Human Resources for Eye Health in Guinea-Bissau

DRAFT ZERO, 04 Nov 2013
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ANALYSIS OF THE SITUATION OF HUMAN
RESOURCES FOR EYE HEALTH
GUINEA BISSAU

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ACKNOWLEDGEMENTS
This report was prepared by Dr. Adidja Amani. I thank Aliou Tandia, Victor Caperuto and
Joao Soares for their support. I we owe a special word of thanks to Victor and Joaes for
their administrative support, for leading and hosting the assessment ,for providing
vehicles and contact with the stakeholders . We also thank all those who agreed to
participate in interviews
Disclaimer: An initial disclaimer that deserves mention upfront is related with the quality
and availability of the data used in the preparation of this report. The reader should be
warned that in many occasions the necessary information was either not available, or
when available was of limited quality and usefulness.

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I. TABLE OF CONTENTS

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LIST OF ACRONYMS
CONAEGUIB Confederação Nacional das Associações Estudantis da Guiné Bissau
(CONAEGUIB
DRHAS Direção de Recursos Humanos e Administração da em Saúde (Directorate for
Human Resources and Management for Health)
ENS Escola Nacional de Saúde (National School of Health)
HRH Human Resources for Health
PNDRHS Plano Nacional de Desenvolvimento de Recursos Humanos em Saúde
(National Plan for Development of Human Resources for Health)
PNDS Plano Nacional de Desenvolvimento Sanitário,
PNSV Programa Nacional de Saude Visuel
WAHO West Africa Health Organization
CSR Cataract Surgical Rate
HRH Human Resources for Health
HReH Human Resources for eye Health
IAPB International Agency for the Prevention of Blindness
PALP Países Africanos de Língua Portuguesa
TI Training Institution

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II. BACKGROUND:
Geography and demography
Guinea-Bissau, officially the Republic of Guinea-Bissau, is a situated on the
west coast of sub-Saharan. The country comprises territory on the mainland and a
number of islands (archipelago of Bijagós) (CIA, fact book, 2013). Guinea - Bissau is
situated on the West Coast of Africa and shares borders with Senegal, Guinea
Conakry and the Atlantic Ocean. The country is divided into 8 regions Bafata,
Biombo, Bissau, Bolama, Cacheu, Gabu, Oio, Quinara and Tombali. The population
of Guinea-Bissau is estimated at 1,533,000 (World Development Report, 2013,
RGPH 2009). 63.3% of the population is under 25 years of age.
Economic, social and political context
The economy is heavily dependent on cashew nut sub sector which represent
about 60 % of GDP. Politically, Guinea-Bissau went through periods of civil wars.it
has been facing political instability and recurrent violence, as reflected in repeated
coups d’état and armed conflict.The social situation is still precarious. Guinea-Bissau
has a very low score on the worldwide Human Development Index (HDI) (The World
Bank, 2013) and ranks 176th out of 185 countries surveyed in the 2013 report. The
average life expectancy is 45.8 years, according to the United Nations Development
Programme (UNDP, 2011) and 66% of the population lives on less than 2US dollars
per day.
The national poverty reduction strategy (DENARP, 2010) priority intervention areas
are peace and political stability, strengthening of the health service delivery system,
and education among others.
Education
The government adopted the Education Sector Policy Paper for 2009 to 2020. The
overall illiteracy rate is 58%, but that of women is 72%. Public expenditure devoted
to education is very low at 11.5% (UNESCO, 2013), less than half of the African
average of 22.6, and at the bottom end of the range.
There are 4 universities in Guinea-Bissau: Universidade Colinas de Boé,
Universidade Lusófona and Universidade Jean Piaget and Universidade Amílcar

