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 Background to the study
. The shortage of healthcare professionals in rural communities remains an intractable problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed distributions of healthcare professionals, favouring urban and wealthier areas (Wilson, Couper & De Vries, 2009). Rural communities are on the average poorer, less educated and have higher disease burden; they also have worse access to health care than people in urban areas (Wilson, Reid, Fish, & Marais, 2009). This discrepancy between health care needs and service provision has been captured by Hart’s ‘inverse care law’, which states that those with the greatest health needs usually have the worst access to healthcare services (Flament, 2012). Rapid urbanization is a global phenomenon but it also poses particular health problems in developing countries with poor infrastructural development (Wilson, Reid, Fish & Marais, 2009). Improved access to healthcare should therefore be seen as an indicator of the level of development of any nation. International attention has recently been drawn to the problems of attracting, retaining and motivating health workers in developing countries particularly in remote areas, which has created human resource for health (HRH) crisis (Williams, 2007). Health workers form the foundation of health service delivery and therefore the staff strength, skill and level of commitment are critical for the delivery of good, quality and effective health care (Serneels, Montalvo & Lievens, 2010). Renewed attention is being given to the role of geographical imbalances in the health workforce, a feature of nearly all health systems. This raises concerns about the equity in access to health care as well as the efficiency of allocation of human resources bearing in mind the impact on health outcomes (Petterson, Serneels, Aklilu & Butera, 2010). The issue is particularly relevant for developing countries with limited resources and poor health outcomes. Ultimately, the difficulties to attract and retain staff in rural facilities may also stem from the preferences and choice made by the health workers. Furthermore, a growing body of evidence shows that apart from wages, other job attributes like training opportunities, career development prospects, living and working conditions may also play a role (Hays, Veitch, Cheers & Crossland, 2007). The challenges in maintaining an adequate workforce that meets the needs of a population with social, demographic, epidemiological and political transitions require a sustained effort in addressing workforce planning, development and financing. Skilled health workers are increasingly taking up job opportunities in the global labour market as the demand for their expertise rises in high income areas. It has been suggested that the rural to urban and international migration of health workers in African countries inevitably leaves poor, rural and remote areas underserviced and disadvantaged (Bach, 2003). Developing countries often experience ‘urban-bias’ where the political and economic forces support the provision of services and investment in urban areas to the detriment of rural areas. This increases the disparities in health worker distribution, access to services and health outcome (Zurn, Dal Poz, Barbara & Orvill, 2004). A regression of data for 117 countries found a significant relationship between health worker density and maternal mortality rates (Gerein, 2006). Nigeria has high numbers of healthcare providers, who together make up the largest human resource for health in Africa. There are 52,408 doctors, 219,399 nurses and midwives, and 19,268 community health workers practicing in the public sector (Professional Regulatory Agencies, 2008). However, these values translate to only 23 doctors, 112 nurses, and 64 community health workers per 100,000 people. To put these figures into context, European health worker density values are 332 doctors and 780 nurses per 100,000 people (World Health Organisation [WHO], 2008). Poor, rural communities experience the lowest health worker densities, with three times as many doctors and two times as many nurses practicing in urban areas as opposed to rural. These figures imply that the number of women in rural areas giving birth unaccompanied by skilled birth attendants is directly impacted by the understaffed rural health facilities.

Project detailsContents
Number of Pages81 pages
Chapter one Introduction
Chapter two Literature review
Chapter three  methodology
Chapter  four  Data analysis
Chapter  five Summary,discussion & recommendations
Chapter summary1 to 5 chapters
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