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November 8, 2006 -- Today The Daily Observer (The Gambia) ran a short item by Sheriff Barry, "Nurses: Critical to health service delivery." The piece is based on remarks by a government health official and others at a "sub-regional workshop" for West African nurses and midwives at the School of Nursing in Banjul. The health official's remarks make two basic points: (1) nurses, though underpaid, are essential to a successful health system, and (2) the region's vulnerable children are not getting the care they need, especially for malnutrition, because health workers lack adequate skill. The piece might have made the link between these points more clear, and also explored whether it was fair to suggest that a lack of health worker skill was really the biggest problem in care delivery, as opposed to severe resource shortages. But the piece is still a helpful reminder of the vital role nurses play in caring for vulnerable populations.

The piece reports that at the workshop, Saihou Janneh, the Deputy Permanent Secretary at the Department of State for Health, "harped on the importance of nurses in the healthcare service delivery of a nation." In fact, Janneh reportedly said that (in the piece's words) "no health system can succeed without the contribution of nurses." However, he apparently noted that despite this key role, nurses are "underpaid generally."

Janneh reportedly also emphasized the problems in managing the care of vulnerable children, which he linked to a lack of knowledge and skills on the part of health workers. He explained the effects:

This has resulted in high mortality of malnourished children admitted in our health facilities. The lack of continuous follow up on care after discharge, has also contributed to high mortality.

The piece quotes Solomon Adeleye, Executive Secretary of the West African College of Nursing (WACN), as noting that the workshop itself is one of WACN's many educational programs for nurses and midwives. This sounds like a response to Janneh's comments about health workers' knowledge. Adeleye himself stresses the devastating effect of malnutrition, noting that (in the piece's words) it "contributes [to] more than half of deaths among children under 5 years in the developing countries." The piece also cites WACN president Maram Bobb's statement that children are the future work force of West Africa, including its health workers.

The piece might have explored what role the situation of nurses and midwives plays in the problems in pediatric care that the piece describes. Assuming nurses are among those Janneh says lack adequate skill, why is that? Can occasional workshops address this problem, or will it require more fundamental improvements in educational systems? What is the role of the "underpaid" status of nurses, especially on developing nations' retention of the best qualified nurses at a time of global shortage? The piece could be read to suggest that the key health problem is a lack of care giver skill--but aren't shortages of clinical resources (e.g. personnel, drugs, equipment, facilities) at least as important?

We thank Sheriff Barry and The Daily Observer for this piece.

See Sheriff's Barry's article "Nurses: Critical to health service delivery," posted on the Daily Observer site on November 8, 2006.

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