The Zanzibar Chief Nursing Officer, Mr Othman Mussa Haji, recently said that the number of nurses in Zanzibar is still very low and needs to be tripled if health services are to improve. He said that Zanzibar has only 1,200 nurses and midwives, for every 30 to 40 births at Mnazi- Mmoja hospital only to attend to each birth.
“There is a critical shortage of nurses and midwives have resulted in complaints from patients particularly when many emergency cases occur simultaneously,” said Othman, who is also the head of Zanzibar Nurses and Midwives Council (ZNMC). He said that the minimum desired ratio is one nurse to six patients, while in Zanzibar it is one to fifty.” This is overwhelming to nurses in the islands where the population is now above a million.”
Othman informed the ‘Daily News’ that nurses and midwives in Zanzibar face many challenges; their welfare and working environment has not been good. “We have many problems and health workers need to be motivated. We have been asking for uniforms for the past 15 years with authorities turning a deaf ear. A uniform costs between 35,000/- to 50,000/- each. “We are not given risk allowances, no telephone allowances, and no responsibility allowances for heads of departments.
It is discouraging and we are asking the government to consider our plight,” he said. A nurse at Mnazi-Mmoja hospital, who requested anonymity, complained: “As we marked World Midwives on May 5 and Nursing Day to be marked on May 12, only two nurses serve the maternity ward each shift. Spare a thought of how hard it is attending to a whole ward of screaming mothers,” she said.
The nurse lamented there is a need to improve staff welfare and working environment in the health sector. The ZNMC Registrar, Mr Haji Khamis, has appealed to the government to lay more emphasis on improving the health sector. Many health workers blame Zanzibar authorities for not doing enough to improve the health sector. A doctor at Kivunge Hospital said: “The poor health system results in avoidable deaths and diseases.”
The World Health Organization (WHO) says that reasons for the shortage of health workers vary country to country, but the common reasons include brain-drain, poor economic policy, low prioritization of health workers and a broken down health system. Brain drain, or the emigration of trained and talented individuals to other nations and also a shift to other professions, is a major complex issue sometimes linked to policy failures.
It is said that poor economic policies are a major driver of brain drain. But, some international economic institutions such as the International Monetary Fund (IMF) are blamed for forcing poor nations to adopt policies that ‘dismantle’ public heath systems and prevent development of new infrastructure. Academicians argue that international institutions impose policies that insist on a public sector ceiling that prevents countries from hiring the required number health workers or paying them enough to retain them.
The lack of sufficient medical supplies and technology, drives some health workers to leave the country for greener pastures. Some governments pump a lot of money into other sectors failing to adequately fund the health sector. The Zanzibar Minister for Health, Mr Juma Duni Haji, has on several occasions admitted that many qualified nurses, midwives, and doctors leave Zanzibar for Tanzania mainland and overseas in search of greener pastures.
“The government is sparing no effort to train more health workers in a bid to come closer to the achievement of the 2015 Millennium Development Goals (MDGs) for the health sector. But we may not achieve our target because of the brain drain,” said Haji, who also blames lack of patriotism for the problem. He said that nurses and midwives are trained at the Zanzibar College of Health Sciences, and in Tanzania mainland, “but those who graduate move to private hospitals and graduates from colleges in the Tanzania mainland opt to remain there.”
For example, out of eight Zanzibar university students who graduated in Tanzania mainland last year, two decided not to return to Zanzibar. The minister also mentioned that about 20 nurses recently abandoned their workplaces in Pemba. “We are still faced with brain drain. We employed many nurses and assistant medical doctors to work in Pemba last year, but some have left,” Haji said before attributing the exodus of health workers from Pemba to inadequate and substandard staff houses.
The minister said that despite economic challenges facing the government, his ministry has been working hard to improve the welfare of the medical personnel, improve hospitals and purchase modern equipment. But, he said, in an effort to control brain drain alongside improving better pay, “The government will soon come up with a policy requiring all graduates under government sponsorship, to serve the public for a set down minimum period.”
He said the government has no plans to build new hospitals, but will focus on improving the existing hospitals, and the welfare of the medical staff. “We need to improve our hospitals by equipping them, employing skilled workers and upgrading health centres, before thinking of building new ones. We are still faced with many challenges including critical shortage of workers capable of even interpreting X-ray films/images,” the minister says. For example, there is only one health worker who can read X-ray images in Pemba.