This paper discusses the implications of shortages of midwives, nurses and doctors
for maternal health and health services in sub-Saharan Africa, and inequitable distribution of
maternal health professionals between geographic areas and health facilities. Shortages of health
professionals reduce the number of facilities equipped to offer emergency obstetric care 24 hours
a day, and are significantly related to quality of care and maternal mortality rates. Some countries
are experiencing depletion of their workforces due to emigration and HIV-related illness. Another
feature is the movement from public to private health facilities, and to international health and
development organisations. The availability of skilled birth attendants and emergency obstetric care
may be reduced due to understaffing, particularly in rural, poor areas. The existing workforce may
experience increased workloads and job dissatisfaction, and may have to undertake tasks for which
they are not trained. If governments and development partners are serious about reaching the
Millennium Development Goal on maternal health, substantial numbers of professionals with
midwifery skills will be needed. Shortages of maternal health professionals should be addressed
within overall human resources policy. A rethink of health sector reforms and macro-economic
development policies is called for, to focus on equity and strengthening the role of the state.