A new study has for the first time quantified the dangerous scarcity of health care workers around the globe, ensuring future failures of most developing country health initiatives without the effective addition of 4 million health workers to stave off catastrophic health, economic and political consequences.
The report's executive summary will be published in the Lancet's 27 November edition, along with an accompanying editorial.
The unprecedented report, Human Resources for Health: Overcoming the Crisis, was sponsored by the Rockefeller Foundation, in partnership with the World Bank and the World Health Organization, with donors including the Bill & Melinda Gates Foundation, Swedish Sida and Atlantic Philanthropies. The study was conducted under the auspices of the Joint Learning Initiative (JLI). More than 100 global health leaders worldwide, coordinated through Harvard University, spent two years documenting health worker patterns and developing viable solutions.
"At stake is nothing less than the course of global health and development in the 21st century," warns Lincoln C. Chen, MD, JLI co-chair and director of the Global Equity Initiative at Harvard University.
The equivalent of one million new health workers-triple the current number-are needed immediately in sub-Saharan Africa to boost collapsing health systems. Climbing rates of HIV, TB, malaria and other pathogens are highest in this region, while the density of health workers is the lowest.
Exacerbating the lean numbers are what the report terms "fatal flows," the so-called brain drain of medical professionals from poor countries to wealthy ones, and from rural to urban regions. For example, there are more Malawian doctors in Manchester, UK, than in Malawi. And a scant 50 of the 600 doctors trained in Zambia remain in that country. In wealthy nations, foreign-trained doctors often constitute a third of working doctors. Meanwhile, even in developing countries with reasonable health worker populations, rural and urban slum communities are often left without the health care they need.
Health workers are lured by the exponentially greater salaries and safer working conditions in richer countries or urban areas. "I have always wanted to go abroad. I am looking forward to a new life out there," said Melanie D'sa, a nurse from Bangalore, India. "We will be paid US$30 an hour in the US. Here the average salary for nurses is about 6,000 rupees (US$120) a month."
The JLI's recommendation to scale up the global health work force by at least 4 million refers to community health workers as well as doctors, nurses and midwives. These auxiliary workers are vital, making up 75 percent of the global health sector. They substitute for university trained professionals, and along with family members, make up the bulk of frontline health workers in poor countries.