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Cabral. Universidade Amílcar Cabral is Guinea Bissau's first University and it is
the only which offers degrees in general medicine. It is a public university .After 7
years, of training, graduates receive the Medicina general, which is equivalent to
MD. So far, all postgraduate studies must be undertaken abroad. The Faculty of
Medicine is supported by bilateral cooperation, by the Republic of Cuba. The Amilcar
Cabral University was suspended by the government in 2008 for 3 years and has
now re-opened.Students pay enrolment and tuition fees and teachers are paid using
primarily these collected resources. Enrolment fee is approximately US$ 20 and
tuition fee is US$ 300 per year per student. Despite the presence of these
universities medical doctors seeking to specialize must go abroad, typically to Cuba,
Portugal, Russia and neighbouring African countries.
An overview of the health system
According to the National Health Development Programme 2008-2017 (Plano
Nacional de Desenvolvimento Sanitário, or PNDS) Public health care structures in
Guinea-Bissau are divided into three levels, primary, secondary, and tertiary. There
are 11 health regions (MOH, 2013). The National Health Programs are as follows:
anti-Malaria Program, National Program to Combat AIDS, National Visual Health
Program, National Program to Combat Leprosy and Tuberculosi, Expanded Program
on Immunization (EPI) and National Family Health Program.In 2006, 5% of the
State’s general budget went to the Ministry of Public Health and 1,22% of the GDP
was spent on health (AHWO, 2009).
According to the RAAB conducted in 2010, Avoidable causes of blindness (92.9%)
are much higher than the VISION 2020 estimate of 85%. According to the same
RAAB report, only 28% of people needing cataract surgery were operated (Oye,
RAAB 2010) .The first two most important barriers to cataract surgery uptake were
linked to the available services for cataract operation and accessibility. In 2013, the
cataract surgical rate is 78 % (PNSV, 2013). There were 7 nurses and 1 doctor for
every 10,000 inhabitants in Guinea-Bissau in 2007, according to a country profile for
Guinea-Bissau produced in 2010 by the Africa Health Workforce Observatory
(AHWO). From 1998-2008 there was only one ophthalmologist in the country. The
health services system depends heavily on external aid to support the health budget
(Fronteira, Dussault, 2010).

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Table..: Evolution over 10 years of the number of health workers and hospitals in
Guinea Bissau source: Direcção de Estatística, Direcção de Higene e de
Epidemologia. * include 40 Cubans doctors
Studies conducted in Portuguese speaking African countries regarding the
health workforce crisis are scanty. In April 2010, the WHO health workforce
observatory published the first comprehensive overview of the health workforce in
Portuguese speaking African countries. The report was followed by the publication of
the situational analysis on human resources for health of the PALP (Fronteira and
Dussault, 2010). The results highlighted a huge deficit of the general health
workforce. Prior to this work, WHO-Afro performed in 2006 an assessment of the
training of professional health workers which highlighted some challenges including
(i) high migration rate(ii) high dependency on foreign countries for training (iii) ageing
of specialized health workers and (iv) excessive dependency on foreign physicians.
These three studies allowed a general understanding of the situation of health
workers, however none have focused specifically on understanding the eye health
workforce1
. Sound initial situation analysis is crucial to identifying the important
contextual variables that influence eye health workforce development.
Research question -Rationale
Fundamental questions regarding the development of the eye health workforce in
other to achieve VISION 2020 goal in PALP remain largely unanswered. There is a
need to generate evidence to deepen the appreciation of the status of the eye health
workforce in these countries through a comprehensive analysis of the situation that
will answer the following questions
1
Eye health workers in this document refer to all cadres in eye health as defined by Vision 2020. They are: Ophthalmologist, Cataract
Surgeons, Ophthalmic Medical Officer, Ophthalmic Nurse , Community Ophthalmic Nurse, Optometrists, Optometrist Technician,
Refractionists, Optical Technician, Eye Instrument Technician, Eye Care Programme Manager and Low Vision Worker
GUINEE-
BISSAU 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Physicians 74 85 73 73 82 102 120 165* 165* 188* 188*
Nurses 1164 1176 1167 1158 1164 1164 1164 1164 1164 912 998
National
hospitals 1 1 1 1 1 1 1 1 1 1 1
Regional
hospital 7 7 7 7 7 7 7 1 7 7 7
Sectorialhospital 26 26 26 26 26 26 26 26 26 26 26
Health centers 371 371 371 371 371 371 371 371 371 371 371
Clinics 3 3 3 3 5 5 5 5 5 5 5
Health
expenditure 8.70% 7.70% 5.00% 6.60%

