Tropical Health Matters

In an effort to ensure the human capacity to deliver malaria services, partners are embarking on in-service and pre-service training throughout endemic countries.  Such training is not something that can be accomplished quickly. Most partners plan training in a phased approach that eventually covers all districts and facilities, but quality training cannot be rushed.

Jhpiego has a 35 year history of capacity building of the health workforce in maternal and reproductive health, including the issue of malaria in pregnancy. Jhpiego has been working in Akwa Ibom State, Nigeria for the past 2 years to test the concept of community-clinic collaboration in the delivery of malaria in pregnancy control services.  The effort began by developing a core team of trainers at the state level, who in turn trained another core among staff of seven of the states 31 local government areas (LGA).

These LGA teams then embarked on training front line health facility staff in both malaria in pregnancy control and outreach through community directed interventions.  The actual service delivery of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) took off in July 2008 after both health workers and community selected and directed volunteers were trained.  Nearly 10,000 pregnant women have received two doses of IPTp since then.

Now the Pioneer Newspaper reports that many of those trained have been transferred to other LGAs, and this could disrupt the smooth delivery of MIP control services.  The challenge in Nigeria is that while the State Ministry of Health provides technical guidance to LGA health staff, and the LGA itself provides the facilities and supplies to run the services, most of the actual health workers are employed by another entity – the State Local Government Service Commission.  Transfers and repostings occur as frequently as every two years or only as often as every 5 years.  Often a transfer is the only way a health worker can move into a higher grade position – in effect get a promotion.

So while the system may benefit the individual employee, it makes it difficult to offer continuity in service and to build strong community relations needed to deliver public health care.  Eventually the State will have the resources through the World Bank Malaria Booster Program to train health staff in all LGAs on malaria. In the short term the efforts to prove that LGA health facilities can improve the quality and reach of malaria in pregnancy control services may be jeopardized.

The ultimate irony is that the bulk of health workers on the front line in Nigeria are not part of a system that could provide coordinated human resource planning for health.  Instead, they are transfered by a non-health bureaucracy like any other LGA civil servant, whether she be a clerk, accountant, secretary or in this case a nurse.  When Nigerian health planners are able to train and update all health staff in malaria, such transfers may not disrupt services.  For now, these planners need to examine the effects of a system that treats health staff like civil service pawns.

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