Women make up 70% of the global health workforce, but only 25% of global health leadership. That is primarily because midwives and nurses make up nearly 50% of the entire global health workforce, and midwives and nurses are over 90% women. Yet only 13% of CEOs in the global healthcare workforce are women. It is said that unlike other sectors, healthcare does not have a “woman problem,” rather, it has a “women in leadership” problem.
At the same time, there is a global shortage of health workers, in particular nurses and midwives, who represent more than 50% of the current shortage in health workers. And as Africa’s most populous country, Nigeria has one of the largest stocks of human resources to employ in healthcare, but it does not have enough people—women or men—working in the healthcare sector to support its population. At 1.95 per 1,000 people, Nigeria’s density of nurses, midwives and doctors is too low to deliver essential health services, which ultimately contributes to the abysmal state of its healthcare system. With the impact of coronavirus bringing global health systems to a halt, the prolonged lack of investment and systemic issues in Nigeria have compounded its vulnerabilities. This scenario makes the African continent susceptible to becoming the new epicentre of the disease.
One way I’m working on supporting confident girls is through my organisation Wellbeing for Women Africa, which amplifies the voices of young African girls, by paying a global network of Youth Partners (currently we have 63 YPs from 18 countries) microgrants to write about their perspectives on the most pressing social issues of our time. For instance one YP recently released a study called Wa Wimbi, which demonstrated evidence that regardless of the sector, women continue to face discrimination and they are unable to progress due to gender barriers. The organisation aims to give young women a platform and in that way, a seat at the decision making table to ultimately allow them control over their own future. Because we know that girls’ learned lack of confidence is a barrier to their success later in life, ensuring that girls understand that their voice is important, their viewpoints are valid and that their perspective is not just interesting but worthy of remuneration, is one small way in which we can build a pipeline of women leaders.
At the same time, there is an endless need for leaders in the public and private sectors to come together to figure out solutions for better recognition, regulation, respect and remuneration for health care workers in Nigeria in the interest of building that pipeline of healthcare workers in the country. My advocacy on this issue goes from strength to strength as Inaugural Goodwill Ambassador for the International Confederation of Midwives, to my membership of the Concordia Leadership Council, and it’s not an issue that is easily solvable or that can be explained with pithy phrases. It’s going to take international collaboration and years of governmental support to create a resilient system that can hold up over generations. One successful approach to increasing the number of midwives in our country was the Midwifery Service Scheme, established with the help of my Wellbeing Foundation Africa, which mobilizes unemployed and retired but able midwives and newly qualified graduates from Nigerian Schools of Midwifery to rural communities for one year of community service. As I recently noted, best practices identified under the scheme need to be reactivated and consolidated nationally.
Within the Wellbeing Foundation Africa, we have seen, recorded and measured the value and sustained impact of placing a highly skilled midwifery workforce at the front, centre and heart of our communities-focused cradle-to-age programming, as coaches, educators, interlocutors, advocates and leaders, as the delivery centrifuge of our unique yet seemingly simple MamaCare Antenatal and Postnatal, SRHR, Nutrition, SGBV PSHE and WASH programs – and the results are crystal clear. Activating, actioning and tracking accurate information regularly through respectful and compassionate compassionate multi-directional conversations engender transformational social behavioural change and trusted learning, which together with deploying data for good, embeds key resilience into our community of best practice, improving the quality of care and lives.
The fact remains that we must attract, employ, retain, remunerate and support healthcare workers by giving a powerful leadership path incentive: healthcare in Nigeria must be made a good career choice. A recent Institute of Economic Affairs report makes the case that Nigeria could do more to partner with high-income countries to secure investment, and do more to attract global investors and international financial institutions to finance their healthcare systems. For healthcare workers to want to stay in Nigeria, they must be supported by better working conditions, training, equipment, and insurance related to workplace risks, and remuneration.
Another way I’m working on this is by ensuring healthcare workers are properly trained. My Emergency Obstetric and Newborn Care Training Programme, or EmONC, is a ground-breaking partnership between the Wellbeing Foundation Africa, Johnson & Johnson and the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine. The partnership focuses on EmONC training in healthcare facilities to improve health outcomes for mothers and their newborns, and it has seen 80% of all maternal deaths result from five complications which can be readily treated by qualified and trained health professionals. EmONC training is so successful because it takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome these obstetric emergencies, in an accelerated knowledge pathway from research bench to bedsides at the multi-tiered facilities most in need. The results again are clear, the state in which we have pioneered this training and achieved program saturation has the enviable status of the lowest preventable maternal and child deaths in the nation, informing my advocacy insistence of a push into the national health strategy, at scale.
At the same time, the Institute of Economic Affairs’ report states that “African countries spend more on paying interests on external debts rather than on public healthcare.” It’s a fact that needs to change, and it can change only by way of leadership from the state and local governments, by ensuring our systems can properly fixate systems underpinned by rightly targeted budgetary planning and fiscal appropriations that invest public funds equitably back into the health of our own people to deliver accessible, affordable health care.