WORLD HEALTH DAY: Chronic Deficit of Health Workers

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Apr 6 2006 (IPS) - There is a critical shortage of health workers – doctors, nurses and lab technicians – in poor countries, which most desperately need them, the World Health Organisation (WHO) warned in its annual report on global health problems.

“A shortage of human resources has replaced financial issues as the most serious obstacle to implementing national HIV treatment plans,” says the report.

The WHO is so alarmed at the health workforce crisis that it went so far as to advise the countries facing the severest deficits of health service providers to disregard conditions set by the multilateral lenders.

WHO Assistant Director General Timothy Evans said “We have to ensure that hiring ceilings related to the fiscal conditionalities of the international financial institutions are not a constraint to scaling up the health work force.”

The World Health Report 2006, which was released Friday, recommends the adoption of emergency national health work force plans for countries in crisis.

At least 1.3 billion people around the world have no access to basic health care, and the reason for that is often a deficit of health workers.

The figures speak for themselves. WHO reported that Africa, which accounts for 11 percent of the world population, has 25 percent of the disease burden and only three percent of all health workers.

Health workers not only include doctors, nurses, and lab technicians, but also management and support personnel such as public health professionals, finance and procurement officers, planners and hospital staff.

But the WHO definition also encompasses a woman caring for her child, sons or daughters who accompany their parents to the hospital, or traditional healers who make use of ancestral knowledge to assist and comfort.

In the stricter definition, however, the number of health workers currently totals 60 million worldwide. Two-thirds, or 40 million, of them are health service providers, while the rest are management and support staff.

Evans stressed that “health workers save lives. As the concentration or density of health workers increasesàsurvival of infants, children and mothers increases.”

However, the effects of the density of health workers reveal some peculiarities. For example, a greater density of nurses tends to correlate with higher coverage for the immunisation of children, but there is no association between immunisation coverage and the density of doctors.

This fact “is not surprising but indicative that some workers are more important for some functions,” noted Evans. “But the main message is that access to services is enhanced with more health workers,” he stressed.

Evans highlighted the “enormous” inequalities in the distribution of the world’s 60 million health workers across different regions. In Africa, there are about 2.3 health workers per 1,000 inhabitants, as compared to 24 per 1,000 in the Americas. “That’s a tenfold difference in the concentration of health workers across regions,” he underlined.

The distribution of health workers by level of health expenditure and burden of disease also reveals major discrepancies, as well as the troubling fact that this unequal distribution of human resources is inversely related to the need for health care.

Africa and South-East Asia, which have the highest global burdens of disease – 25 and 27 percent respectively – have the fewest health workers per capita, while the Americas, the region with the lowest burden of disease, has the highest number of health workers.

These regional inequalities are equally marked when it comes to financial considerations. The Americas have over 50 percent of all the world’s financial resources for health, whereas Africa has less than one percent.

“These are the patterns of enormous inequality globally that we see today,” Evans commented to IPS during the presentation of the report.

Another of the messages stressed by Evans was the existence of what he called “an emergency crisis in human resources for health.”

“There are shortages in 57 countries globally that are inhibiting the provision of essential life-saving interventions,” including immunisation, he explained. These 57 countries are disproportionately concentrated in sub-Saharan Africa and South-East Asia, he added.

For his part, WHO Director-General Lee Jong-wook emphasised, “The global population is growing, but the number of health workers is stagnating or even falling in many of the places where they are needed most.”

“Across the developing world, health workers face economic hardship, deteriorating infrastructure and social unrest,” said Lee.

“In many countries, the HIV/AIDS epidemic has also destroyed the health and lives of health workers,” he added.

In order to overcome the gap in human resources and ensure enough health workers to provide essential interventions in the 57 countries facing the most critical shortages, an additional four million health workers would be needed, said Evans.

Further exacerbating this crisis is the rising demand for health workers in many developed countries, due mainly to advances in medical technology and aging populations. This growth of health systems and the demand for health workers in wealthy nations is pulling large numbers of skilled professionals from developing countries, as part of the so-called “brain drain”.

“Nearly 25 percent of doctors trained in Africa are currently working in OECD countries,” said Evans, referring to the Organisation for Economic Cooperation and Development, which groups together the world’s wealthiest, most industrialised nations. When it comes to African-trained nurses, the figure is five percent or one in 20, he added.

“These are very significant numbers, especially when you consider that the existing shortages in Africa can hardly support that level of migration,” he pointed out.

The new WHO report makes a series of recommendations, which include improving the working conditions of health workers in Africa who are dealing with the HIV/AIDS epidemic, reorienting professional training to place greater emphasis on rural regions and impoverished areas, enhancing educational training, and putting priority on programmes for tuberculosis, malaria and maternal and infant health.

To finance these programmes, the report recommends increasing per capita spending on health care in every country by 10 dollars throughout the next 20 years. The new funds that result should be devoted to the training of health workers and payment of their salaries, it adds.