More than a mere shortage, a regional imbalance is noticed in EmOC staff distribution, with rural areas being most affected.
Because it is a federal establishment, the staff distribution is representative of Nigeria's ethnic and cultural diversity.
Furthermore, despite decentralization efforts, key functions of human resource management (recruitment, overall staff distribution, remuneration, promotion and transfers) remain highly centralized.
At the operational level, the HRH action framework (which includes the human resources management systems) helps to address issues related to staff shortages, uneven staff distribution, skill and competency gaps, low retention, and poor motivation [ 14].
Lack of data quantifying staff distribution and workload may have contributed to the lack of follow-through on staffing recommendations to meet the anticipated HIV service challenges [ 22, 38].
To support these priorities, an effective, functioning human resource information system needs to be in place, which can be used to monitor staff distribution, client/patient numbers and thereby staff workload, and inform implementation of the Human Resources for Health Strategic Plan.
The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763.
This staff distribution would depend on the population's dispersal: either nine or 10 midwives in a hospital, and the rest in the health centres of the district, or one midwife per village, with intensification of the referral system [ 3].
At the time of the study each ward had 5 8 paediatricians, 5 8 paediatric trainees per day and 5 6 nurses per shift and this staff distribution did not differ on weekends and weekdays.
Concentration curves and indices for health workers in the public, private and NGO sectors confirm the skewed distribution, with the exception of the NGO sector where staff distribution appeared to be more equal, reflecting the strong rural presence of NGOs (McPake et al. 2013).
