What’s the Issue? Not Enough Health Workers in Susan’s Maternity Unit

When Susan Alio describes what she likes best about her job, a smile spreads across her face and her eyes light up. “When mothers come,” she says softly and swiftly, “and they have a normal birth, they go with their babies, healthy, without any complication, that one gives me joy.” She’s perfectly poised in her crisp white uniform and cap. 

Susan obviously loves her job as a midwife at Naguru Hospital in Kampala, Uganda, but it’s not easy. She feels the effects of the global shortage of health workers firsthand, on a daily basis. When she’s asked about her challenges, her big smile fades and her words slow down. “My biggest challenge is usually not enough staffs on the station, because you end up being stretched, and then when you’re stretched you’re not able to deliver at your best,” she explains.

CapacityPlus is participating in the first ever World Health Worker Week. Every day we are featuring our favorite health workers from our “I’m a Health Worker” video series. The goal of the week is to educate people on who health workers are and why they're important and, today, what the main issues are.

According to the World Health Organization, there is an estimated shortage of four million health workers worldwide. This means that an estimated one billion people have no access to essential health services. As a result, 1,000 women die from preventable causes related to pregnancy and childbirth every day; 99% of all maternal deaths occur in developing countries like Uganda. Most of these deaths could be prevented if these women had access to a skilled health worker like Susan.

Susan always advises expectant mothers to come with items to help them during their delivery—things like sugar for tea and clothes for the new baby. She also encourages them to come with at least one person to help her. “In most cases an attendant is very important at the hospital given the fact that we are not enough at the stations,” she explains. “So we can always utilize attendants.”

In Uganda, CapacityPlus works closely with the IntraHealth International-led Uganda Capacity Program to address the health workforce shortage. CapacityPlus strengthens the preservice education and in-service training of health workers, helps with retaining health workers in the areas they are needed most, and supports the country’s health workforce information system that is based on iHRIS.

To encourage the effective use of health workforce information for decision-making, CapacityPlus is using its stakeholder leadership guidelines to build the capacity of stakeholders to advocate for action in planning, managing, and supporting the health workforce. Through recent application of the Rapid Retention Survey Toolkit, iHRIS Retain, and a health workforce compensation study, CapacityPlus collected data to inform retention strategies and is now helping the Uganda Capacity Program to stimulate health workforce stakeholders to use the results and implement a national health workforce retention strategy.

When Susan remembers a woman she helped, her beautiful smile returns. “One time I delivered a mother who was earlier advised that she had twins,” she recalls. But as Susan monitored her patient, she could only hear one fetal heart beat. “I said, ‘I can’t get the second one.’ Then I said, ‘No, it must be there.’ At the end of it, I delivered her but it turned out one big baby.” At this point Susan’s eyes get very wide, and she pauses for a few seconds, looking around as her smile gets even bigger. She adds that although the baby was very big, the mother did not react well because she still expected twins. “But I said, ‘No madam, it’s good it’s a normal birth. I’m the only midwife here."

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Thanks to Maurice Middleberg for interviewing Susan.