The Government of Eritrea established a comprehensive macro policy that includes the strategy of developing human resources for health as the key to attain modern and developed health system, which focuses on providing primary health care to all people. To make this a reality, the government has been making efforts over the years to develop and maintain capable and motivated health workers. The efforts are part of sector-wide reforms that aim to transform and strengthen health service delivery throughout the country.
Following a situational analysis of the current status of human resources systems and practices in the health sector, the national human resources strategic plan has been developed. The focus of the Human Resources for Health (HRH) strategic plan is on developing the most appropriate, feasible and cost-effective mix of strategies to ensure equity in the deployment of health workers and access to quality care irrespective of geographic locations, and make health professions attractive.
According to Dr. Berhane Debru, Act. Director General of the Department of Policy, Planning and Human Resources Development at the Ministry of Health, modern medicine was introduced in Eritrea during the Italian colonization, and in 1955 the Nursing School was established in Asmara. During the armed struggle, the EPLF established a healthcare system with all the essential units, including operation rooms, at its base in Sahel and gave health care services in the liberated areas.
Following Eritrea’s independence in 1991, the government has engaged in building and renewing hospitals. In the first decade following Eritrea’s independence in 1991, the Ministry of Health (MoA) engaged in raising people’s awareness about the benefits of modern medicine. The following decade, 2001 to 2011, the government mainly focused on renovating old hospitals and building new regional hospitals. After 2011, the MoA shifted its focus to building new regional referral hospitals and a national referral hospital. As a result, referral hospitals were built in Barentu, Tesseney Assab, Dekemhare and Mendefera and Orotta National Referral Hospital was built in Asmara.
Dr. Berhane noted that the total number of health facilities in Eritrea was 93 (16 hospitals, 5 health centers, 72 clinics and health stations) before independence, which has risen to 341 in post-independence Eritrea. This has resulted in 80% of the Eritrean people having access to health care by travelling a maximum of 10 km from their home.
To determine HRH requirements, the MoH prescribed levels of health care service delivery as defined in the national health policy of 2004 and 2006. According to the policy, there are three levels of service delivery — primary, secondary and tertiary levels.
The services given at community health, health station, health center and community hospital are categorized under primary level services, the regional referral hospitals under secondary level and the national referral hospitals under tertiary level.
Community health services offer basic health services and form the foundation of the health delivery system. They are delivered by community health agents or volunteers such as village health workers and traditional birth attendants.
Health station services, the first formal health care unit of primary level service, refers to facilities that provide basic preventive and curative services and awareness raising messages about public health. Their service includes health education, treatment of minor ailments, reproductive/child health services, family planning, school health services, immunization services for children and mothers and continuation of TB treatment.
Health center services is a primary health care facility above the health station providing preventive and curative health services and awareness raising messages about public health and has both out-patient and in-patient sections with appropriate laboratory services. They are staffed with nurses, nurse-midwives, laboratory technician, pharmacy technician, public health technician and associate nurses.
Community Hospitals (CH) are hospital services in the sub-zones which are at the apex of the primary level of health service delivery. Some Sub-zones have more than one CH serving as referral hospitals to the primary health care facilities within a catchment area. A CH offers both out-patient and in-patient services and is equipped to perform minor surgical and obstetric procedures and provides basic laboratory support services.
Regional Referral Hospitals (ZRH), which are secondary facilities, are the highest referral hospitals at regional level. It offers specialized services in medicine, surgery, gynecology, pediatrics, and eye, dental and mental health, and emergency and trauma services. They also serve as clinical training sites for health workers.
National Referral Hospital (NRH) services, which give the highest level services, are categorized as tertiary level. NRHs are specialized facilities located in Asmara serving the entire country. They are Orotta Hospital for surgical and medical cases for adults, Orotta Pediatric Hospital, Orotta Obstetrics and Gynecology Hospital, Berhan Ayni Ophthalmic Hospital and St.Mary’s Psychiatric Hospital. These facilities are staffed with high level specialists on a range of specialties.
Alongside its efforts in building and renewing infrastructures the MoH has been developing human resources to meet the growing needs in terms of quantity and quality. Training and staff development interventions have been initiated at the pre-service and in -service levels to ensure availability of adequate numbers and appropriate mix of health works, who are equipped with knowledge, skills and right attitudes to deliver quality care. To improve the supply of HRH, the government provides opportunities for training free of charge to all staff members or trainees.
The government also established a medical school in 2004 and is keen to implement initiatives that ensure a sustainable supply of health workers. The initiatives include bridging courses to prepare students for diploma and degree courses, affirmative action for disadvantaged ethnic groups, promoting and securing funding for distance learning targeting younger health workers, supporting graduates to remain in the country and providing opportunities for professional development for senior positions within the MoH structure.
The establishment of training centers, colleges of health sciences and school of medicine was one of the most important steps the government took in human resource development. The school of health science was founded in 1998, Orotta School of Medicine in 2004 and the school of specialization in 2008 with a vision to produce qualified health professionals. Moreover, three schools of associate nurses were built at different locations. The first one was built in 2003 in Barentu to serve Gash Barka and Anseba regions, another was built in 2005 in Ghindae to serve Northern and Southern Red Sea and the third one was built in Mendefera in 2007 to serve Central and Southern regions.
Regarding the initiatives taken in human resource development in the health sector Dr. Birhane said, the number of medical doctors has increased from 100 in 1997 to 291 (192%) in 2020. In the same period, the number of dentists has risen from 6 to 59 (883%), the number of nurses from 625 to 1474 (135%), the number of assistant nurses from 1220 to 2918 (139%), dental therapists from 11 to 165(1400%), pharmacists and pharmacy technicians from 97 to 486 (401%), laboratory technicians from 99 to 517 (422%), radiologists from 28 to 132 (371%), physiotherapy technicians from 6 to 140 (2233%), and doctors with specialization from 5 to 74 (1380%).