Staffing the public health sector in Sierra Leone, 2005‐11: findings from routine data analysis

September 2014

Authors: Haja Wurie, Mohamed H Samai and Sophie Witter

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This report forms part of a multi‐country ReBUILD study on the evolution of health worker incentives in post‐conflict settings. It is based on the analysis of routine human resources data from Sierra Leone from 2005 to 2011. As the data includes the period of the introduction of the Free Health Care Initiative in Sierra Leone, it allows us to draw some preliminary conclusions about its apparent effects on staffing levels, number of posts filled, attendance, attrition, density to population changes and health worker outputs. The validity of these conclusions is dependent on the completeness and robustness of the secondary data.

The data shows an increase in the staffing numbers of health workers in the period running up to and accelerating in the FHCI implementation year. Cadres of health workers that were key to the effective implementation of the FHCI saw an increase in staffing numbers and a reduction in attrition. This implies that the rapid recruitment and salary increase had a positive impact on retention. The analysis of staff to population ratios showed a two fold increase in the number of health professionals in 2010 compared to 2009. Health care activity data from Koinadugu district, a hard to reach rural area, also showed improvements in the post‐  FHCI phase in comparison to the pre‐FHCI phase. However, there was no accompanying increase in number of health workers, compared to that reported for the urban Western Area.    This confirms regional disparities in the distribution of the human resource available for health.   Increases in MCH outputs in Koinadugu district, with no changes to staffing, resulted in an apparent increase in productivity, especially for institutional deliveries and antenatal consultations. Despite a relative reduction in 2011, the output per health worker was higher post‐FHCI than before for both general services and maternal health care.

The overall national attrition rate for health workers fell from 5‐6% at the start of the period to 3‐4% at the end.    This was highly variable between cadres, with higher cadres more likely to leave the service. A number of senior positions, such as registrars, remained unfilled, and absolute numbers of staff remained low for a number of key cadres, including midwives.

The data showed improvements in the national level of absenteeism after the implementation of the Staff Sanction Framework and its accompanying attendance monitoring tool. National levels of absenteeism reduced to 1.1% in February 2014 from 12.5% in December 2010, if reporting of absenteeism remains robust.

These findings show some achievements of MOHS and other stakeholders, as well as the outstanding challenges. These challenges include continuing to fill essential positions, ensuring an even distribution of staff across the districts, maintaining a strong downward pressure on absenteeism, and further reducing attrition. These, combined with further actions to stimulate demand for and access to health care, are essential to improving the health system and health outcomes in Sierra Leone.

Read the full report: Staffing the public health sector in Sierra Leone, 2005‐11: findings from routine data analysis