A shortage of health care workers disproportionately affects developing countries, but it endangers us all.
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| Mary A. Pittman |
Here in the United States, we hear a lot about the problem of access to health care, and that problem is often equated with access to health insurance. But at least as basic as the ability to pay for health care is the availability of qualified health care workers.
Shortage of Health Care Professionals
Today there is a worldwide shortage of doctors, nurses, pharmacists, midwives and other community health workers. In the United States and other developed countries, the shortage is particularly notable in hospitals, in part because there are more and more employment options for health care professionals in other settings. In many developing countries, the shortage pervades all settings--hospitals, primary care facilities and public health and community clinics. Shortages tend to be particularly acute in rural areas in both the developed and developing countries.
To better understand the distribution of health care workers around the world, we need examine only a few numbers. With a world population of over 6.5 billion and, according to the World Health Organization (WHO), 59.2 million full-time paid health care workers, there are only 0.11 health care workers per 1,000 people across the world. Contrast that with the United States, where there are roughly 10 employed physicians and registered nurses per 1,000 people.
Also consider that a threshold of 2.5 health care professionals (counting only doctors, nurses and midwives) per 1,000 population is considered the minimum to achieve 80 percent coverage for deliveries by skilled birth attendants or for measles immunizations. One can quickly infer the magnitude of the developing world’s shortage. “There are currently 57 countries with critical shortages equivalent to a global deficit of nearly 2.4 million doctors, nurses and midwives” [WHO’s World Health Report 2006]. This number continues to grow.
Migrating Health Care Workers
Improvements in communication and transportation have brought increasing globalization to the health care workforce. The worldwide shortage and maldistribution of the health workforce have highlighted the problem of international migration of health care workers.
There are “push” nations--where low pay, bad work environment and lack of opportunities for career and family encourage professionals to migrate from their home countries--and “pull” nations--where factors such as aging populations, chronic diseases with new care needs, labor-demanding technologies and growth of consumer preferences increase demand for skilled professionals. Some “sending” countries once might have viewed exporting health care workers as a development strategy--surplus health care workers who migrate from their countries send remittance income back home to their families, thereby providing resources that boost the economy. Now those sending countries are experiencing a significant shortage of health care workers, possibly preventing them from covering their population’s health care needs.
Other countries are in worse straits. For example, in 2004 Ghana’s medical education community graduated 40 physicians, but only 2 remained in the country. The other 38 went to either the United Kingdom or the United States to practice. This trend is particularly alarming because there are only 0.15 physicians per 1,000 Ghanaians.
Liberia has approximately 3 million people but only 34 government doctors, and 95 percent of Liberian health care facilities were destroyed during its civil war. It is no surprise that, with such a deep brain drain and lack of infrastructure, the stress on the doctors who are left is tremendous.
Consequences for All Countries
This situation is not unique to Africa--it affects Southeast Asia, some Caribbean and South American nations, and the eastern Mediterranean. All face workforce challenges, and those challenges have implications in the United States. They impede not only our ability to obtain workers but also the ability of those nations to contain diseases that could become global pandemics. Furthermore, the ability of the challenged nations to maintain an adequate economic base is hindered because their population shoulders a disproportionate burden of disease.
How can we approach this problem? According to the World Health Report 2006, “A clear mandate has emerged for a global plan of action bringing forth national leadership backed by global solidarity.… The growing international nature of the health workforce related to the flows of migrants, relief workers and volunteers calls for cooperative agreements to protect the rights and safety of workers and to enhance the adoption of ethical recruitment practices.”
We need to better understand the causes and effects of international workforce migration on both sending and receiving nations. We need to look at foreign aid and the role of government in human resource planning. Most of all, we need to commit to developing a global plan of action and taking a worldwide perspective on what is truly a worldwide problem.
Mary A. Pittman, Dr.P.H., is president of the Health Research & Educational Trust.
Note: To learn more about these issues and solutions for both developing and developed nations, join HRET and the International Hospital Federation at the 2007 A Call to Action: Ensuring Global Human Resources for Health, which will be held March 22-23 in Geneva. For information, go to www.hret.org.
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This article 1st appeared on December 19, 2006 in HHN Magazine online site.
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