The global shortage in health workers is a global crisis that is undermining efforts at international development.
Natalie Sharples is a senior policy advisor at Health Poverty Action
The global shortage in health workers is undermining efforts at international development.
In 57 countries around the world there are less than 23 health workers for every 10,000 people. Despite their centrality to health systems, the critical shortage of health workers has not received enough focus in current discussions on development.
Lack of health workers fundamentally weakens health systems – vaccines, equipment and health centers are useless without anyone to administer or run them – and this hinders development and exacerbates global inequalities.
The migration of health workers to high income countries undermines the health systems and economies of low income countries, denying their citizens the benefits of the health workers they have paid to train. Studies have estimated that for countries in sub-Saharan Africa alone the investment lost to educating migrant health workers may well reach several billion US dollars.
How the UK benefits
Of all the countries in Europe the UK has received the most internationally-trained doctors and nurses, and is therefore a key beneficiary of this ‘reverse aid’. More than 30 per cent of all doctors and 10 per cent of all nurses in the UK are internationally-trained and in the mid-2000s it was widely reported in the media that there were more Malawian doctors in Manchester than Malawi.
Whilst the UK introduced a Code of Practice on the international recruitment of health workers in 2001, it fails to cover the private sector, and some studies have questioned its impact. The UK has taken a ‘boom and bust approach’ to health worker migration, actively recruiting internationally – trained health workers when it suits and placing strict restrictions on recruitment when it doesn’t, such as during the current economic downturn.
This, coupled with increasingly restrictive immigration policies, may be the main reasons for the current low levels of health worker migration to the UK. However, whilst health worker migration to the UK might be low today, we still have much to do to correct our legacy.
Greater political commitment
The UK should focus its attention on strengthening health systems in low income countries, building bigger and better trained workforces, and supporting their retention through improved support and working conditions. There needs to be greater political commitment to this issue, and it must be central to discussions around health systems in the new framework that will replace the Millennium Development Goals.
Perhaps most importantly, when we talk about financing for development we need to remember the benefits we have reaped at the expense of low income countries, and rather than ‘aid’ think instead of compensation.
Decision-makers in all countries have a responsibility to consider the impact of their policies on this global crisis. The World Health Organization Global Code of Practice on the International Recruitment of Health Personnel, adopted by all WHO member states in 2010, provides an impetus for action, but the Code itself has limits and is voluntary, needing political will to implement it.
With various initiatives during this week’s Health Worker Week, including the launch of a new EC funded project ‘Health workers for all and all for health workers across eight European countries, we hope to build momentum and political will in the UK and across the EU to address our responsibility to the countries whose health systems we have helped to undermine.
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