Health workforce development and retention in Guinea: a policy analysis post-Ebola

Abstract

Background: The state of the Guinean health workforce is one of the country's bottlenecks in advancing health outcomes. The impact of the 2014-2015 Ebola virus disease outbreak and resulting international attention has provided a policy window to invest in the workforce and reform the health system. This research constitutes a baseline study on the health workforce situation, professional education, and retention policies in Guinea. The study was conducted to inform capacity development as part of a scientific collaboration between Belgian and Guinean health institutes aiming to strengthen public health systems and health workforce development. It provides initial recommendations to the Guinean government and key actors.

Methodology: The conceptual framework for this study is inspired by Gilson and Walt's health policy triangle. The research consists of a mixed-methods approach with documents and data collected at the national, regional, and district levels between October 2016 and March 2017. Interviews were conducted with 57 resource persons from the Ministry of Health, other ministries, district health authorities, health centers and hospitals, health training institutions, health workers, community leaders, NGO representatives, and development partners. Quantitative data included figures obtained from seven health professionals' schools in each administrative region of Guinea. A quantitative analysis was conducted to determine the professional graduate trends by year and type of personnel. This provided for a picture of the pool of professional graduates available in the regions in relation to the actual employment possibilities in rural areas. The districts of Forecariah and Yomou were chosen as the main study sites.

Results: Limited recruitment and a relative overproduction of medical doctors and nurse assistants have led to unemployment of health personnel. There was a mismatch between the number of civil servants administratively deployed and those actually present at their health posts. Participants argued for decentralization of health workforce management and financing. Collaboration between government actors and development partners is required to anticipate problems with the policy implementation of new health workers' deployment in rural areas. Further privatization of health education has to meet health needs and labor market dynamics.

Keywords: Decentralization; Ebola virus disease; Health systems reform; Health workforce finance; Health workforce retention; Human Resources for Health Governance.

Fig. 1

Evolution of HRH policy in Guinea post-Ebola

Fig. 2

Geographic distribution of health training institutions in Guinea, April 2017

Fig. 3

Distribution of graduates from 2010 to 2015 by staff category. Hierarchy A applies to physicians, dentists, and pharmacists. They have A-level exam + 6 years (physicians) or 5 years of training. Hierarchy B is composed of nurses, midwives, laboratory technicians, public health technicians, and social assistants. They all have A-level exam + 3 years of training. Hierarchy C is composed of nurse assistants (ATS). They have O-level exam + 3 years of training

Fig. 4

Distribution of graduates from 2010 to 2015 by type of institution (private or public)