The past century has seen the most spectacular medical
breakthroughs in human history, but these advances are of little
value without qualified health workers putting them into
practice.
Unfortunately, a steady exodus of doctors, nurses and other
health workers from developing countries to higher-paying jobs
abroad has created a health workforce crisis. The resulting
shortage of health workers in the developing world comes at a time
when traditional diseases, such as malaria and tuberculosis, are
combining with modern lifestyle-related diseases, such as diabetes
and heart disease, to place an unprecedented strain on health-care
systems. Add to this burden a wave of newly emerging threats such
as avian influenza, and the day may not be too far off when the
quality of healthcare will be jeopardized in many countries.
This critical shortage of doctors, nurses, midwives and other
health workers takes its greatest toll on the poorest and most
vulnerable populations. In the World Health Organization's (WHO)
Southeast Asia and Western Pacific Regions, for instance, more than
5,000 children under the age of 28 days die every day. Many of
those infants would survive if skilled attendants were on hand
during childbirth. Yet, only 43 percent of births in India and 60
percent of births in the Philippines take place with the assistance
of a health worker.
Many health workers from poorer countries are being pulled away
by the lure of bigger pay cheques and better working conditions in
wealthier nations. In fact, about one-quarter of all licensed
physicians in Australia, Canada, the United Kingdom and the United
States are from the developing world, with India, the Philippines
and Pakistan providing most of them. In effect, developing
countries are providing a reverse subsidy, in which the costs of
the global mobility of health workers are being shouldered by
poorer source countries, while the benefits are concentrated in
wealthier recipient countries. The result: Asia has about three
health workers for every 1,000 people, less than one-10th of the
ratio in North America.
The effects of unfettered migration can be devastating. The
Philippines loses more than 15,000 nurses annually, more than any
other country. Many of them are among the country's best-educated
and most-experienced nurses, leaving a critical shortage of
qualified specialty nurses. Some doctors in the Philippines are
training for higher-paying nursing jobs in the United States.
The shortage of doctors, nurses and health workers in the
developing world is made worse by imbalances within many countries,
where there might be a sufficient number of doctors and nurses in
cities but too few in the countryside.
Health workers are not just the cornerstone of health systems.
By improving the quality of life of others, they enable them to be
fuller members of society. In countries with inadequate number of
health workers, national productivity suffers and the fabric of
society is weakened. But policy-makers often overlook the needs of
these unsung heroes. Decades of budget cuts and under-investment
have created the crisis we now face.
What can be done? First, we need to pay health workers
reasonable salaries. While it is true that the kinds of pay
increases that can be offered in developing countries won't close
the gap with salaries elsewhere, paying decent wages and paying
them on time will go a long way towards convincing doctors, nurses
and other health workers that their contribution to society is
recognized.
Second, we need better non-financial incentives. In fact, we
need a comprehensive package of reforms to address working
conditions, transport, housing, opportunities for career
advancement, and the education of family members.
Third, governments need to seek creative solutions. In Mongolia,
where the average health worker earns only US$40 a month,
scholarships are being offered to medical students willing to
return and work in rural areas for at least three years. Thailand
has found that training staff with a locally focused curriculum
encourages retention in rural areas and a drop in migration.
Finally, there needs to be better international co-operation.
Wealthier nations must increase investment in the education and
training of health professionals to meet their own domestic needs.
They also need to target some of their development aid to programs
that will help expand the health workforce in poorer countries. And
they need to work with ministries of health, training institutions
and other relevant national authorities to avoid claims of
"poaching" and other unethical recruiting practices. A code of
ethics is being developed by WHO and its partners to ensure
transparency and fairness in the international recruitment of
health workers.
Surveys of migrating workers show that the vast majority would
prefer to work in their home countries as long as the conditions
are right, which generally means improved wages and working
conditions.
The WHO is using World Health Day 2006 (which falls today) to
announce a new Alliance for Human Resources. It's an effort to
ensure that we do all we can to retain the doctors, nurses and
other health workers the developing world needs to ensure good
health for all.
The author is the World Health Organization's Regional
Director for the Western Pacific.
(China Daily April 7, 2006)
