This session will focus on different model programs incorporating novel techniques to optimize training of health workers. Discussion will include the realities of “brain drain,” health worker migration, and maintaining a vibrant health workforce.

1. Models for Training & Maintaining the Global Health Workforce Ann Kurth, RN, CNM, PhD NYU, UW GHEC Conference Seattle 4/5/09

2. Global Health Workforce Health care workers (HCWs) = all people engaged in the promotion, protection or improvement of the health of the population Health mgmt & support workers: Professionals e.g. accountants, IT Associates e.g. administrators Support staff e.g. clerical, ambulance drivers Craft and trade workers e.g. hospital gardener HCWs: Professionals e.g. physicians, professional nurses, pharmacists, mental health professionals Associates e.g. associate nurses, lab techs Other community providers e.g. traditional practitioners

3. Current HCW Density Imbalances: Gender (>70% MDs male, >70% RNs female) Geographical Urban Sector? Public (2/3rds) vs. private (1/3rd) WHO ’06; Zurn ‘04

4. Distribution 16 million nurses globally; 2.2 million nurses in the US (8% foreign-trained) Hagopian 9/07; Aiken ‘07

6. Health Expenditure Inequality WHO ‘07

8. Migration 1/5 MDs, 1/10 nurses African-born are working abroad (Clemens ’08) Egypt Liberia Malawi

10. WHO ‘06

15. Nurse Trainers Teaching HIV/AIDS Nurse Specialists (HANS) in Ethiopia Vitiello ‘06

16. Traditional Roles of the Nurse (Task Oriented) Vital Signs & Weight Paperwork, completing forms Taking blood Support/ Counselling Dispensing Medication with specific orders from the MD Administrative Duties, Attending meetings Konjore, Vitiello, Weaver, Winters I-TECH 7/08

17. Expanded Role of the Nurse Side Effect Management, Laboratory Testing & interpretation of results Initiation and Refill of ART for stable patients ART readiness counselling Comprehensive assessmen t of pre-ART patients Nursing Leadership role as a active member of the Multidisciplinary Team On-going ART Adherence Assessment and Counselling Konjore, Vitiello, Weaver, Winters I-TECH 7/08

18. Nurse to physician ratio: 1.8 worldwide 0.5 in Mexico 3.5 in US 30 in Malawi Physicians per 100K Nurses & midwives per 100K Nurse to doctor ratio Community Health Workers per 100K Botswana 40.0 265.0 6.6 na Ethiopia 3.0 20.0 6.7 26.0 Kenya 14.0 118.0 8.4 na Lesotho 5.0 62.0 12.4 na Malawi 2.0 59.0 29.5 na Mozambique 3.0 31.0 10.3 na Namibia 30.0 306.0 10.2 na Rwanda 5.0 39.5 7.9 148.0 South Africa 77.0 408.0 5.3 32.0 Swaziland 16.0 662.0 41.4 434.0 Tanzania 2.0 35.0 17.5 na Uganda 8.0 66.0 8.3 na Zambia 12.0 189.0 15.8 na Zimbabwe 16.0 72.0 4.5 4.0 Above average 16.6 166.6 10.0 128.8 US average 256.0 937.0 3.7 na