Availability and distribution of human resources for emergency obstetric care services in Ethiopia

Abstract

Background: Being able to provide emergency obstetric and newborn care requires a frontline team of skilled personnel that includes physicians, surgeons, anesthetists, nurses, midwives and other cadres. Meeting in-country and international standards for the development and distribution of human resources is a key component of a system-wide strategy to lower maternal and newborn death rates. This study uses the findings from the national Ethiopian Emergency Obstetric and Newborn Care Assessment to provide an overview of the status of human resources for health in the country and the availability, distribution and status of in-service training for EmONC.

Methods: We used a secondary data analysis technique of the 2016 Ethiopia Emergency Obstetric and Newborn Care Assessment that included 3,804 facilities providing childbirth services. Using the data on overall staffing, we calculated the number of midwives, nurses, physicians, general surgeons, neonatologists, emergency surgical-officers and anesthesiologists in order to make comparisons with national and international benchmarks.

Results: Ethiopia met national standards of health facility staffing much more often than international ones. There is a relatively equitable distribution of health worker cadres across regions, location and managing authorities. Despite policies to accelerate the training of midwives, nurses and health officers in the country, large proportion of these professionals had not received in-service training in either basic or comprehensive emergency obstetric and newborn care services, or on neonatal intensive care, which are critical to saving lives when a woman or her newborn develops or is born with severe complications.

Conclusion: This study suggests that national numerical standards are being met but key international standards are not, especially for physicians, nurses and midwives. Although a large proportion of higher-level cadres had training on emergency obstetric and newborn care, the mid-level health workers who attend most births had much lower levels of specialized training. Policies aimed at keeping health workers in the public sector must be implemented in order to prevent more health professionals from clustering in big cities and private facilities.