Africa's Health Care Worker Crisis
Views from the Ground
Nurses outside of a clinic in Luwero, Uganda

A health
worker displays
the entire drug
supply at a
clinic in
central
Kampala,
Uganda’s
capitol city.
The statistics are stark.
• Africa suffers a shortage of approximately 1.5 million health workers;
some estimates are even higher.
• African countries lose 20,000 skilled health workers per year, with up to
60% of doctors trained in some countries migrating within two years of
graduation.
• Africa suffers 25% of the global burden of disease but has only 3% of the
global health workforce.
• Despite being the epicenter of the HIV/AIDS pandemic, less than 1% of
the world’s health funding is spent in Africa.

DENOSA, the
Senegal has 6
doctors per national nursing
100,000 union in South
people, the
Africa, predicts
equivalent of
that more than
having 36
doctors for 300 specialist
the entire city nurses leave the
of Boston.
country every
month.
Source: The Joint
Learning Initiative 2004
Above: A child sleeps in a hospital bed in Karamoja, one of
the poorest and most underserved areas in Uganda.
Ask any African doctor or nurse, any relief worker or international
health official working in Africa--the continent’s health worker shortage
is a catastrophe. It is caused by many factors: small government
health budgets, recruitment by Western countries and research
projects, and even the welcome availability of AIDS treatment, which
is flooding clinics not unequipped to deal with so many people. But
there are solutions.

“I want to become a
doctor because there is so
much suffering here.
Africa is known as
the sick continent, with
more illness than
anywhere else. I really
want, in my small way,
in my small area,
to help Africa.
If year after year, we
all go away, the
Ugandan system will
continue to crumble.
What about our kids?
What about the future of
the country?”
--Stella Oolo, a Ugandan Medical Student

Health workers are the engine that drive health systems.
A broken ambulance in Gulu, Uganda
“Our overwhelming finding to date is that all life-saving programs, no matter
how simple and obvious their potential implementation may seem, suffer
from the enormous global deficit in skilled healthcare workers. The World
Health Organization estimates there is currently a critical deficit of 2.4
million doctors, nurses and other healthcare professionals, meaning that
people are already suffering and dying for lack of this pool of talent.”
--Laurie Garrett, member of the Global Health Program of the Council on
Foreign Relations, June, 2007

What Causes the Health Worker Crisis in Africa?
Many factors contribute to the
health workforce crisis in
Africa. Most African health
workers want to stay and
practice medicine in their own
country. However, a variety of
challenges make it very hard
for doctors and nurses to stay:
#1 Low salaries and benefits
#2 Severely limited training and
career opportunities
#3 Shattered health systems
#4 Inadequate occupational
safety
#5 Migration to wealthy nations
#6 The impact of HIV/AIDS

Challenge #1: The Impact of Low Salaries
“I very much want to stay in Uganda but there is a big temptation to work abroad.
We are offered peanuts in Uganda, and huge salaries in other countries.
Ugandan doctors make $250 a month—I have a relative in UK who makes 50 pounds
PER HOUR. He makes as much in 4 hours as I would make in a month. Another
friend’s uncle, a psychiatrist in the UK, makes 8,000 pounds per month.
Students have a passion to help their own people, but we need money.”
--Ronnie Kiweewa, a Ugandan Medical Student
Ronnie (far right)
and a group of
medical student
AIDS activists in
front of Mulago
Hospital in Uganda

Challenge #2: Severely Limited Training
and Career Opportunities
We have almost 2 months off for
We do not have the information
Christmas holiday. I don’t want to stay
resources we need to learn.
home and do nothing, but there are no
opportunities for us to do research so we
We need new textbooks that are can gain new insights and new skills.
not old and outdated. We have
no E-learning system—there are
We need activities that are free of charge
not enough computers.
and productive to expand our expertise.
--Nixon Niyonzima, Makerere
--Ronnie Kiweewa, Makerere Medical
Medical School Student, Uganda
School Student, Uganda

Challenge #3: Shattered Health Systems
Some hospitals have no hand
soap, no disinfectant to clean
operating rooms, no latex gloves,
no masks, and limited essential
medications. In some cases there
may be only one health worker
for an entire clinic, who is on call
seven days per week.
A 2002 study by the Uganda
Ministry of Health found fewer
than 20% of clinics surveyed had
electricity, only 66% had an on-
site water source, only 40% had
infection control provisions like
sharps containers in place, and
many lacked properly trained
staff.
Empty supply shelves in Rakai, Uganda