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• What is the current situation of eye health workers in Guinea Bissau?
• Which effective interventions are required for the development of the eye
health workforce in other to achieve vision 2020 goal in Guinea Bissau ?
OBJECTIVES
Through a comprehensive analysis of the situation we shall specifically:
1. Analyse the human resources for health policies, strategies and practices in
Guinea Bissau that affect eye health workers
2. Determine the reasons for migration of the eye health workers and factors
that might motivate them to remain in their respective countries
3. Identify opportunities and recommend appropriate strategies and policies to
develop the eye health workforce.
III. METHODS
This study was conducted with an aim to review existing national HRH related
policies, plans, guidelines and strategies, identify gaps and make recommendation
This study was conducted in 2 days.
a) Ethical approval
Ethical approval for this work was sought and obtained from the participants . The
research participants were explicitly explained about the objectives and methods of
the study, benefits of the study was explained. Use of study findings was clarified to
the research participants. Written informed consent from the participants was
obtained prior to commencing the interviews.
b) Data collection methodology
Phase 1: We searched MEDLINE from 1963 to 2013. Search terms were
“ophthalmologists”, “eye health”, “training”, “guinea Bissau”. We also searched
websites of organisations working to improve health-worker performance, reference
lists from identiﬁed reports. Some documents and data were identified later through
direct contact with the Ministries of Health, Education and Public service

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Phase 2: The second phase involved the designing and administration of a
semi-structured questionnaire as a data collection tool for gathering information. The
questionnaires were field-tested in Benin in July 2012. After minor revisions, it was
used to assess the Human resources for eye health in Guinea Bissau.
Pre-field-trip: The stakeholders were contacted by the representation os Sightsavers
in Guinea Bissau. Identified institutions were contacted and informed about the
study. Prior to the interviews, the researchers explained the objectives and
approaches of the study to each person being interviewed. The full list of the
interviewees is in the annex.
Phase 3: The third phase comprised field work. The assessment team was
led by the HRH focal point of Sightsvers. The team consisted of 3 people from
Sightsavers office in Guinea Bissau. According to the pre-set calendar, field
constraints, or the workload of informants approached, some of them were not
available and thus their direct collaborators had to give us the information we were
looking for. Due to time constraints and the urgency of the mission , In-country data
collection was conducted in 2 days: 1 working day (Friday the 25 October ) and on
the week end (Saturday 26 October 2013) with interviews of key informants at the
national level. And these dates clashed with the swearing ceremony for military
were all the authorities have to attend.
The In-depth interviews with stakeholders lasted 60 to 120 minutes depending
on each case. We interviewed 9 individuals from Ministries, training institutions,
hospital and health staff involved in the delivery of eye care services. The sampling
procedure was not intended to be statistically representative for the whole country,
but to provide insights from the key decision according to the objectives of the study.
The list of those interviewed is given in Annex
Phase4: in the fourth phase information collected with the questionnaires was
entered into a database involved an analysis and interpretation of the study findings.
The answers from the different questionnaires were analysed and a draft report was
prepared that will be shared with all the stakeholders who were interviewed.
IV. RESULTS

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The analysis of the situation will follow the HRH Action framework components
promoted by the World Health Organization (WHO) and the Global Health Workforce
Alliance(GHWA) that is HRH leadership, management, policy, finance and
partnership. Qualitative findings are illustrated using quotations translated verbatim
from Portuguese to English, the original language of the interview. Each quotation is
followed by precise information on the respondent’s sex and professional title
Respondent characteristics
9 respondents effectively participated in the study, 4 males and 5 females. The
female were respectively at the policy level within the Ministry of Health, the Ministry
of Public service and Head of training institution. There was one eye health worker
(ophthalmologist) in the sample.
The quantity , the mix and distribution vis a vis vision 2020 targets
There are overall 4 ophthalmologists in the country with 3 in Bissau and 1 in the
region of Farim. 25 out of the 44 (56% ) eye health workers in Guinea Bissau are
female . Their training was supported for some by faith–based organizations and for
the recent one by Sightsavers. The latter is then national trachoma coordinator
trained in Nigeria with Sightsavers support. With the exception of Dr. Meno, the
national eye care coordinator who was trained in Russia, the majority of the cadres
were trained in Africa particularly in Nigeria and the Gambia. They are currently 2
cataract surgeons in training in the Gambia. All cadres including cataract surgeons
and optometrists are recognised by the authorities and systematically integrated as
civil servant upon their return.
Category of Eye Health
Worker
Currently
available
(total)
Number
Required
GAP
Ophthalmic Nurses/
Ophthalmic Medical
Assistants
6 16 10
Cataract Surgeons 9 10 1
Ophthalmologists 4 7 3
Optometrists 8 33 25

