SOMALILAND: Underlying Causes for Health Facility Inefficiencies in Low Income Countries

Dr Essa Abdi Jama holds MBBS/ Master of international health from john Hopkins University, he also a member of Global Unification International (GUI) Health Commission

whilst the largest shortages in numerical terms are expected to be in parts of Asia, it is in sub-Saharan Africa where the shortages will be especially acute.
imageOn education and training, for example, in the 47 countries of sub-Saharan Africa, just 168 medical schools exist. Of those countries, 1 1 have no medical schools, and 24 countries have only one medical school. ,” says Dr. Carissa Etienne, WHO Regional Director for the Americas.(November 2013 The Third Global Forum for Human Resources for Health) “The best strategy for achieving this is by strengthening multidisciplinary teams at the primary health care level.” Task shifting for medical professionals. “One of the challenges for achieving universal health coverage is ensuring that everyone – especially people in vulnerable communities and remote areas – has access to well-trained, culturally-sensitive and competent health staff,” As the Universal health coverage aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.

Training of health professionals must be aligned with the health needs of the country. Health facility inefficiencies are often due to a combination of possible reasons and factors so my Article usually targeted to or focused in The health systems mainly lack the proper health governing system, and lack of Trained Health workers that cover the gap and deliver the services needed, due to lack or in sufficient six Health building blocks Which World Health Organization recognizes and they are the following points. A Health Financing B leadership and Governance C Health informatics D Services Delivery. E Health work force or Human resource for health F Drug supply, Technology and infrastructure. The gap of this above main health systems pillars will directly related to health facility in efficiency that result low productivity, and low patient demand . Diagram .Global Health Distance learning Diagram.

John Hopkins School of Public Health. Inefficient organization of services or work processes: Poor organization can contribute to health facility inefficiencies because health workers and managers do not optimize resources. Tasks may take longer to complete or may be organized in overly complex processes, or materials may be unnecessarily wasted. Signs of poor organization include long patient waiting times, inadequate or inappropriate staff scheduling, lack of health worker accountability, and poor management. Poor organization can lead to a need for more resources to attend to a given number of patients or can lower patient demand due to a perception of poor quality. Either way, productivity is reduced. Insufficient equipment, supplies, or infrastructure: When other health systems inputs are inadequate, it can compromise health workers’ ability to deliver services.

Missing or broken medical equipment, supply or drug stockouts, or lack of water/electricity/utilities may prevent health facilities from providing their usual services, even with adequate staffing. This typically leads to fewer patients and hence reduced productivity. Poor time management: Related to poor organization, a health team may spend its time inefficiently to produce desired outputs. Poor time management could result in a facility’s need for additional staff to maintain the desired level of service delivery outputs. Inadequate staffing: Inefficiency may arise when the facility is staffed with health workers who are not qualified or experienced. The ratios of health workers to patients and the ratio of health workers to supervisors affect staff workloads and service outputs. If there is not adequate staffing, not only in terms of numbers but also type and skill mix, then inefficient provision or poor quality of services may result if less-qualified or -experienced staff members have to perform the job instead. Low health worker motivation/know-do gap: The know-do gap refers to the difference between what trained health workers know to do and what they actually do on the job. Not performing their tasks to the best of their ability often results from a lack of motivation. Low motivation can have many causes, including inadequate remuneration, poor working conditions, high workload, and lack of accountability. If health workers are present but are not motivated or engaged to do their jobs effectively and efficiently (i.e., in a timely manner), then they may not produce adequate output levels. Health worker inefficiency may also relate to time management. When a health facility has inefficient service provision, the communities seeking care at that facility may become discouraged and stop seeking services. As a result, a common secondary effect of health facility inefficiencies is the reduction in patient demand for services. As described earlier, the problems of health workforce productivity are often intertwined. In security / Disease outbreaks and famine: as common in some countries around the world in security is common which delays that communities or clients to seek health care because of their safety, similar incidents occur in West Africa when Ebola outbreak tragedy happens , some of the communities and health care professionals did not go to their health clinic due to stigma and discrimination for Ebola Taboo and myth which was not really right and lack of health promotion measures , traditional and cultural beliefs hence reduce productivity . Dr : Essa A Djama M International Health, Mph Candidate Post Conflict countries Health systems expert And Researcher Global Unification International Advisory commissioner Member Pan African Youth Leadership forum. Humanitarian Activist Somaliland Republic

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