Health human resources (HRH), also known as human resources for health or health workforce, comprises of individuals who engage in actions aimed at improving positive health outcomes. According to the World Health Organization's World Health Report 2006, HRH is identified as one of the six core building blocks of a health system. HRH typically represents about two-thirds of the health services production function. Building a sufficient quality and quantity of health workforce is crucial to the functioning of health systems as it is foundational to each of the other five health system building blocks (OECD, 2019). HRH should be considered a transversal pillar that permeates all health systems, more than a single one of the six pillars (Shannon et al., 2019).

Health human resources include physicians, nursing professionals, pharmacists, midwives, dentists, allied health professionals, community health workers, social health workers, and other healthcare providers. Health management and support functions personnel like cleaners, guards, etc. also add crucial value to the wider health system and enhance the delivery of essential healthcare services effectively and efficiently. Effective health system functioning requires well-trained health services managers, medical records and health information technicians, health economists, health supply chain managers, medical secretaries, and others.

The field of health human resources strives to address issues such as workforce planning, merit-based recruitment, onboarding, training and development, performance management, promotion, management, retention, health human resources information management, and research on human resources for the healthcare sector. In recent times, increased awareness of the critical role of HRH in enhancing health system performance and improving population health outcomes has made the health workforce one of the highest priorities on the global health agenda. HRH play a vital role in progressively overcoming geographical, economic, sociocultural, organizational, ethnic, and gender barriers to ensure all communities have equal access to comprehensive health services without discrimination, that are appropriate, timely, and of good quality. "Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability, and quality" (WHO, 2016).

Building resilient health systems towards Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) more broadly begins with human resources for health. The demand for health workers is rapidly growing with increased income, the increasing pace of medical advances, and with the urgent need to correct severe imbalances between and within countries in the availability of healthcare workers. Yet, supply does not match demand in an increasingly globalized health labor market. The COVID-19 pandemic has brought to the fore the weaknesses of health systems, impeding the world’s preparedness and ability to tackle challenges related to looming health and environmental risks (Agnès Soucat et. al., 2022).

THE CHALLENGE OF INADEQUATE HRH IN NIGERIA

In Nigeria, the health sector faces numerous challenges, particularly in training, funding, employment, and deployment of the health workforce. According to Adeloye et al. (2017), the Nigerian health system remains weak, and there is yet a coordinated response across the country. Several health workforce crises have occurred due to months’ salaries owed, poor welfare, lack of appropriate health facilities, and emerging factions among health workers. Poor administration and response at different levels of government have contributed to internal crises among health workers, with different factions involved in a sustained power struggle. These crises have consequently impeded optimal healthcare delivery to the Nigerian population.

Current health statistics in Nigeria indicate a degrading capacity of the health system. The global health observatory estimates a neonatal mortality rate of 35/1000 live births; infant mortality rate of 72/1000 live births; under-five mortality rate of 113/1000 live births; maternal mortality rate of 814/100 000 live births; and relative probability of dying between 15 and 60 years, the mortality rate for women was at 318 per 1,000 female adults, while the mortality rate for men was at 357 per 1,000 male adults in 2020. In 2022, life expectancy at birth in Nigeria was approximately 61 years, with a life expectancy of 60 years for males and 63 years for females. Life expectancy at birth in Nigeria is among the lowest in Africa and the world (Aaron O'Neill, 2022).

Insufficient infrastructure and inadequate compensation packages have resulted in a significant number of medical professionals, including physicians and nurses, leaving Nigeria for developed countries where they can find more fulfilling and lucrative employment opportunities. In addition to this brain drain, there is also a geographic imbalance in the distribution of healthcare professionals, with a disproportionate concentration in urban areas. This causes motivational problems for health workers in underserved areas, leading to a lack of courtesy to patients, absenteeism, poor quality patient care and other challenges.

The persistent low and uneven distribution of health workers presents a significant challenge for the Nigerian health sector. Historically, brain drain has been a major setback for Nigeria, with one in four doctors and one in twenty nurses trained in Africa currently working in developed countries, leading to a shortfall of over 1.5 million health workers in the region. Currently, only about 30,000 medical doctors are practicing in Nigeria out of the roughly 80,000 registered with the Medical and Dental Council of Nigeria since 1960, with a doctor-to-patient ratio of one doctor to 4000-5000 patients instead of the recommended one doctor-to-600-patient ratio by the World Health Organization (WHO).

There are many reasons why medical professionals are leaving Nigeria, including high rates of insecurity, unemployment, low remuneration, poor infrastructure, and a bad healthcare system. The Nigerian government needs to prioritize addressing these crucial issues to retain healthcare professionals and achieve sustainable development goals, specifically, SDG number 3 (good health and wellbeing) and its target. In Nigeria, the health workforce density is only estimated at 1.95 per 1000 populations, and there is no national policy guiding the postings and transfers of health workers. Redeployment is often based on the discretion of administrative officers who may have different interests.

Healthcare strikes have become common, with poor healthcare leadership and management being the most significant contributory factor. Even when the government intervenes, their promises and responses are focused on the short-term, with subsequent reneging on such promises after the resumption of duties.

Khadijat Kareem's article highlights the alarming issue of emigration among doctors in Nigeria, resulting in a significant shortage of medical practitioners. According to Dataphyte, there are only four doctors for every 10,000 patients in the country.

This situation can be attributed to several reasons, including the attrition of healthcare professionals to better-paying jobs and opportunities abroad. The feminization of the healthcare workforce is also a contributing factor, as women are more likely to migrate for various reasons.

The OECD's 2019 report, Health at a Glance 2019, sheds light on this global phenomenon and how it affects healthcare systems worldwide. The report emphasizes the importance of investing in healthcare workers and incentivizing them to work in rural and underserved areas to improve access to care for all.

Policy Brief - Human Resources For Health In A Globalized World, authored by Agnès Soucat, Paris Louis Pizarro, and Geneva Michel Kazatchkine, provides solutions to this critical issue. The brief highlights the need for a comprehensive approach to human resources for health, including policies that prioritize education, training, and retention of healthcare professionals.

It is imperative to address this shortage of doctors and nurses in Nigeria, as it seriously affects the quality of care and the overall health of the population. Ensuring that healthcare professionals are adequately compensated, trained, and supported in their work is necessary to provide accessible and quality healthcare to all Nigerians.