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Optometric Assistants 0 127 127
Ophthalmic Equipment
Technicians
2 6 4
Programme Managers 1 1 0
Community Ophthalmic
Nurses
15 326 311
Optical workshop
Technicians
1 3 2
Low vision specialist no data no data
Total 46 529 483
Table: National eye health workforce of Guinea Bissau source: Ministry of Health, Direction of Human
resources, data collected on February 2013. Ref. annex for disaggregated data by cadre, by service
delivery level and geographic area
HUMAN RESOURCE MANAGEMENT SYSTEM
Effective HRH management generally requires an information system that provides
reliable data to plan for necessary staff, train, appraise staff performance, and
provide salaries and incentives for their retention
The Human resource capacity of the Directorate of human resources include 9 staff
that manage the 2,000 workers in the health sector (DRHAS, 2013)
The existence of a costed HRH strategic plan that is not being implemented because
of the lack of funding (DRHAS, 2013)
HREH PLANNING/PROJECTIONS
According to the projection of National Human resources development plan 2008-
2016, the Ministry of Health plan to train 20 ophthalmology technicians, 8
Optometrists and 10 cataract surgeons by the end of 2016. There are no data for
ophthalmologists. These projections are not in coherence with vision 2020
requirements.
There is also natural attrition of the workforce to retirement, resignation and death
that was not addressed with the planning of the current workforce.
The ratio of eye care cadres to the population as well as distribution: However there
is a better distribution of the eye health mid-level workers. All the health regions have
at leat one eye health works in charge of the eye health unit.

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RETENTION AND THE BRAIN DRAIN PHENOMENON
There are regional disparities with respect to the distribution of health professionals.
In the region of Bolama Island where there is only one doctor working in the region
(MOH, 2013) .
“Retention of human resources is one of the chronic problems of health systems
especially in remote area”
(Maria Aramata Injai, Directora dos servico de Recursos Humanos e Administração
da Saúde)
The brain drain of health workers was not perceived as a current problem. It was
acknowledge that the phenomenon of massive migration happened during the civil
war of 1998 but it is not anymore an issue.
HRH Financing
There is a weak government financial capacity. Despite the small progress made in
mobilizing domestic resources, the country is still dependent on foreign aid to finance
public expenditure .The proportion of the budget allocated for human resources for
health and eye health is not clear and could not be obatined. Although Guinea-
Bissau signed the Abuja Declaration in 2000, by which African states committed
themselves to spend 15% of their annual national budgets on health, this country’s
budget allocation to was 4% in 2007 (WHO, 2011). The human resources directorate
currently has no funding, no budget line. There is no specific budget allocated to the
HR department. The minister centralizes the budget and can allocate according to
the need. Almost all recurrent expenditure is on salaries, leaving little room for
manoeuvre in relation to other expenditure.
The payment of salaries to health workers has often been subject to delay. When
paid the salaries is not attractive. For a medical doctor, it is 170,000-180,000 XOF
(£217.0- £230.0/month) and XOF 59,000 (~£76) for mid-level health workers
(DRHAS, 2013). When there is a top up by the INGOs it is within XOF 40,000-
100,000 XOF/ Month. Community eye health workers are recognized but do neither

