Unemployed, unpaid health workers in Africa: governance, accountability and the informalisation of health systems in Nigeria, Uganda and Sierra Leone

In many African countries, an ongoing shortage of health workers is occurring alongside a rise in the numbers of unemployed nurses, midwives, doctors, pharmacists and allied professionals. Their labour is critical to the effective functioning of health systems (including the achievement of Universal Health Coverage), but it is not being absorbed in the formal system as governments do not have the fiscal space for, or do not prioritise, their recruitment. This paradoxical surplus of health workers stems from and leads to a number of governance and accountability challenges. In this panel we discuss these challenges from a number of perspectives, exploring how labour and expertise is being informally incorporated into health systems as unpaid volunteers in public facilities (Charles and Ellen) and medicine sellers working in shops and markets (Jen and Eleanor).

Panelists:

Eleanor Hutchinson is an Associate Professor in Anthropology and Public Health at LSHTM. Her work on informal patterns of practice and relations in health systems has developed into a critical concern with governance: whose rules matter and dominate in particular settings, which forms of rule breaking matter most and what drives them. She draws on anti-corruption theory and is interested in how public health can learn from theory and practice within International Development more broadly.

Pieternella Pieterse is a researcher at the School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland. She is the Principal Investigator of a four-year Irish Research Council funded study into "The impact of unsalaried health workers in Sierra Leone on public healthcare delivery". Her research focuses on accountability and access to basic public services, and she works mainly on public health and health systems related issues.

Jennifer Palmer is an anthropologist at the London School of Hygiene & Tropical Medicine. Her works examineshow armed conflict and humanitarian aid shapes disease experiences and engagement with health services by forcibly displaced populations, including the mediating role of conflict-affected healthcare workers. Her work in Uganda is a collaboration with refugee-led organisations, Youth Social Advocacy Team (YSAT) and SSWBA (South Sudanese Women Building Association), and focuses on the lives of refugee health workers from South Sudan seeking livelihoods within and outside the government-led humanitarian response.

Charles Orjiakor is a clinical psychologist with interest in rule breaking/antisocial behaviors. He is also a health systems researcher with the Health Policy Research Group in the University of Nigeria, Enugu. He has been involved in several projects exploring rule breaking and wider health systems corruption with specific focus on health worker absenteeism and procurement corruption. Charles is currently a postdoctoral fellow in the University of Toronto, Canada.

Discussant:

Suzanne Kiwanuka is an Associate Professor and Head of Health Policy Planning and Management Department at Makerere University School of Public Health (Kampala, Uganda) with a passion and vast experience in health systems strengthening and evidence based policy making through strengthening of implementation research and production of evidence products including policy briefs, newspaper articles and position papers.

Chair:

Dina Balabanova is a Professor of Health Systems and Policy in the Department of Global Health and Development at LSHTM and an Adjunct Professor at Njala University, Sierra Leone, with over 25 years of experience in health systems and policy research in low- and middle-income countries (LMICs). Her main expertise is in health systems governance and anti-corruption, effective delivery models and health systems strengthening.

About the TWG AAA

The Thematic Working Group on Action on Accountability and Anti-corruption for SDGs (TWG AAA) is dedicated to exploring and addressing the root causes of weak accountability and corruption in health systems, with a particular focus on the systemic structures that allow these challenges to persist. The group champions effective governance as a cornerstone for sustainable development and the realization of the Sustainable Development Goals (SDGs), especially Universal Health Coverage (UHC).

Find out more about their work and how to join the group on the dedicated TWG AAA page.