MercoPress. South Atlantic News Agency

Serious shortage of health workers in 57 countries

A serious shortage of health workers in 57 countries is impairing provision of essential, life-saving interventions such as childhood immunization, safe pregnancy and delivery services for mothers, and access to treatment for HIV/AIDS, malaria and tuberculosis.

This shortage, combined with a lack of training and knowledge, is also a major obstacle for health systems as they attempt to respond effectively to chronic diseases, avian influenza and other health challenges, according to The World Health Report 2006 - Working together for health, published by the World Health Organization (WHO).

More than four million additional doctors, nurses, midwives, managers and public health workers are urgently needed to fill the gap in these 57 countries, 36 of which are in sub-Saharan Africa, says the Report, which is highlighted by events in many cities around the world to mark World Health Day, Friday April 7. Every country needs to improve the way it plans for, educates and employs the doctors, nurses and support staff who make up the health workforce and provide them with better working conditions, it concludes.

"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," said WHO Director-General Dr LEE Jong-wook. "Across the developing world, health workers face economic hardship, deteriorating infrastructure and social unrest. In many countries, the HIV/AIDS epidemic has also destroyed the health and lives of health workers."

The World Health Report sets out a 10-year plan to address the crisis. It calls for national leadership to urgently formulate and implement country strategies for the health workforce. These need to be backed by international donor assistance.

Infectious diseases and complications of pregnancy and delivery cause at least 10 million deaths each year. Better access to health workers could prevent many of those deaths. There is clear evidence that as the ratio of health workers to population increases, so in turn does infant, child and maternal survival.

"Not enough health workers are being trained or recruited where they are most needed, and increasing numbers are joining a brain drain of qualified professionals who are migrating to better-paid jobs in richer countries, whether those countries are near neighbours or wealthy industrialized nations. Such countries are likely to attract even more foreign staff because of their ageing populations, who will need more long-term, chronic care," said WHO Assistant Director-General Dr Timothy Evans.

To tackle this crisis, more direct investment in the training and support of health workers is needed now. Initial costs will be for the training of more health workers, and as they graduate and enter the workforce, funds will be needed to pay their salaries. Health budgets will have to increase by at least US$10 per person per year in the 57 countries with severe shortages to educate and pay the salaries of the four million health workers needed to fill the gap. To meet that target within 20 years is an ambitious but reasonable goal, the Report concludes.

Financing this gap will require significant, dedicated and predictable funding from national sources, as well as from international development partners. The Report recommends that of all new donor funds for health, 50% should be dedicated to strengthening health systems, of which 50% should be dedicated specifically to training, retaining and sustaining the health workforce.

At least 1.3 billion people worldwide lack access to the most basic healthcare, often because there is no health worker. The shortage is global, but the burden is greatest in countries overwhelmed by poverty and disease where these health workers are needed most. Shortages are most severe in sub-Saharan Africa, which has 11% of the world's population and 24% of the global burden of disease but only 3% of the world's health workers.

The Report calls for prompt and innovative initiatives to improve efficiency. For example, HIV/AIDS, TB and other priority disease programmes have implemented ways for health workers with limited formal training to successfully carry out specific health tasks. These experiences should be drawn upon to develop national health workforce strategies.

The World Health Report recommends that in order to achieve the goal of getting "the right workers with the right skills in the right place doing the right things," countries should develop plans that include the following:

Acting now for workforce productivity: better working conditions for health workers, improved safety, better access to treatment and care; Anticipating what lies ahead: a well-developed plan to train the health workforce of the future; Acquiring critical capacity: workforce planning; development of leadership and management; standard setting, accreditation and licensing as drivers for quality improvement.

Beyond the national strategies the report urges global cooperation:

Joint investment in research and information systems; Agreements on ethical recruitment of and working conditions for migrant health workers and international planning on the health workforce for humanitarian emergencies or global health threats such as an influenza pandemic; Commitment from donor countries to assist crisis countries with their efforts to improve and support the health workforce.