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are civil servant nor do they receive a salary. However they are incentivize if there is
any specific tasks.
HRIS
The collection systems include information on eye care staff however there is no
technical expertise in that area. Availability of systems and capacity for the
collection, integration and analysis of HRH data and information
HRH PLANNING
There is a mismatch between the staffs projections versus the actual numbers
trained. There is no reference to the model for projecting staff . It is not clear what
was the rational and objective base for the estimated numbers.
HRH Policy
Health workers are managed through a complex system involving 3 ministries: The
Training institutions. A soon as they graduate the MoH ensure that the list of
graduates is sent to the Ministry of Public Service for approval. Then the list os sent
to the Ministry of Finance for salary purposes. The process take 9-12 months before
he graduates perceived their first salary.
In the ministry of public service , there is no written procedure for the management
of data that includes collection, preservation, cleaning, quality control, analysis and
presentation of data is implemented throughout the country Existence of up-to-date
HRH policies in place; evidence that HRH policies are actually used or implemented
RECRUITMENT POLICY
The recruitment of health workers is done centrally at the Ministry of Public Health in
collaboration with the Ministry of Public Service and the Ministry of Finance. The
recruitment is systematic for all graduates however there is no planning document
for recruitment. It is done on an ad hoc basis following the government policy, rules
and regulations.. The age limit to get into public service is 50 years. 100% of health
workers whether trained in Guinea-Bissau or abroad have been recruited by the
Ministry of Health.

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However, there is a long pipeline (9-12 months) between the graduation and their
integration as civil servant. Training institutions in public sector are autonomous and
formulate their own recruitment policy and rule, which are approved by the
government. The private academic institutions have more liberal policy of
recruitment.
CAREER PROGRESSION
Any Promotion or career progression of civil servant has been suspended since
2012. There is no instrument for evaluating the performance of health workers.
However at the Ministry of Public service a new career progression scheme is being
developed but there is no capacity to finalize it or to mobilize resources for its
implementation. The evidence from the data collected showed that health workers
were expressed much dissatisfaction with the salary they received.
IN-SERVICE AND CONTINUOUS TRAINING
In-service training in the public sector is not coordinated. It responds to the needs of
different programmes and services and the regional health directorates, and
depends on the availability of funds from donors. Currently there is a request of 4
medical doctors who wish to specialize in ophthalmology but here are currently
scholarship available.
Education
During the field visit on Friday 25 October, the teachers and students have been on
strikes for 19 days. This strike is planned for 60 days (CONAEGUIB,2013). The
main reason is the dissatisfactions with the non-payment of teachers’ salaries for the
past 10 months.
PRE-SERVICE EDUCATION
There is one nursing school and one medical school in Guinea Bissau. There are no
eye health training institutions in the country
The existence of a domestic residency training program is considered as an
important aspect of a country’s medical education system and prospects for
physicians’ retention. The director is from guinea Bissau, the 2 vice rectors that are
from Cuba. The training of medical students is done at Universidade Amílcar Cabral,
the Guinea Bissau's first University. The school was re-opened in 2006 after being

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closed for 10 years that during the civil war of 1996. Since its reopening 2 batch of
medical doctors graduated. The intake 10 to 15 students/year. The first batch
graduated in 2011 with 88 medical doctors and in 2012 with 37 medical doctors
among them only 5 females ( MoH, 2013). In medical schools, the ratio male to
female is almost 1to 8, while in nursing the school , there is a feminization of the
graduates . in 2010 it was 1 male for 2 female, in 2011 2.3 for 1.
The main factor of dissatisfaction of student in nursing school was related to the poor
quality of support systems (library, computers, laboratories) and the heavy load (and
poor organization) of formal teaching hours. The cost of training for a nurse is
approximately XOF 360,000 (~£461) for the 3 years of training.
CURRICULUM
Since 2009, the curriculum used in nursing school is the harmonized West African
Health Organisation (WAHO) curriculum - but which still has a huge Portuguese
influence.
Year of graduation 2009 2010 2011 2012 Total
Medical school
Universidade
Amílcar
0 0 88 37 125
Nursing school,
Escola Nacionale
de saude
no data 657 556 338 1551
Total 657 644 375 1676
Table.. Numbers of graduates in the health field in Guinea Bissau per year
PARTNERSHIP
To effectively respond to national health goals, relevant government sectors must
have a shared vision and a readiness to play their part.
 The main development partners of Guinea-Bissau are the European Union
(EU) together with European bilateral donors, Economic Community of West
African States (ECOWAS) and West Africa Economic Monetary Union
(WAEMU), West Africa Development Bank (BOAD) the African Development
Bank (AfDB), United Nations agencies, UNFPA and WHO

