Global Health Worker Shortage

In many countries, the shortage of qualified health workers is one of the greatest obstacles to achieving the United Nations Millennium Development Goals (MDGs). Of the eight goals adopted in 2000 by 189 Member States, which aim to reduce poverty by 2015, three are directly related to health: 1) to reduce infant and under five mortality by two thirds; 2) to reduce maternal mortality by three fourths; and 3) to halt and reverse HIV/AIDS, tuberculosis and malaria epidemics.

Fifty-seven countries, 36 of which are in sub-Saharan Africa, have severe shortages of health workers, according to the World Health Organization (WHO). The world health body estimates that more than four million additional doctors, nurses, midwives, managers and public health workers are urgently needed to fill this gap.

However, current trends indicate that this gap is set to widen rather than close.

Countries with a critical shortage of health service providers.
(click for larger image - [61KB])

A March 2006 report by the International Council of Nurses: The Global Nursing Shortage: Priority Areas for Intervention [242KB], posits that at the very same time as the demand for health services and nurses continues to grow (due to aging populations, increasing population growth rates, and a growing burden of chronic and non-communicable disease), the supply of available nurses in some countries is dwindling and is expected to worsen.

One recent UNFPA report: Internati onal Migration and the Millennium Development Goals [1.59MB] puts the shorfall, in sub-Saharan Africa, at a conservative miniumum of 720,000 doctors and 600,000 nurses.

To make matters worse, this poor health worker availability situation in sub-Saharan Africa is being exacerbated by the huge demand for more health workers from industrialized countries already with much high densities of health workers. As reported in the International Herald Tribune (July 27th 2006), "the shortage of doctors, nurses, and community health workers is a two-sided problem in many developing countries. Not only do many countries lack the universities to train and educate all the personnel they need, but often the nurses and doctors they do produce decide to leave Africa for the better pay and more comfortable living and working conditions of the industrialized world."

A "brain drain" of human resources for health (HRH) is occurring from developing countries to countries such as the U.S. where, according to a 2004 report by the journal Human Resources for Health: The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain [284KB] - "a total of 5,334 of America's physicians received their training in sub-Saharan Africa, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana.

To address the question of health worker migration in Ghana, Realizing Rights: The Ethical Globalization Initiative, in conjunction with the Ministry of Health of Ghana and Physicians for Human Rights, held a health seminar in Accra; Ghana, on March 8th 2006 to investigate solutions for the strengthening of local health systems in light of this migration.

A summary report of this seminar, entitled: "Ghana Health Worker Migration and the Need to Strengthen Local Health Systems" [254KB] highlights key aspects of the debate around searching for solutions to this complex issue, including bi-lateral international agreements and engagement of the diaspora.

In addition, Realizing Rights is organizing an important meeting on September 12th in New York, to immediately precede the UN General Assembly High Level Dialogue on Migration and Development due to take place from September 14th - 15th 2006.

The meeting, which will be co-hosted by Physicians for Human Rights, the WHO Global Health Workforce Alliance, and the Commonwealth Secretariat, will push for sustained and innovative policy action to meet the needs of both sending and receiving nations. It will bring together leading policy makers and experts from Africa, the US and the UK to debate the issue and forge new solutions.

The meeting will also launch a Policy Working Group to assess existing efforts such as bilateral and multilateral agreements, codes of conduct and Diaspora efforts, and to promote new policy initiatives and agreements between nations.

Further reading:

In April of this year, President of Realizing Rights, Mary Robinson, wrote an article in the UK newspaper The Independent: British Hospitals are Africa?s Real Poachers.