Yet the typical education system in developing countries accepts more students than it can reasonably accommodate. Some of the challenges include overcrowding of education and health facilities; low competence and motivation of instructors; poorly functioning libraries; and limited support systems to facilitate the teaching and learning process.

Simple measures such as infection prevention through Personal Protective Equipments and hand-washing practices are often nonexistent. As a result, some students acquire infections from the hospitals where they are training.

It is common to find health science institutions with limited electricity and water. Students have to read by candlelight and use rainwater to bathe. The teaching hospitals often use students in the same manner as fully fledged practitioners, requiring them to prescribe medicines and conduct surgical procedures before they are qualified to do so. Due to the difficult circumstances, a large proportion of the students tend to drop out. In other instances, a number of students qualify without any clinical exposure. For example, some midwifery students graduate without having attended or assisted in any delivery.

Additional challenges await the health professionals after graduation. Sometimes these graduates are denied their qualification certificates or licenses, or cannot access in-service training or continuing professional development for an undefined period of time. The rural and remote areas they are assigned to often lack resources to help them provide services they are trained on. There are instances where they have to travel to the capital cities to resolve salary issues. Their access to technology, public resources, and loans is limited. The HR information system in most of these countries is either absent or weak, which means these health workers are forced to carry their qualification information with them to their universities, employers, and districts offices for validation.

As health workers strive to support their dependents and respond to the expectations of their extended families, they often engage in additional employment options, such as moonlighting and side businesses. The extra workload adds a huge burden to the health professionals and their families, significantly affecting their performance.

Similar to other professionals, health workers in developing countries are real people who have needs and aspirations. But one of the things that make them unique is their endurance to overcome multiple challenges. I think about them every day through my work on the CapacityPlus project, which is implementing a comprehensive pool of health workforce interventions that encompasses human resources management, health workforce development, performance support, and the strengthening of HR information systems. Health workers are the center of the health care delivery system, and we dedicate our efforts to them.

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Photo by Crystal Ng.