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 Cuba's assistance in international health. Cuban professors have helped to
found medical schools in Guinea Bissau and the Cuban government provides
the human resources which trains up the local population
 Other INGOs , specifically CBM who recently trained 3 Cataract surgeons ,
 Instituto de Higiene e Medicina Tropical (Institute of Hygiene and Tropical
Medicine) of the Universidade Nova de Lisboa (technical support)
 There is quasi no information about the for-profit health care sector which
appears to be underdeveloped. None of the respondents mentioned the
private sector as a supporter.
Leadership
Human resource for health development is said to be a priority in the country as
there is (i) a directorate in charge of their development, (ii) a policy document of
human resources for health, (iii) a systematic recruitment of eye health workers
trained (iv) with a regular salary . However, the country ownership is insufficient as
75% of the respondents failed to make reference to themselves as potential
supporters in any project to develop the eye health workforce in GB.
There is also a limited institutional capacity and human resources in the country
(Ministry of Public service and health ) for successfully planning and implementing
development policies and programs;
V. CONSTRAINTS AND THE CHALLENGES IN EYE HEALTH
WORKFORCE DEVELOPMENT
Guinea Bissau been described as a stage on a continuum where the risk of
destabilization remain with a cycles of peace and war, security threat is an important
concern for all. Several constraints might be envisioned for the development of the
eye health workforce.
ON LEADERSHIP

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 Almost all the interviewees mentioned the international partners to best
support any HRH initiative. They didn’t see themselves primarily as potential
supporters, that might lead to low ownership of any program if started
 Pressure to restore and repair public services to meet emergency needs
frequently diverts attention from long-term issues such as policy development
and reform
ON FINANCING
 There is a plan for the development of HRH, but it faces major challenges in
implementation. The financial structures in which to raise local revenue are
damaged and the likelihood to attract foreign investment is low.
 Inefficient resource allocation. There is no public budget for eye care and the
budget cycle suffers from malfunctions in all of its phases. The current budget
is allocated on a contingency basis and there is no budget breakdown
department of the MoH. It is imperative that the budget present an
expenditure breakdown. This would help assess the real situation in the
sector as well as contribute to introduce more transparency and credibility into
the budget process.
 The payment of salaries to health workers has often been subject to delay,
and morale is said to be poor. The In Guinea-Bissau, where the starting
monthly salary of a public sector doctor was US$ 320,
ON EDUCATION
 Heavy dependency on foreign staff (the Cubans). 100% of teaching staff in
medical school are Cubans. Ways must be identified to make Guinean
resources sustainable, including building up a medical teaching faculty
 Difficulties with the supply of electricity are among the greatest obstacles to
economic and social development in Guinea-Bissau. Only 5.7% of the
population has access to electricity (World Bank. 2012.)
 Government concentrate on educational institutions and training, while
neglecting others aspects of human resources development.
OPPORTUNITIES

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The assessment indicates that, despite all the setbacks, some progress have
recently been achieved in specific aspects of education and health sectors amid
social tensions and disputes with unions
 There is close tied and collaboration between the national eye care
coordination and the human resources for health department
 Health appears to receive more priority from the government. While teachers
are on strike, the salaries of health workers are paid on a regular basis.
 Guinea Bissau is member of WAHO, the health branch of the Economic
Community of West African States (ECOWAS), who works to improve health
in the region by harmonizing policies and pooling resources.
 Guinea Bissau is also member of CPLP and PALP
 Faculty development highlighted by the Human Resources Development
Strategy (2007) and Action Plan by focusing on the production of health
personnel in close collaboration with the Oswaldo Cruz Foundation (Brazil)
which will train the faculty.
LIMITATIONS AND CONSTRAINTS
This situational analysis faced a number of important constraints some of which
were expected; others proved more challenging than anticipated. The fact that it
was during the period of the swearing ceremony of militaries, we were not able to
meet with the Dean of Medical School as well as the official of the Ministry of
Finance as they were to attend this official ceremony.
No electricity, we spent half of the time of this situational analysis in the dark at
both schools and were not able to print documents
Obtaining key documentation proved challenging as no single organization had a
comprehensive set or sense of what should be available. Those contacted were
encouraged to send any additional thoughts and documents by email but none
were received. If it had been possible to start contacting stakeholders more than

