Migration, Governance at Root of Global Shortage of Health Care Workers
Wendy Glauser
World Politics Review
Mar 13, 2008
KAMPALA, Uganda -- Earlier this month, 1,000 people from around the world gathered at a World Health Organization-sponsored forum here to discuss what's increasingly being seen as a global crisis: the acute shortage of health care workers.
The WHO estimates that more than four million health care workers are needed in the 57 countries it defines as grossly understaffed (fewer than 2.3 doctors, nurses and midwives per 100,000 people). Thirty-six of the 57 worst-hit countries are in Africa (Malawi has around 265 doctors for 12 million people; Zambia has about 650 for the same population). But when it comes to actual population, Asia is the most affected by the dearth of health care personnel. According to WHO figures, Asia requires 3 of the 4 million health care workers required to bridge the human resource gap.
But with aging populations, the health care worker shortfall in industrialized countries, while much less severe than that of Southeast Asia or Africa, is also driving up the demand for trained hospital and clinic staff. According to Judith Oulton, the CEO of International Council of Nurses in Geneva, Switzerland, the United States will need 800,000 nurses by 2015.
With stark international competition for the wearers of turquoise cotton, the most contentious and talked about issue at the conference was the migration of doctors and nurses. According to the WHO, one in four doctors trained in disease-plagued Africa is currently working in an OECD country, where patients see doctors to combat the sniffles.
"It is disturbing to note that the recruitment of these prized assets continues unabated," said Manto Tshabalala Msimang, the Minister of Health of South Africa.
Yaw Osafo Maafo, Ghana's former minister of finance, noted that close to 70 percent of Ghanian medical officers trained between 1999 and 2003 have emigrated out of the country. "There are more doctors in the state of New York than the total number of Ghanaian doctors in public sector," he said.
Who is to Blame?
While the scale of the migration became shockingly apparent in the week-long forum, which ran from March 2-7, the question of who to blame for the problem was less clear-cut: Is the West guilty of unethically poaching doctors from developing countries, or does the fault lie with third-world governments, who haven't done enough to keep them?
In the blame-the-West camp, advocates argued that IMF loan conditions that put limits on salary increases for public service workers have tied recipient governments' hands. "The developed countries don't train enough of their own health workers and then the IMF creates incentives for people to leave developing countries," said Rotimi Sankore, a Nigerian activist with the Africa Public Health Alliance. "It seems like a conspiracy theory but it's true."
Rick Rowden, an American policy analyst with ActionAid, added that while the IMF's spendthrift strategies made sense in the global recession and third world debt crises of the early '80s, they've become "unnecessarily restrictive."
But Agnes Soucat, a senior health economist with the World Bank, argued the IMF is no longer enforcing wage caps. And Dr. Jonathan Nshasho, the director of a medial school in Uganda said IMF wage restrictions have been "an excuse" for African governments.
African governments pay public administration staffers, also affected by the salary-tightening regulations, significantly better than they do doctors, he argued.
