A health worker shortage in the under-developed world

The number of nurses and doctors serving the under-developed world is at crisis levels. The World Health Organization says most poor nations have only 2.3 doctors and nurses serving every 1000 people. Contributing to the problem is the fact that most doctors or nurses educated in poor nations move to rich countries for better paying jobs.

From the Guardian, health writer Sarah Boseley talks to the Global Health Workforce Alliance about how such a brain drain can be remedied.

Dr Mubashar Sheikh, executive director of the Global Health Workforce Alliance (GHWA), set up in 2006 to pull together national governments and other organisations interested in promoting health, says this is "a truly global crisis". Health workers move not only to wealthier nations, but also within their own countries, from the countryside to the towns, seeking better working conditions and pay.

"Mobility is a human right," says Sheikh. "You can't stop people from moving. Our argument is that people have a right to move, but access to health is a human right too. There has to be a balance."

Unless things can be improved, says Sheikh, there will be little chance of meeting the UN's health-related millennium development goals (MDGs) by 2015, but the scale of the problem is daunting.

Of the 57 crisis countries, 36 are in sub-Saharan Africa, which is struggling with the MDG targets of cutting child deaths and the numbers of women who die in childbirth. Africa, which bears 24% of the global burden of disease, has just 3% of the health workforce, according to the WHO. An estimated 1.5 million extra health workers are needed across the continent. According to a 2005 estimate, 334,000 skilled birth attendants would need to be trained globally just to reach 72% of annual births.

This is why the global health movement has been moving in recent years away from treating diseases such as HIV/Aids in isolation to support for "health systems" in general. Five million people with HIV in developing countries are now on drugs to keep them alive, but one survey estimated the treatment programmes took up the services of 20-50% of all health workers in two countries and 10% in a further 10. Today's thinking is that it makes no sense for a nurse to treat only HIV when the woman in front of her may have a child with pneumonia or a baby with life-threatening diarrhoea.

Improving health systems doesn't have to mean building smart hospitals, says Dr Sheikh. "We don't necessarily need fancy infrastructure," he says. The crucial part is well-trained and well-motivated people, who need to be able to access the drugs required and emergency care for patients. "There is a general consensus that health workers are the lifeline of the system." He includes not just the obvious doctor, nurse and midwife but also the lab technician, the theatre assistant, the researcher and the manager.