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two weeks before the field visit began, some of the above limitations might have
been reduced / mitigated.
I. CONCLUSION AND RECOMMENDATIONS
 There is a plan for the development of HRH, but it faces major challenges in
implementation.
 The human resources for health policies that affect the general health
workforce are the same that affect the eye health workforce. However there
no training programs for eye health workers in country
 There is no public budget for eye care and the budget cycle suffers from
malfunctions in all of its phases. The current budget is allocated on a
contingency basis and there is no budget breakdown department of the MoH.
 There is a low satisfaction. The starting monthly salary of a public sector
doctor was US$ 320
 migration/brain drain is said not to be an issue in the country .it has been the
case in the past due to the civil war of 1998 and a better motivation will be
done through reducing the pipeline , better working conditions, increased of
salary and payment of salaries on time
 Regionalizing area of training of ophthalmologists. It was suggested that a
partnership with Angola and Cape Verde be established in other to developed
are of speciality and subspecialty in more developed countries like cape
verde, which will circumvent the 1 year language requirement in the Gambia
or Nigeria and the prohibitive cost of being trained in Portugal or Brazil,
enhance the south to south collaboration for sustainable results
 it is essential to contribute to “life support”—to pay civil servants’ salaries and
reduce the chances of a resumption of conflict
 The new human resources strategy and action plan in the health sector
should be effectively used to create linkages between planning, production
and deployment of personnel.

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 Overcoming the deficit of skills emerges as a necessary condition for the
success of Public administration. The capacity building of civil servant
authorities in preparing planning and policy documents is essential .
 Political instability remains a persistent risk to the continuity and consistent
implementation of actions envisaged in the HRDP.
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12.Documento de Estratégia Nacional de Redução da Pobreza. Adopted 2005.
Corrected version published 2005. See: http://www.stat-
guinebissau.com/denarp/denarp.pdf.
13.20 Fronteira I, Ferrinho F, Dussault G, Ferrinho P. Avaliação final da
Implementação e Execução do Plano Nacional de Desenvolvimento Sanitário
2003-2007 da República da Guiné Bissau. Associação para o
Desenvolvimento e Cooperação Garcia de Orta, 2007.
14.Ferrinho et al.: The training and professional expectations of medical students
in Angola, Guinea-Bissau and Mozambique. Human Resources for Health
2011 9:9.
15.EFA Country Profile Guinea Bissau UNESCO, 2012
http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Dakar/pdf/EFA%20cou
ntry%20profile%202012%20%20%20-%20Guinea%20Bissau_01.pdf accessed on the 2
November 2013
16.Three-year Plan for the Development of Education: 2011 - 2013 Carta de
Política Sectorial, a policy document
17.World Bank. 2012. PPIAF assistance in the Republic of Guinea-Bissau.
Public-Private Infrastructure Advisory Facility (PPIAF). Washington D.C. : The
Worldbank. http://documents.worldbank.org/curated/en/2012/08/17518648/ppiaf-assistance-
republic-guinea-bissau
18.WHO (2013) Global Health Expenditure Database

22
19.Research, 6(1), 97-113.Fronteira & Dussault, Human Resources in the Heath
Sector of Portuguese-speaking Afrian Countries, Reciis, Vol. 4, No. 1, 2010
RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.1, p.71-78,
Jan., 2010
VI. ANNEX
Annex 1: Human resources for health requirements Source : HRDP, Ministry of Health

23
ANNEXE ..: Roster of eye health workers in Guinea Bissau as February 2013 source,
Human resource department and National eye care program, Ministry of Health

24
ANNEX ..:

25
Three-year Plan for the Development of Education: 2011 – 2013 Source: Republic of Guinea-
Bissau Ministry of National Education, Culture, Science, Youth and Sports
ANNEX..... LIBRARY AT ESCOLAR NACIONAL DE SAUDE

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