“The heath system is
shattered.
Patients came to the clinic
where I worked looking for
medicine, but the only lab
tech was gone. We could not
send their samples for tests,
so could only diagnose using
clinical guidelines.
We can’t properly serve our
patients this way, which is
discouraging.”
--Nelson Igaba, a Ugandan
School Student

Challenge #4 Inadequate Occupational Safety
“There is also the
obvious problem
of protection—we
have not had
access to
Hepatitis B
vaccinations or
PEP (and) there is
no guarantee of
safety—no gloves,
no drugs, no
vaccines.”
--Nixon Nixonzima
Ugandan Medical
Student
US and Ugandan health workers present a
potential campaign on occupational safety and
gloves for health workers at a symposium in
Kampala

Challenge #5: Health Worker Shortages
in Wealthy Nations
Developed countries have their own health workforce shortages, which are exacerbated by a
lack of investment by these countries in health worker training. Many of these developed
countries depend in part on African countries to subsidize their own health worker shortfalls.
This high demand,
combined with high
salaries and better
facilities, is
important to many
health workers who
want to both have
access to cutting-
edge technology to
heal patients and
earn enough to
support their
families and build a
life.
A Western Union Billboard in Kampala Uganda shows a health worker in a
developed country, with the latest medical equipment, sending money home to
her family in Uganda--a common occurrence across the continent.

Challenge #6: The Impact of HIV/AIDS
Left: A small clinic in Uganda
administers drugs for opportunistic
infections to a man whose daughter
is dying of AIDS and was too sick
herself to come to the clinic.
AIDS is exacerbating the health workforce crisis:
•The epidemic has put a major strain on already overburdened health systems
and health workers, leading to stress and fatigue.
•Across Africa, AIDS has killed thousands of health care workers. In South
Africa, 16% of the current health workforce is HIV positive, and the Malawian
government estimates they will lose nearly 3% of their workforce each year to
the disease.

While daunting, the health workforce crisis in Africa can be solved.
Innovative programs across the continent are helping alleviate health worker shortages:
• The COBES program in Uganda brings medical students to rural areas to teach and
learn from the community, making it more likely student will work in rural areas
upon graduation.
• In Swaziland, HIV positive health workers often forgo AIDS services at the same
facilities as their patients, fearing a loss of trust and authority. As a result, a
Wellness Center has been created to provide integrated and comprehensive
services for about 6,000 health workers and their immediate families.
• In Ghana, the concentration of health workers in urban centers means there are
almost no doctors in rural areas. With the help of the community, a mobile health
professional is placed at a rural health center, greatly increasing health services,
and other positive health outcomes.

Global Advocacy is Making a Difference:
Together, activists from across the globe are coming together in solidarity to fight for more
support for health workers in Africa, so they can support the health rights of their communities.
Joint conferences, meetings with policy makers and media outreach, in the US and Africa, have
brought this issue to the forefront of AIDS and public health discourse.

East African Advocacy:
In East Africa, health workers and medical students are coming together to form activist
groups that call for more government health spending and support for health workers in Africa
so they can reach even the most remote and vulnerable people with high-quality health care.
For more information on this work, please
contact PHR’s partner groups in East Africa:
Action Group for Health, Human Rights and
HIV/AIDS (AGHA-Uganda)
agha@utlonline.or.ug
+256 41 348 491
Kenya Health Rights Advocacy Network (KHRAN)
khran@khrc.or.ke
+254 20 387 4999

US Advocacy in Solidarity with African Health Workers
In the early 2000s, few people were addressing the health worker shortage as a
separate problem. But in 2004, Physicians for Human Rights published a major
“brain drain” report which made headlines around the world.Joining with US NGOs
like Health GAP and working closely with African health workers, PHR has brought
the problem to the attention of powerful US decisionmakers in the White House and
Congress.
The President’s Emergency Plan for AIDS Relief has identified the health worker
crisis as its central obstacle to delivering AIDS care.
Senator Richard Durbin has introduced the African Health Capacity Investment Act
of 2007, which is quickly gathering support In Congress.
But more support is needed. You can help.

Contact us to help!
For more information
about our campaign,
see:
www.physiciansfor
humanrights.org
or contact
Kate Krauss at
Physicians for Human
Rights:
kkrauss@phrusa.org
Updated September, 2007
Special Thanks to
Nicholas Leydon
Above: Medical students from Physicians for Human Rights and the American Medical
Students Association demonstrated at the Toronto International AIDS conference in 2006
in solidarity with their African colleagues. Empty white coats symbolized the doctors and
nurses missing from African countries.