Jan 3, 2009 Written by JAFFAR MJASIRI Daily News THE prevailing shortage of medical nurses and midwives in hospitals and health centres in the country has been blamed on opportunistic departures in search of greener pastures abroad. Poor working conditions are another factor believed to have contributed to the thinning of the workforce. It is unfortunate that a single nurse is forced by circumstances to serve more than 50 patients a day in a medical ward, says the Chairperson of the Tanzania Nurses and Midwifery Council, Ms Joyce Safe. Speaking to the Daily News this week, she said that there are critical complaints and demands floated by nurses and midwives that are yet to be met by the government. The grievances and demands have, to some extent, affected the quality of health service delivery in the country. Ms Safe said that among the most thorny issues were salary concerns, scheme of service placements, shortage of manpower and lack of requisite equipment and other paraphernalia in hospital wards. She also said that it was due to shortages of funds that the allocations of medical drugs and materials to hospitals at national, regional and district levels were inadequate. In most cases, she said, medical supplies fell too short to meet the needs of patients and staff. Tanzania, which has a population of about 40 million people, has a medical workforce comprising 13,292 nurses and midwives. According to health experts, Tanzania has four nurses per 10,000 patients, which translates into a ratio of 1:40. It is estimated that one nurse serves an entire ward of 50 patients. International standards peg the ratio at 1:6. She said that on the other hand, the overhead costs were much higher than the funds allocated to government health facilities. The meagre financial allocation is expected to meet procurement of materials for the wards, equipment, uniforms, as well as payment of night and risk allowances for medical personnel. Some nurses have not been given uniform allowances for more than two years. This means they either have to go without them or purchase them on their own, she said. She said that the deterioration of services was partially due to overwork on the part of the nurses a situation that is stressful. This situation is akin to imposing a burden on them which they cannot handle, she said. As if this unfriendly atmosphere was not enough, the same nurses are blamed roundly and even punished for unsatisfactory service delivery, she said. I am not trying to defend any incompetence or laziness on the part of the nurses and midwives. This is the real situation on the ground. Those in authority should take into account the predicament faced by these workers. They should not be blamed arbitrarily, she added. Medical nurses in Temeke, Mwananyamala and Ilala hospitals pointed out that the same nurse who starts a drip on a child in the paediatric ward, often rushes to help a pregnant woman deliver a baby in the maternity ward. The nurses, who spoke on condition of anonymity, told this reporter that the nursing profession was no longer a calling as it used to be in yesteryears. They were concerned that they have been denied their basic rights for too long. We undertake very risky work in the quest to ensure that we save the lives of patients. But what are the rewards for us? one nurse queried. Some people call us killers a situation that is humiliating, a senior nurse at Mwananyamala hospital, who wished to remain anonymous, said. The appalling working conditions have prompted professional nurses and midwives into seeking employment in countries such as Botswana, UK and the US over the last two decades, said the Chief Nursing Officer in the Ministry of Health and Social Welfare, Mr Clavery Mpandwa. The nurses and midwives were among registered and enrolled nurses who hold Bachelor of Science degrees, diplomas and certificates, he said. He said that Tanzanias 13,000-strong team of nurses and midwives keeps diminishing every year. Nearly all the departures head for greener pastures abroad, he said. He explained that at degree and diploma levels, for every 20 graduates, one or two of them attempt to seek employment in the UK or US. Diploma holders, however, are mainly employed in Botswana where most young females are often attracted to marriage. According to the Global Atlas of the Health Workforce, World Health Organization (WHO), Geneva Report, there are 13,292 midwives and nurses in Tanzania. Among them, 8,608 midwives serve in the rural areas, while 2,121 are employed in urban settings. In another development, there is an insignificant reverse trend on the ground. Currently, there are 17 Tanzanian qualified nurses seeking employment in Tanzania, after so many years of service abroad, said the Chief Nursing Officer. He said that there was security of employment in the government. At the moment, the government has embarked on reviewing the salaries of midwives and nurses, which is transforming the profession from worse to best. There was also a new scheme of service ready to be implemented from next year. The new Scheme of Service is just waiting to be tied up with the next budget, he said. He also said that there were many health sector programmes which are lucrative and have already attracted some medical nurses.