ATLANTA, Georgia – The backbone of public health–its workforce–is compromised by personnel shortages that simply cannot support the weight of the global disease burden.
The World Health Organization released a report at last month’s Third Global Forum on Human Resources for Health that predicts a global shortage of 12.9 million health care workers by the year 2035. “A universal truth: No health without a workforce” highlights Sub-Saharan Africa as the epicenter of this human resources crisis limited with global health workers.
Africa lags behind other continents in virtually every metric applied to measure the stability of a nation’s health care system. For example, while the United Nations’ minimum threshold of 23 skilled health care workers per 10,000 people is surpassed by the global average (50 per 10,000,) Africa’s rate lags behind with only eight medical professionals per 10,000 individuals. The dichotomy between the West’s robust workforce and Africa’s feeble pool of medical professionals underscores the importance of heeding the Organization’s recent warning despite statistics that may indicate progress on a global scale.
Sub-Saharan Africa is simply the sickest and poorest region on Earth. It is home to 11 percent of the world’s population and 24 percent of the global disease burden; yet, it contains less than 3% of the global health workforce and receives less than one percent of the world’s financial resources allocated toward health care. Conversely, the Americas (dominated by the United States and Canada,), which represent 14 percent of the global population and only 10 percent of the international disease burden, hoard 37 percent of the international health workforce and 50 percent of all health-care related funds.
Driving forces behind Africa’s personnel shortage include health needs, health systems and context, each of which has created significant challenges in providing quality care.
Africa’s health needs are substantial. The aggregate disease burden weighs heavily on the continent, largely due to the continued impact of HIV/AIDS on mortality and the mortality of health care workers themselves (a 2007 study estimated that between 18 and 41 percent of medical workers were infected with HIV at the time.)
The health care system has suffered from a lack of funding due to health sector reforms that have impeded nations’ ability to attract health care workers and invest in new infrastructures and institutions. Two-thirds of countries in Sub-Saharan Africa have only one medical school.
11 countries do not house a single one. The technology and curricula are outdated, with a focus on clinical training and very little emphasis on public health. Educated workers have fled to countries with lower birth rates, large elderly populations and economic benefits that afford a decent standard of living. This exodus, known as “brain drain,” has robbed most African nations of between 20 percent and 60 percent of domestically trained doctors.
Political instability further complicates the issue, as evidenced by the logistical challenges imposed upon aid workers valiantly attempting to administer polio vaccinations to children in regions of Syria currently commandeered by rebel factions. Health care workers must often put themselves in dangerous situations to administer medications to patients, and many doctors and nurses are simply unwilling to sacrifice their own safety to work in consistently conflict-ridden countries.
Africa is precariously situated on the cusp of crisis due to an inability to mitigate public health risks with a capable and sizable network of health care professionals. Progress made thus far toward decreasing childhood mortality, increasing maternal health and controlling the HIV/AIDS epidemic (facets of the Millennium Development Goals) could stall or reverse if health care workers, “the lifeline of the system,” are not well compensated, educated and supplemented.
– Casey Ernstes
Sources: International Journal of Environmental Research and Public Health, The Daily Star, The Guardian, The World Health Organization
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