WHO: 57 nations short of skilled health workers

[Angel]

A shortage of health workers in 57 countries--two-thirds of them in sub-Saharan Africa--is handicapping efforts to combat HIV, tuberculosis, malaria and other diseases and is contributing to falling life expectancy in some of the worst-hit countries, the World Health Organization said Friday.

In South Africa, about half the jobs for nurses at public clinics are unfilled, and in some rural areas of the country the government is receiving no applications when it advertises vacant nursing jobs, according to the government payroll offices.

Tanzania, Malawi, Mozambique, Ethiopia, Sierra Leone and Niger, some of the African countries hit hardest by the medical skills shortage, today have 3 or fewer doctors per 100,000 people, a small fraction of the 256 doctors per 100,000 people in the United States, a WHO report released Friday said.

Worldwide, 1.3 billion people lack access to most forms of basic health care, largely because there are no health workers to serve them, the report said.

"Not enough health workers are being trained or recruited where they are most needed, and increasing numbers are joining a brain drain of qualified professions who are migrating to better-paid jobs in richer countries," Dr. Timothy Evans, WHO's assistant director general, warned in the report.

Ads lure workers away

In South Africa, newspapers are filled with advertisements from Britain, Australia, the United States, Canada and Saudi Arabia seeking qualified doctors and nurses, and the lure of higher pay and often better working conditions in less-crowded clinics is tough to resist.

In the United States, the average doctor earns $17,000 a month, far more than the $540 a month in Zambia, according to a report by the South African Institute of International Affairs. Further, doctors and nurses in many African countries face tougher living conditions than their developed-world colleagues, with little access to advanced training, research grants or other amenities.

Such problems are one reason that what was once a trickle of skilled African workers leaving the continent has become a torrent. From 1976 to 1984, an average of 4,444 Africans, many of them skilled workers, left sub-Saharan countries each year, according to the International Organization for Migration and the United National Economic Commission for Africa. Since 1990, the exodus has reached 20,000 a year.

Today, 1 in 4 doctors trained in Africa works in a developed country elsewhere, according to WHO.

The result is that Africa, which has 24 percent of the world's disease burden, has just 3 percent of the world's health-care workers and 1 percent of world health-care spending, the report said.

The more developed Americas, by comparison, account for just 10 percent of the international disease burden but are home to 37 percent of the world's health-care workers and half of international spending on health.

The health worker shortages, particularly in places like Africa, are "inhibiting provision of essential life-saving interventions" from childhood immunizations to prenatal care, Evans said. That, combined with stubborn epidemics of diseases like AIDS, tuberculosis and malaria, means that life expectancies are falling in some parts of Africa even though they are rising in much of the rest of the world.

Life expectancy gap

A child born in Zambia between 2000 and 2005, for instance, can on average expect to live 33 years, according to the UN, compared with 77 years for a child born in the United States.

African governments in places like Malawi have responded to the doctor shortage by training less-educated health workers to take on tasks once left to doctors, such as diagnosing ailments and even performing emergency Caesarean sections in rural clinics.

But turning around the problem will require recruiting, training and then paying 4 million additional doctors, nurses, midwives, health manager and public-health workers worldwide, the report says.

It calls for a $10 per person boost in the national health budgets of the countries most severely affected by shortages, from an average of $33 to $43 per person over the next 20 years, with international donors paying at least half that cost.

Countries like South Africa also are seeking to stem the shortage in health-care personnel by opening new nursing schools, luring home doctors who have emigrated and trying to require nurse trainees to work a year in underserved rural areas.

"Nothing short of a skills revolution . . . will extricate us from the crisis we face," South African Deputy President Phumzile Mlambo-Ngcuka warned last month as she announced a new national initiative to ease the country's shortage of skilled workers, including not just doctors and nurses but also engineers, computer technicians and other professionals.