Health Action AIDS

Strengthening Africa’s Health Workforce

In Sub-Saharan Africa, 3% of the world's health workers struggle to combat 24% of the global disease burden. Health experts estimate Sub-Saharan Africa needs 1 million more health workers. While each country will have different health worker needs, these statistical snapshots highlight the scope of the crisis. This shortage is directly caused by such factors as the burden of care caused by HIV/AIDS, the pandemic's toll on the health workers themselves, and the largescale emigration of health workers ("brain drain"). Meanwhile, health workers are distributed quite unevenly within countries, as richer and more urban areas typically have many more health workers than poorer and rural areas.

Brain drain

• Brain drain results from massive underinvestment in health systems and inadequate attention to the health workforce. Health workers struggle with unsafe workplaces, inadequate compensation, lack of professional training opportunities, inadequate supervision and unmanageable workloads. They cannot meet the needs of their patients, as they lack the necessary medicines, supplies, and equipment. Health professionals working in these difficult conditions often look abroad to find more sustainable work. A shortage of health workers in rich countries leads to active recruitment of doctors and nurses from countries that can least afford to lose them.

Impact of Health Worker Shortage

• International health goals for controlling and treating major diseases and significantly reducing maternal and child mortality cannot be reached without addressing the health worker shortage.
• Poor infrastructure and the health worker shortage may be the greatest impediments to scaling up HIV anti-retroviral therapy and meeting tuberculosis control targets.
• In sub-Saharan Africa, a woman's lifetime risk of maternal death is 1 in 16, compared to 1 in 2,800 in rich countries. According to the World Health Organization, "Putting in place the health workforce needed for scaling up maternal, newborn and child health services towards universal access is the first and most pressing task."

Recommendations

• Countries must develop and implement strategic health workforce plans for achieving international and national health goals. The World Health Organization and other health and development agencies should provide and facilitate the necessary technical support.
• Wealthy countries will have to provide much of the financial investment required to meet health worker needs. Preliminary estimates place the cost of doubling Africa's health workforce by 2010 at $2 billion in 2006, rising to about $7.7 billion annually by 2010.
• Significant use of paraprofessionals and community health workers will often be central to health workforce strengthening. Community health workers must be afforded sufficient compensation, training, supervision, and other support. Additionally, a sufficient number of physicians and nurses must supervise community health workers to ensure quality care.
• Health workers must have safe working conditions, adequate compensation, the capacity to help their patients, and the support of a sound management system.
• Donors and national governments should increase capacity to educate new health workers.
• Programs critical to improving public health should be exempt from budget and wage ceilings contained in agreements with the International Monetary Fund (IMF) and other international financial institutions.
• Donors must fully support the Global Fund to Fight AIDS, Tuberculosis and Malaria, and provide technical support to countries to enable them to apply for and implement programs for health system strengthening.
• Wealthy nations must stop actively recruiting health professionals from developing countries, except as part of an agreement with those countries, and must become more self-sufficient in meeting their own health worker needs.
• Donors should provide the World Health Organization and regional health and development organizations the funding they require to provide technical support, share information and build local health worker planning and management capacity.
• While there are capacity deficits in many AIDS-burdened countries - lack of health workers, problems with drug procurement, inadequate management of health personnel and other aspects of the health system - the proper response to these capacity deficits is not to limit funding to accommodate weak capacity, but rather to invest heavily in health workers and health systems to build that capacity.