Following the devastating Ebola outbreak in 2014, it became clear that the health systems in countries in West Africa were not prepared to effectively respond to public health emergencies with the speed and efficiency required to save lives and contain the spread of disease.
This realization underscored the region’s pressing need to strengthen its health systems, and Benin, Burkina Faso, Côte d’Ivoire, Guinea, Niger and Togo acted on this task in October 2017 by initiating a collaborative effort between the West African Health Organisation (WAHO), France Development Agency (AFD) and Expertise France.
The project known in French as Renforcer les institutions pour la préparation et la réponse aux urgences sanitaires en Afrique de l’Ouest (project for Public Health Capacity Building in Francophone West African Countries) or RIPOST, aimed to strengthen health institutions, promote the ‘One Health’ approach, and enhance human resource capacities. However, the project was suspended in 2018, due to the disparate levels of health system maturity among participating countries.
In a recent turn of events, a two-day technical meeting, which was held in Nigeria in May 2024, ushered in the Renforcer les Ressources Humaines en Santé Publique (RHSP) — a French title that translates to Strengthening Human Resources in Public Health. It aims to develop a robust and resilient human resource framework for public health that integrates gender equality into its foundation.
At the meeting, stakeholders in West Africa’s French-speaking countries, particularly Togo, Benin, and Guinea, discussed the initiative’s objectives, and challenges, and proposed strategic actions for achieving its goals. Among the core objectives, one that stands out is the aim to leverage gender equality in health policies and capacity building to strengthen public health human resources in these countries.
Gender gaps in healthcare human resources in Togo, Benin, and Guinea.
According to Dr. Olumuyiwa Ojo, Technical Officer for Human Resources for Health at the World Health Organization (WHO), the role of gender equity in achieving Universal Health Coverage (UHC) can only be successfully attained when all forms of inequality, particularly those related to gender, are actively acknowledged and rectified within the health sector.
In Togo, although women form a substantial part of the healthcare workforce, they continue to be significantly underrepresented in leadership positions. This observation reflects a broader pattern highlighted in a policy action paper produced by the Global Health Workforce Network’s Gender Equity Hub (GEH), co-chaired by the World Health Organization (WHO) and Women in Global Health. It revealed that while women constitute around 70% of the global health and social workforce, they hold less than 30% of senior management positions in healthcare institutions.
This situation perpetuates a gender imbalance in leadership roles within the healthcare sector, leading to a loss of diversity in voices that reflect various experiences and expertise in decision-making processes and ultimately limiting women’s ability to influence policy and resource allocation.
In Benin, gender inequality manifests in systemic wage discrimination and limited opportunities for professional advancement. This disparity reflects a pattern of gender discrimination that hampers women’s economic empowerment, exacerbating their vulnerability to poverty, and limiting their capacity to contribute fully to the country’s healthcare system.
Only 35% of female healthcare workers have participated in any form of professional development training from 2013 to 2015, compared to 50% of male healthcare workers.
Guinea’s healthcare workforce reflects a similar pattern of gender inequality, with women underrepresented in higher-status roles and facing limited opportunities for professional growth. According to Guinea’s Demographic and Health Survey published in 2018, women only constitute 40% of healthcare workers, with the majority occupying lower-status positions such as nursing aides and support staff.
‘One Health’ approach and what it means for West Africa
Another crucial aspect of the RSHP project apart from promoting gender equality in the health workforce is the adoption of the One Health approach. One Health recognizes the interconnectedness between human, animal, and environmental health, emphasizing the necessity of collaboration and integration across sectors and disciplines at all levels, from the local to the global.
The implementation of the One Health approach aligns with the International Health Regulations (IHR), which offers a platform for global collaboration in preventing and responding to public health threats. Three countries in the Gulf of Guinea region — Togo, Benin, and Guinea — have signed up to the IHR, pledging to enhance their capacities to identify, assess, report, and respond to public health emergencies.
Strengthening the IHR with a ‘One Health Approach’ in West Africa recognizes the importance of multisectoral, coordinated efforts in safeguarding public health. The recently amended IHR at the just concluded Seventy-seventh World Health Assembly should further strengthen preparedness, surveillance, and response to public health emergencies.
While the One Health approach provides a solid foundation for strengthening health systems in West Africa, further steps were recommended during the technical meeting:
System Strengthening: This requires investing in resources, training, and community-based partnerships to ensure that public health systems are better prepared to detect, prevent, and respond to potential outbreaks.
Capacity Building: The establishment of robust public health institutes in Benin and Togo is integral to bolstering the public health system in West Africa. The implementation of initiatives that enhance the skills and resources of healthcare workers and institutions, particularly in these two countries, is crucial to realizing this objective.
Avoiding Silos: This underscores the need to avoid duplication of efforts and foster a unified, streamlined approach to pandemic prevention and control across sectors, from healthcare and agriculture to public health and environmental agencies.
In West Africa’s quest to enhance the healthcare workforce, sustained collaboration between WAHO, Expertise France, and other regional and international partners will be vital in building robust, adaptable public health systems capable of tackling present and future health challenges. The integration of gender considerations and the adoption of the One Health approach will not only lead to improved public health outcomes but also ensure that the benefits of health interventions are shared equitably among all members of society.
