A STUDY OF SOME ASPECTS OF HEALTH MANPOWER ON NIGERIA: THE SUPPLY OF NURSES

Abstract

The purpose of this study is to examine the development of some aspects of health manpower in Nigeria. The central theme of the thesis is the supply of nurses. The study objective is to identify and examine the factors which determine and affect supply of nurses in Nigeria. Major problem facing the nurse training institutions which are the main source of supply are examined. Other factors relating to distribution, service conditions and attrition are also examined. According to the World Bank Report 1983, Nigeria has a nurse population ratio of 1:3080. But when questionnaires were sent to the 19 States' Ministries of Health and the Teaching Hospitals that employ and utilize over 75 per cent of all the nurses throughout the Federation, the data from the eleven states and six Teaching Hospitals who responded showed that the nurses in active nursing practice in Nigeria were actually less than half of the number in the register, usually used for planning purposes. At 2.5 percent growth rate the present population of Nigeria will rise to 141.9 minion people by the year 2000 while at 3.2 per cent it will be 155 millions. The population of the three groups of high users of health services (that is, population under 15 years of age,women in the child bearing age of 15-44 years and the older citizens of 65 years and above) alone will reach 100.7 million people by the year 2000 at 2.5 per cent growth rate and 110.1 million at 3.2 per cent growth rate. These rapid increases in the population of high users will create a demand higher than can be met by the present rate of supply. The instrument to assess the implications of rapid development in health technology for nurses' supply focused on the growth in the number of specialist institutions and social welfare services between 1963 and 1986 in response to an increase, in the number of persons requiring specialist care such as the blind, deaf and dumb, the aged, the crippled, the mentally ill, children under 15 years of age, women in child bearing age and people with chronic conditions . Three separate instruments were designed for the training institutions. There was one for the prospective applicants totaling 1,890, one for those currently in training totaling 849 and one for the trainers and the administrators with a total of 62. Another instrument was administered on serving nurses in randomly selected hospitals in Ibadan and those who have left the service to determine the reasons for the high rate of exodus of experienced, nurses. The study shows that rapid development in health technology has implications for nurses supply. In 1963, there were only 4 psychiatric hospitals, 4 tuberculosis hospitals, 18 leprosaria and only 1 teaching hospitals. By 1986 the psychiatric hospitals had increased to 13, tuberculosis hospitals increased to 7, teaching hospitals increased to 12 and leprosaria increased to 41. In addition, Orthopaedic, Ophthalmic, Prisons, Armed Forces and Children Hospitals that were not available in 1963 had by 1986 been established in many parts of the country. More and more nurses are needed to provide nursing services in those institutions. Among the factors that affect the supply of Nurses were increased training period and increase in training costs. Nurses now spend longer periods in training institutions for the post basic education and to specialise in one or more areas of the fourteen specialties now available for nurses in Nigeria. In addition, more and more nurses now pay for their basic nursing education and many post basic such as the tutors' programme in U.C.H. Ibadan, the nurse anaesthetists’ programme in the University of Nigeria Teaching Hospital Enugu and the nurse administrators' programme at Benin now abase between N1,500 and N3,000 for various post basic courses. The increased training periods and increase in the training costs coupled with some new regulations by the Council have resulted in the gradual decline in the admission of students into basic and post basic training institution, for example in Oyo State between 1980 and 1986. As to the reasons for the high percentage of nurses leaving the profession prematurely, there was a 24.8 per cent attrition of nurses in randomly selected hospital in Ibadan. At the University College Hospital Ibadan, where more accurate(s) records were available, the attrition rate was 30.65 per cent, which is 5.85 per cent higher than the attrition rate obtained in randomly selected hospitals in Ibadan. The rate at U.C.H. was found to be similar to the rate obtained in America, (ANA 1966) and in Britain, (Moore et al. 1982.). One of the most important issues in estimating supply of nurses is the determination of the exact number of nurses in active nursing practice. In Nigeria, calculating exact number of nurses has been very difficult because of the lack of accurate data and the method of multiple registration of nurses by the Council. This study examined and identified the various problems associated with the multiple registration of nurses and recommended ways of resolving the problems. Findings on the applicants seeking admission into Schools of Nursing showed that 81.48 per cent of applicants were genuinely interested in nursing and that they were prepared to pay 'for their nursing education if scholarship or bursary was not available. The findings also showed that Schools of Nursing will be able to recruit sufficient number of qualified candidates. 87.98 per cent of students nurses would prefer student status to civil service status and would be prepared to pay for their nursing education. Many student nurses were actually paying for their training at the time of this investigation. The findings also showed that 30.58 per cent of schools belong to voluntary agencies and 31.78 per cent that belong to to Governments can only train a very small number of nurses at a given time. A total of 76.9 per cent of schools lack the organisational structure, facilities and finances for their efficient administration and for coping with a large number of students that may wish to enter nursing. The recommendations of the study include the restructure and re-organization of schools of nursing to the status of a post-secondary institution that is - College status and that the Federal Government should give financial assistance to state governments while the state government take over the responsibilities of voluntary agencies. In planning for future supplies, factors that affect supply must be carefully considered and the accurate population of nurses in active practice urgently ascertained.