Why too many clinics hurt developing countries

Last September, Sierra Leone conducted an assessment of the distribution of public-health facilities and health workers in the country, in order to guide discussions on the Human Resources for Health Strategy 2017-2021.

The results were stark: only 47% of the country’s health facilities employed more than two health workers, including unsalaried workers and volunteers.

Seven percent of health facilities had no health workers assigned to them at all – an empty promise in physical form.

This situation is not unique to Sierra Leone – or to Africa.

 In Indonesia, the government invested oil revenue in the massive and rapid expansion of basic social services, including health care.

But today an insufficient number of doctors plagues many of these facilities, particularly in remote areas, where absenteeism also is high.

There are many nurses, but most are inadequately trained.

Still, they are left to run remote facilities on their own.

Beyond personnel, remote health facilities in Indonesia lack adequate supporting infrastructure: clean water, sanitation, reliable electricity, and basic medicine and equipment.

Decentralized local governments, which have little authority over remote clinics, cannot supervise their activities.

Small wonder that Indonesia has one of the highest rates of maternal mortality in East Asia.

An excess of poorly equipped health facilities is not only ineffective; it can actually make matters worse, owing to factors like poor sanitation and weak emergency referral systems.

During the recent Ebola crisis, underequipped facilities caused even more deaths, not just among patients, but also among the health workers committed to helping them.

Rather than continuing to pursue the uncontrolled proliferation of poorly equipped and operated health-care facilities, policymakers should consider a more measured approach.

Of course, people living in remote areas need access to quality health care, without having to navigate rough and dangerous roads that can become virtually inaccessible during some periods of the year.

But outreach services and community health workers could cover these areas much more effectively.

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