By Eddie Miaway Farngalo, MPH, RN, BSN
Many nurses who are assigned in leeward counties like those in the southeast and other remote areas do that at their own risk and incentives. The Ministry of Health has no incentives to equitably commensurate with the sacrifices they are making to save lives in “hard-to reach” areas, often where they are the only reliable health practitioners. As such, the turnover rate of staff in those areas has drastically increased as well as the burnout rate. Consequently, frustrated health workers are looking for greener pastures in other field of studies.
Nurses/midlevel health care workers assigned in hard to reach areas are losing/ have lost their relationships (husband or wife), educational opportunities, recreational centers in many cases, relatively decent living areas and worse of all – have been paid very low government incentives that are not sustainable and disproportional to money spent on acquiring such degrees or certificates.
“We leave our families in Monrovia and go to rural areas where social services are not available, and incentives provided cannot sustain the two homes that we have to support due to the job – one in Monrovia one here…you work a whole year and you will not recoup the money spent in school.”
Responding, why some nurses do not leave due to the hardship? Some respondents perceived that they are using the health facility/centers as transit points for better jobs and due to lack of job opportunities:
“I am working right now in the hospital because I do not have job. But when opportunity comes, I will leave immediately. ”
“I am working here because I am desperately in need of a job for me to sustain my family, but I will leave anytime I get something better to do.”
What disturbs me as a health care worker with practical field experience and other colleagues are the “deaf ears” and threatening remarks usually made by policymakers and authorities regardless of their employees’ welfares. In February 2014, health care workers’ request for a safe working environment and increase incentives during the peak of the Ebola outbreak was approached ironically by threats. The then Health Minister, Dr. Walter T. Gwenigale dismissed heads of the health workers association (Joseph Tamba and George Williams) who decided to make their plight known through strike action. Regardless of the Senate committee on Health and Gender’s mandate to reinstate the dismissed health workers, he openly confirmed his decision as stating: “They will never be reinstated as long as I remain the Minister of Health and Social Welfare” (Focus.com.lr) while threatening to replace them (striking health workers) with additional group if it (strike) continues (FrontPage Africa). Till date, those health care workers remain dismissed.
Furthermore, in Liberia, nurses/midlevel health care workers who get assigned in rural Liberia often stay there for years without being rotated, and delay in getting on government’s payroll regardless of the distances they are assigned. Worse, the relatively little incentives cannot come on time. This has mired their educational advancement while undermining their passion for the field. Some who refused to be held back because of advancement have been removed from government’s incentives by hospital administrations. Nurses who served for more than 5 years are even victims.
These factors according to respondents have led to exodus of nurses/midlevel health workers.
Low incentive and work environment, like no equipment, work overload, and nurses not being too passionate about the field has made people to move to other fields that pay at least well.
“We thought coming in the rural areas to work will help us get on government payroll but it is not so. Then, the little amount they have to give you as incentive is not forthcoming…how do they expect us to sustain ourselves while we work?”
Some nurses ascertained that supervisory roles assigned to some individuals in health facilities and districts and amenities provided for doctors who are believed to be relaxed than nurses are some underlying factors.
“You are working in a facility where you have been supervised by someone who you are more qualified than…like for example, someone with an associate degree supervising me that have Bachelor of Science degree in Nursing (BSN)…even some District Health Officers are do not even have BSc but still they are supervising people that are more educated… what do you expect?
“We do the dirty work like prescriptions and treatment of patients but doctors are given better houses or facilities that nurses don’t have…we are here renting house from the small incentives that are not even paid on time and sometimes we will have to beg our landlords not to put us outside because we owe them rent. But doctors who are making more than us are given house where they are not paying rent.”
The Ministry of Health needs to be appreciated for operating nursing schools, but must this be the only solution to the shortages of health workers in the country? Categorically No!
Let me make my side very clear, I am not against the proliferation of free nursing schools across the country, but I will highly appreciate if the work force can be retained in a holistic way. Moreover, most of our health facilities are under staffed. Nurses/midlevel heath care workers are career individuals like any other professions, and their welfares need to be taken into higher consideration.
Nurses/midlevel health care workers who seek assignments in hard to reach areas do this because of the Nightingale’s pledge and for the sole purpose of contributing to government’s responsibility of providing quality health care to its citizens, which is their fundamental human right.
To reduce the high rate of turnover (resignation) and migration of nurses/midlevel to other part of the world and sectors, the MOH and its partners need to be cognizant of motivational packages (financials or otherwise), make public the study leave policy, rotate staff after some period of services in a particular region or county, revisit incentives provided, provide staff quarters for health care workers across the country while providing a robust performance based/service scholarship scheme.
Finally, these issues if not taken care of will be like the government is fishing with nets that have holes. Meaning, the shortages of nurses/midlevel health worker will continue to exist regardless of the symbolic nurses graduations around town. This is because registered nurses/midlevel health workers will continue to leave their profession for another that seems to be relatively flexible, financially stable and career rewarding.
The Author: Eddie Miaway Farngalo is the Head of the Research Department at the Center for Liberia’s Future which is currently conducting a national study on community perceptions about Ebola and the reintegration of Ebola survivors, orphans and caregivers. Contacts: +231886484351/+231777590035: email address: [email protected]