57 countries have shortages totaling 2.4 m doctors, nurses, midwifes, 4.3 m total (WHO)
1 to 1.5 million needed in sub-Saharan Africa (JLI, WHO)
New Graduates, 1985 to 2005 Slide from Pascal Zurn New grads per capita, OECD avg.
WHO: Africa has 24% of the world’s disease burden, but only 2% of the world’s health care workers. (Scheffler, 2008)
Physician Density per 100,000 Population Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.
Countries with a critical shortage of health service providers and respective emigration factors 13.9 13.9 10.7 8.4 1.3 1.7 5.2 1.6 1.4 Source: Mullan, F. (2005). The Metrics of the Physician Brain Drain. NEJM: 353:1810-1818. Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.
African docs in the U.S.= 6127 10 medical schools in 5 countries produce 75% of African migrants to the U.S. http://www.human-resources-health.com/content/2/1/17 Source: AMA masterfile School Country U.S. Physicians Nigeria 2636 South Africa 1901 Ghana 561 Ethiopia 359 Sudan 268 Others 546
Characteristics of Physician Workforces of US, UK, Canada, & Australia Source: Mullan, F. (2005). The Metrics of the Physician Brain Drain. NEJM: 353:1810-1818. Geez. Country Physicians per 100,000 population % IMGs in MD workforce (total IMGs) % IMGs from lower income countries % IMGs from other three countries U.S. 293 25.0 (208,733) 60.2 6.5 U.K. 231 28.3 (39,266) 75.2 2.5 Canada 220 23.1 (15,701) 43.4 22.3 Australia 271 26.5 (14,346) 40.0 33.5
Foreign-trained proportion of new doctors in rich countries is growing over time As a result of the growth in the demand for health professionals, combined with reduced domestic training rates, foreign trained doctors have made a progressively greater contribution to the health workforce in many OECD countries.
Source: OECD population censuses and population registers, circa 2000. Authors’ calculations Foreign-born doctors and nurses in OECD countries, by birthplace 50,000 20,000
Nurses Applying for External Licensing by Qualification, Uganda 2000-2005 (n=586) Over 75% of the nursing workforce applying for out-migration are Registered Nurses or Midwives. … Using routine licensure data (newly computerized)
New York Times June 24, 2007, graphic by Farhana Hossain from UN Population Division data http://www.nytimes.com/ref/world/20070622_CAPEVERDE_GRAPHIC.html Global Migration Snapshot
Money Source: Lancet, Vol 371 February 23, 2008, p. 675-681 - McCoy, Bennett, et al. Zambian doctor makes $1400/month Ghanaian doctor makes $1200/month after moonlighting American doctor makes $160,000 per year. Any questions?
Dear U-, Is anyone here listening to the voice of health workers especially those in developing countries whose parents have invested heavily in their training and their entire village looks up to them for something better? Does it mean that if one was born in poor Africa they should die there and are lesser human beings? They need to have something good for their children and future generations and if migration offers this then why not?I rest my case. Peace, M I
Is there evidence of a problem with health workforce supply and distribution?
If there’s a problem, what caused it?
Who are the stakeholders in this problem?
If we don’t solve the problem, what are the consequences?
What can be done to solve the problem?
What could you do to get involved?
At 2.5 workers per 1,000, health service coverage tends to level off 1yr olds fully Immunized against measles Births attended by skilled health personnel JLI report Fig. 1.3 Liberia, CAR, Chad, Mali, Eritrea, Ethiopia, the Gambia, Rwanda and Somalia have <.25 workers per 1,000 2.5 workers per 1000 population is minimum standard to achieve basic health goals
Doctors leave with other professionals Source: OECD International Migration Outlook, 2007, p. 177-Slide thanks to Pascal Zurn High rates of emigration of doctors is also generally associated with high rates of emigration of tertiary trained people in general . Highly skilled Doctors R=.6723
Statement Regarding the First Global Forum on Human Resources for Health-- Representatives from the United States have joined leaders and experts from around the world at the First Global Forum on Human Resources for Health, organized by the Global Health Workforce Alliance this week in Kampala, Uganda. This meeting highlighted many important issues regarding the shortage of health workers. The United States is fully committed to working with all stakeholders to address this shortage, and demonstrates this commitment every day through our partnerships in international public health and development worldwide. While the U.S. Government has not signed on to the Kampala Declaration or its associated Agenda for Global Action, we look forward to continuing to work on this critical issue in the future.