Shortage of public sector health workers : a case study undertaken at a selected hospital in Windhoek, Namibia

Abstract

This mini-thesis was proposed to investigate the shortage of public sector health workers through a case study conducted at a selected hospital in Windhoek, Namibia. The study triggered by the media’s (print and audio-visual) outcry that the public has been receiving insufficient and inadequate health care services at state clinics, hospitals and health care centres. The criticisms persisted over the years after Namibia gained independence that healthcare services delivery is inefficient in its quality due to the shortage of health workers in public hospitals. This accusation was probed to establish whether the public outcry could be substantiated. This study was conducted using a qualitative inductive approach to accept the study’s outcome and to allow the investigation of the causes and effects of the shortages of health workers in the Katutura Intermediate State Hospital (KISH) in Windhoek, Namibia. This approach allowed the research questions to be answered and the research problem to be dissected. The study’s participants were drawn from all the key directorates and divisions responsible for delivering health care services in the Katutura Intermediate State Hospital (KISH). This study employed a descriptive design to organise data into patterns and themes that arose during data analysis. The data-gathering techniques employed in this study were individual and focus group interviews. The philosophical assumptions of this research study are epistemology, ontology and axiology. The study employed the epistemology interpretivist philosophy because of the nature, validity and scope of the knowledge required to establish an understanding of the causes and effects of the shortage of health workers in the Katutura Intermediate State Hospital (KISH). The study sought to deduce the justifiable beliefs and opinions of the participants. The idea was to discover the participants’ knowledge of possible remedial measures that could be employed in combating the shortage of health workers. In simple terms, the study aimed to employ interpretivist epistemology to gain an overview of the real situation by engaging in a holistic examination of the shortage of health workers at the KISH. The study found that the KISH faces a dire shortage of health workers, especially in specialised disciplines, such as doctors and nurses. It was established during the interviews that the highly specialised health workers in the hospital, such as acute-care doctors, anaesthetists, cardiologists, internal medicine doctors, paediatricians, surgeons and urologists, are non-Namibians. Namibia's number of health workers is insufficient to sustain both the public and private health sectors. Most specialists’ positions in the hospital’s organizational structures have been vacant for many years because the Namibian labour market does not have the required skills, and the local institutions of higher learning in the country do not train specialised doctors and nurses. Namibia’s sole medical school trains only general practitioners, many of whom are not Namibians; thus, there are insufficient specialists to suppress the shortage. This study established that the Health Ministry is struggling to attract health workers from the private sector because of its low remuneration, poor employment conditions and working conditions. It was found that the staff loss through issues such as retirement, demise, resignation, medical boarding and discharge due to misconduct contributes to the deficiency of health workers in Namibia. The poor retention policy is also one of the contributing factors because the KISH cannot constrain health workers due to gaps in Namibian Health Ministry’s policy. The study revealed that the ratio of nurse/doctor to patient is excessive compared to the standard ratio of the World Health Organisation and that this shortage resulted in overwork and burnout among the health workers, which led to poor health care service delivery. It is recommended that the Namibian Health Ministry should increase its training budget to enable more people to study medicine-related fields. It is also recommended that the said ministry should strengthen its retention policy by stipulating the employment conditions for health workers whose studies are/were funded by the MoHSS. Furthermore, the study recommended that the Government of the Republic of Namibia should offer attractive remuneration packages to health workers and improve their working conditions as a retention incentive. Lastly, the study proposed the model that should assist the MoHSS to develop medical-related skills within the country.