Nairobi — Dr Geoffrey Kasembeli says he worked almost seven years without a day off: that's how severe the shortage of obstetricians and gynaecologists in Kenya is. A similar situation prevails across the continent, a symptom of the weakness of reproductive health care in Africa.

Until the end of 2009, Paul Mitei was the only doctor specialising in reproductive health at the Kisumu Provincial Hospital, handling all referrals for an entire province. A second gynaecologist has joined him at the hospital - working pro bono - but he says the workload is still very heavy.

"Wow, I am not sure how many patients I see in a day, after a while I lose count," he told IPS. "They are simply too many, almost overwhelming.

"I used to literally go for several months without being off-duty because I was the only gynaecologist in the hospital. While other doctors and the mid-wives can help, there are essential specialised services that must be attended to by a gynaecologist, so this meant I had to be at the hospital for long hours and days on end."

Across Africa, there is an acute shortage of specialists in women's reproductive health.

Professor Joseph Karanja of the University of Nairobi belongs to a regional association of obstetricians and gynaecologists in Eastern and Southern Africa.

 He says Uganda and Tanzania each have around 200 such specialists for populations of 33 and 45 million respectively. Zambia has 50 for its 13 million people. Lesotho can boast of only two or three for its nearly two million people.

Namibia's medical directory lists 13 gynaecologists. In Oshakati, 750 kilometres from the Namibian capital Windhoek, Dr Innocent Mavetera can identify with his Kenyan counterparts.

"We are not enough, that's why there is now a situation where general practitioners are performing caesareans,taking advantage of the critical shortage, fuelling chances of complications during the operation," he said. "We are stretched, and are always fully booked.

I am already fully booked until the end of October and this disadvantages patients."

Kenya has only 340 registered gynaecologists serving a population of 38 million. Karanja says the shortage of these highly-qualified personnel is exacerbated by the uneven distribution of the few who are available.

"With so few specialists, it means women in rural and peri-urban areas have no access to a gynaecologist because the few who are available are concentrated in urban areas and they are expensive," Karanja says.

Only a tiny proportion of African women have access to skilled medical care for a wide range of reproductive health issues including cervical and uterine cancer, problems with fertility, or reconstructive surgery for conditions like fistula.

The shortage also impacts on reducing maternal and infant mortality rates - in most countries, the women most likely to develop complications and need high-level intervention are also those unlikely to have timely access to such care.