The Need

Critical shortages of health care workers exist throughout much of sub-Saharan Africa. In 2006, the World Health Organization reported that the region accounted for 3% of the world’s total health workforce despite being home to 25% of the global disease burden.

Nurses and midwives are the gateway to health care in most communities and provide 90% of care in many African countries. In areas with a shortage of physicians, nurses have helped increase access to lifesaving care, including antiretroviral treatment for HIV. Despite practicing with an expanded scope of services, nurses are often unprepared and under-trained for the clinical realities they face.

Long-standing underinvestment in pre-service nursing and midwifery education has limited the capacity of many African nursing education institutions and clinical services to educate nurses and midwives in sufficient numbers and with the appropriate clinical skills to meet current and anticipated population-level health needs. 

Competent, well-trained, and skilled nurses improve health care quality for all. Sustainable health care systems depend on building the capacity of nurses and midwives to meet the demands of the people they serve.

Nursing Needs in NEPI Focus Countries

Lesotho
Lesotho has the third highest prevalence of HIV/AIDS in the world, at 23% of the adult population.The ratio of nurses and midwives in Lesotho has decreased from 1.07 per 1,000 people in the mid-1990s to 0.49 per 1,000 in 2011, significantly affecting the country’s ability to meet the complex health needs of its population.

Malawi
Nurses and midwives constitute 87% of the health workforce in Malawi, often serving as the sole health provider in rural settings. The vacancy rate for nursing and midwifery positions in the public sector is 65%. Lacking adequate training, many nurses and midwives are ill equipped to function optimally as the sole service provider.

Zambia
Nurses and midwives constitute 63% of Zambia’s healthcare workforce and are the highest skilled clinical worker in almost half the country’s public health facilities. In spite of recent growth in the nursing workforce, Zambia is currently operating at 47% of its nurse/midwife target, with an anticipated nurse/midwife gap of 20% by 2020.

Ethiopia
Constituting 32% of Ethiopia’s health workforce, nurses and midwives are the second largest category of health workers in the country. The country’s nurses and midwives are unequally distributed between urban and rural areas, with a density of 1.6 nurses per 1,000 people in urban areas and 0.3 per 1,000 in rural areas.

Democratic Republic of Congo
DRC is experiencing a critical shortage of health care workers and has made few gains in reducing child mortality or new HIV infections. Nurses and midwives constitute 55% of the country’s health workforce, with a density of 0.59 per 1,000 people.

South Africa
Nurses and midwives are the largest group of health care workers in South Africa, significantly outnumbering physicians. However, there is a lack of retention of health graduates in the country’s public health sector and high attrition from key health professions.