KHOPOTSO: April 07th of this year, 56 years since the first World Health Day was observed, is dedicated to acknowledging the important contribution made by the almost 60 million health workers around the world. Two-thirds of that figure are health service providers on the front-line of services. The annual World Health Report, normally published on this day, focuses on the key issue of human resources for health care in the world.
Dr TIM EVANS: Who are the health workers? The report defines health workers as all people whose main activities are aimed at enhancing health. And there are two primary categories that the report identifies. The first are health service providers, which is a category that, intuitively, most people would expect ‘ nurses, doctors, pharmacists, lab technicians, dentists, etc. But secondly, and most importantly, a set of management and support workers, which include public health workers, financial officers, procurement managers, administrators, planners and hospital staff.
KHOPOTSO: Dr Tim Evans, Assistant Director-General for Evidence and Information for Policy at the World Health Organisation, speaking at a media conference in Johannesburg. The report, entitled ‘Working together for health’ is to be launched in Zambia today. It is no surprise it identifies a dire shortage of health service providers in Africa, compared to, say, in the United States or Canada.
Dr TIM EVANS: The Africa region has the lowest number of health workers as well as the lowest density of health workers, defined as the number of health workers per 1000 population. The Africa region has 2.3 workers per 1000 in comparison to the Americas where the density of health workers is about 24.8 health workers per 1000, nearly 25. So, (it’s) a ten-fold greater density of health workers in the Americas relative to the African region.
KHOPOTSO: With almost 22 million, the Americas have the highest concentration of health workers in the world. Africa pales in comparison, with the lowest number just a little over one-and-a-half million. In contrast, the continent has a far higher burden of disease ‘ about 25% – and only 3% of the work-force to deal with it.
Dr TIM EVANS: The critical shortages are a primary constraint to the achievement of health targets as well as a constraint to an effective response to looming threats, including Avian Influenza.
KHOPOTSO: The shortage has a particular impact on a major programme of public health in South Africa ‘ the national rollout of the government’s AIDS treatment programme.
Dr TIM EVANS: Perhaps a quote based on a study from this country suggested that a shortage of human resources has replaced financial issues as the most serious obstacle to implementing national HIV treatment plans.
And what’s happened in the area of HIV where there’s been a large global commitment to scaling up access as drugs have become cheaper and billion dollar funds have been mobilised to help in the financing, those on the ground have run into the constraint that there are not enough or enough workers who are appropriately trained.
KHOPOTSO: Last year, the World Health Report identified Maternal and Child Health as a priority public health service in urgent need of skilled workers. About 300 000 skilled birth attendants were needed globally to increase access to life-saving maternity services for mothers. And the situation is not about to get better.
Dr TIM EVANS: In the OECD countries, the economically developed countries, populations are ageing rapidly. The demands of these populations for chronic care, new technologies, are driving the growth of health systems such that there are major shortages in those countries at the moment. At the same time they are not expanding the production or training of their health workers’¦ Those gaps in health workers that OECD countries are facing will be filled, undoubtedly, through international recruitment.
KHOPOTSO: These workers are most often recruited from the 57 crisis zones the report identifies. And 36 of these are in Africa. To prevent the brain drain from needy countries the WHO has developed a set of ethical recruitment codes of practice to be followed by the rich nations. In addition, individual countries including South Africa, have bi-lateral agreements between themselves, such as the South Africa-UK one. But, says Dr Evans, the final responsibility is with countries losing much-needed skills to improve working conditions and to train increased numbers of health workers to counter the recruitment drive.
Dr TIM EVANS: We need emergency national health work-force plans in the crisis countries’¦ These plans have to make sure that health workers that are in the system now are used more effectively’¦ We need a very significant increase in training capacity. We are exiting, hopefully, from an era whereby training was seen as costly and work-force seen as recurrent costs to be minimised.
KHOPOTSO: Meanwhile, the Department of Health in South Africa will today launch its plan for human resources improvement. The plan will address issues such as the number of health workers needed in different categories and how many need to be trained in the next few years. But while number crunching is important, the plan also tries to address the working conditions of health workers, career development and issues of salaries and other incentives.