The shortage of human resources (HR) in the health sector is common in many sub-Saharan
African countries (U.S. Agency for International Development [USAID], 2003). The number of
trained health care providers has historically been inadequate, but in recent years many countries have
suffered from scarcities of almost all cadres of health workers. Production of health workers has not
kept pace with needs, especially with the ever-increasing burden of diseases brought about by
HIV/AIDS and resurgent epidemics.
Challenges to health sector HR often reflect political, social, and economic problems within
countries (World Health Organization [WHO], 2005). Since 2002, the situation surrounding health
sector HR in Côte d’Ivoire has reached crisis proportions due to civil war (USAID, 2003). The overall
functioning of health services has been severely affected, resulting in the population having only
limited access to health care, particularly in conflict zones (Joint United Nations Programs on AIDS,
2004). According to WHO’s Health Action in Crisis Report in November 2004, 70 percent of health
facilities across the country are not functioning. The majority of medical staff have relocated or fled,
or are unable to go to work due to lack of security. Public health programs, including immunization,
have been halted, and essential drugs are out of stock in many locations. Furthermore, the health
surveillance system across the country is very weak. All those factors contribute to increasing the risk
of communicable diseases (WHO, 2004).
Côte d’Ivoire faces three main challenges to expanding HR for health. First, it is very complex to
estimate the total number of health workers needed to deliver HIV/AIDS and other basic health
services without a comprehensive methodology. Currently, directors of regional health offices
identify HR requirements in an empirical way. The Department of Human Resources of the Ministry
of Health and Population/Ministère de la Santé et de la Population (MOH) consolidates these
regional requirements into national ones and transmits them to the Ministry of Civil Service. Even
though the country has good ratios of health personnel to the total population compared to other West
African countries, data show that the health system requires additional health workers to effectively
deliver needed health services. These HR requirements have increased with the expansion of
HIV/AIDS programs and the resurgence of other diseases due to the civil conflict.
Second, due to declining socio-economic conditions and structural adjustment measures
recommended by the International Monetary Fund (IMF)/World Bank, the Ministry of Civil Service
in collaboration with the Ministry of Finance has restricted recruitment of civil servants since 1996.
This has resulted in an imbalance between the number of health workers currently employed and the
number needed by the MOH, as shown by 2001 and 2004 data. On average, the actual number of
health workers hired during this period represents only 40 percent of the expressed need.
Third, the civil service entrance examination, introduced in 1996 to serve as “gate keeper” to the
civil service in response to public sector budgetary constraints, impedes absorption of trained health
workers into the public health sector. Even though the MOH Department of Human Resources
identifies real needs, a considerable number of doctors fail to enter the public sector.