By Chauna Gibson
Global efforts to achieve the Millennium Development Goals (MDG) targets are being hindered by a shortage of health workers, often due to inequitable distribution, and gaps in their capacity, motivation and performance. (GHWA). Due to health workers being the core of health systems and achieving health outcomes, a global strategy is needed to find out how to take up health worker development.
Figure 1
As expected, Lower Middle Income Countries (LMICs) face the most severe lack of suitable health workers. The Global Health Workforce Alliance estimated a gap of 7.2 million professional health workers in 2012 and predicted a deficit of 12.9 million health workers by 2035 (GHWA). An example of how a lack of a health workforce can substantially weaken the health system is the Ebola Epidemic in West and Central Africa. There were simply not enough health workers to respond to the compounded issues at hand. The shortage of doctors, nurses, and midwives are most severe in sub-Saharan Africa and South East Asia, accounting for 25% and 47% of the total deficit, respectively (GHWA). With generated data from the Global Health Workforce Statistics, figure 1 shows the number of nurses and midwives in the following select countries in Africa and Southeast Asia: Sierra Leone, Cabo Verde, Mali, Burkina Faso, Ghana, Cameroon, Rwanda, Kenya, Zimbabwe, Mozambique, Zambia, South Africa, Madagascar, India, Bangladesh, Sri Lanka, Myanmar, Thailand and Indonesia. . South East Asia has a higher deficit because their shortages are within some of the most populous countries. According to the Global Health Workforce statistics, most countries with a density of skilled health professionals below 22.8/10,000 population and a coverage of births by skilled birth attendants (SBA) below 80% are in Africa (31 countries, 57.4%) and in South East Asia (7 countries, 12.9%). This is currently one of the major obstacles to achieving the MDGs and other international health goals.
The Global Health Workforce crisis is not limited to just LMIC countries. High-income countries are often reliant on migrant health workers from developing countries and also have to plan for their growing population. One quarter of the doctors in the United States come from abroad, and the “medical tourism” market for travel to such countries as Thailand and Singapore is growing at a rate of 20% annually (Mullan). In addition, diseases spread, so people worldwide are at risk for infectious epidemics. This means health professionals are interdependent and share the same dilemma.
Workforce by Country or Region in 2010
Workforce of Doctors and Nurses According to Country or Region in 2010. shows that there are 9.2 million doctors and 18.1 million nurses worldwide.9 The United States, with 4% of the world's population, has 8% of the doctors and 17% of the nurses. The United States has a nurse-to-doctor ratio of 4, whereas the ratios in China and India are close to 1.
There are more barriers to the global health workforce than just a shortage of health workers. There are other global issues that are hindering the delivery of care around the world.One of the major issues causing lack of health workers in terrorism, this leads to a stop in economic growth and most importantly it hinders human development and can leave health systems overwhelmed and a lack of staff. Another issue at hand is urbanization, many people over the world are migrating into cities, along with the health workers. This leaves people who live in more rural areas without access to health care facilities and health workers. Lastly, a barrier in producing health workers, mainly in LMIC is gender inequality. With women having additional barriers of lack of education, and other gender biases they are unable to join the workforce and this further worsens the shortage.
References
Crisp, N., & Chen, L. (n.d.). Global Supply of Health Professionals — NEJM. http://www.nejm.org/doi/full/10.1056/NEJMra1111610?query=featured_global-health
Global Health Workforce Statistics (GHWS), World Health Organization, Geneva http://www.who.int/hrh/statistics/hwfstats
Health workforce data and statistics. (n.d.) http://www.who.int/workforcealliance/knowledge/data/en/
Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;353:1810-1818