Module 1: Overview of the Shrinking Health Workforce
Brain Drain and Its Repercussions on Healthcare Systems in the Developing World
As physicians and nurses from developing nations migrate in droves to Western countries in search of higher pay and better working conditions, healthcare systems in their home countries become understaffed, compounding the fight against diseases like AIDS that disproportionately torment the developing world.(1)
“Africa accounts for 24% of the global disease burden but only 3% of the global health workforce. The reasons for this are well-documented and include inadequate salaries and poor working conditions leading to staff attrition, unwillingness of international donors to support financing for human resources, an insufficiency of medical schools, and the brain drain of health staff to resource rich countries.”(2)
“Thousands of doctors are leaving Africa, but the continent will need a million extra healthcare workers to meet the millennium development goals.”(3)
Not only is the health crisis in sub-Saharan Africa intensified by health professionals leaving their home countries to work elsewhere, but the mounting burden of disease in this region further exacerbates the crisis. Moreover, the health systems in these countries are underdeveloped to begin with, which poses a further challenge.
A combination of “push” and “pull” factors can account for this brain drain.
Countering Brain Drain
Health workers cannot be blamed for leaving their home country in search of more opportunity overseas, especially if their home countries are mired in poverty and conflict. Developing countries must first make a commitment to improve local healthcare systems and create incentive for health workers to stay. The government must create a positive working environment for health workers, such as increasing their pay and increasing funding for essential drugs and hospital equipment. Recently, countries have stepped up their efforts to counter brain drain:
“One country that has launched such an effort is Malawi, according to the WHO report. In the face of inadequate health care staffing to provide basic health care or deliver HIV/AIDS related services, the country in 2004 launched a $278 million 6-year Emergency Human Resources Programme, with funding support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Kingdom Department for International Development, and other donors. The program includes financial and other incentives to boost recruitment and retention, salary increases, improved housing for staff, better management of health workers, and expansion of domestic training programs. By 2005, 5400 physicians, nurses, and other health care staff had received salary increases and more than 700 new health staff had been recruited. Plans to expand domestic training programs called for tripling the number of physicians-in-training and nearly double the number of nurses-in-training.”(4)
Each country must develop strategies to address their own specific challenges. Of course, developing countries must have the support of the international community. In particular, affluent, Western nations have a moral obligation to create policies that control the loss of professional health workers from poor countries.(5)
Meanwhile, to counter the healthcare crisis induced by a shrinking health workforce, many creative solutions have evolved, such as the use of trained surgeons and community health workers. In the absence of physicians and nurses, these health workers are indispensable to the developing world's welfare, as they have been mobilized to bring the health crises of many countries under control, with success. Unite For Sight, for instance, relies on community health workers in many of its day-to-day operations.
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Footnotes
(1) Wilson, Brenda. "Developing Countries See Health Care 'Brain Drain'." NPR 03 Nov 2005 Web.11 Jun 2009. <http://www.npr.org/templates/story/story.php?storyId=4987628>.
(2) Datiko DG, Lindtjørn B, 2009 Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial. PLoS ONE 4(5): e5443. doi:10.1371/journal.pone.0005443
(3) Lucas, Adetokunbo O . "sBMJ/Human Resources for Health in Africa." 2008.http://archive.student.bmj.com/issues/05/12/editorials/443.php (accessed 6/9/2009).
(4) Kuehn , Bridget M. . "Global Shortage of Health Workers, Brain Drain Stress Developing Countries." The Journal of the American Medical Association 298 16Oct 2007 1853-1855. Web.11 Jun 2009. <http://jama.ama-assn.org/cgi/content/full/298/16/1853>.
(5) Dovlo D (2005) Taking More Than a Fair Share? The Migration of Health Professionals from Poor to Rich Countries. PLoS Med 2(5): e109. doi:10.1371/journal.pmed.0020109