Which countries are still ‘in crisis’?

Which countries are still in crisis_South Sudan 1

Mother Nyayalny holds her son Duolduet, six months while they wait for a clinical officer at the Primary Health Care Center in Pagak, South Sudan to prepare his vaccinations.
Credit: Colin Crowley/Save the Children

Analysis for the 2006 World Health Report identified 57 countries that were considered to have a severe health worker crisis. All countries in this category had less than 22.8 skilled health professionals per 10,000 population and less than 80% coverage rate for deliveries by skilled birth attendants (an indicator of low health service coverage).

What is a skilled birth attendant?
The WHO defines an SBA as an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.

GHWA’s new report reviewed trends in these 57 countries to determine which have remained in the crisis category. The report found that:

  • For 3 of the 57 countries (Comoros, Equatorial Guinea, and Eritrea) there is no recent data on SBA coverage data, so they have been excluded from the count;
  • For the remaining 54 countries, six (Benin, Congo, Democratic Republic of Congo, El Salvador, Iraq, Peru) indicate that SBA coverage has increased above 80% in 2011 and thus they exit the grouping of low HRH density/low service coverage;
  • 6 countries (Bolivia, Cape Verde, Guatemala, Solomon Islands, Timor-Leste, Vanuatu) however now indicate that SBA coverage has dropped below 80% and thus they enter this category of low HRH density/low service coverage.

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There is therefore a change in the list of ‘crisis’ countries but this is due exclusively to changes in SBA coverage, rather than due to increases in the number or density of doctors, nurses and midwives.

Most of the countries originally classified as having an HRH crisis have however seen improvements in health service utilisation, coverage and population health outcomes, including reductions in child mortality . Further research is needed to better understand how countries have achieved progress in spite of relatively low density levels of doctors, nurses and midwives. In some instances improvements in productivity and the growth of other categories of health workers, working within and close to communities, may have been critical factors.