Resource Spotlight: Where Have All the Workers Gone? The Extent of the Global Healthcare Worker Shortage, Why Workers are Leaving and Some Strategies for Addressing the Crisis
Throughout the 1980s, the doctor and nurse-to-patient ratio in sub-Saharan Africa was well below that of other developing countries – 1:10,800 for doctors and 1:2,100 for nurses. Some twenty-five years later, ten sub-Saharan African countries still have a 1:10,000 doctor-to-patient ratio, as compared to Honduras, India and Bolivia which each have approximately one doctor per 3,000 population. The problem is most acute in nursing and midwifery. In many countries, the education sector has also undergone reforms that have decreased the number of teachers and allocated fewer resources for public sector basic education. As a result, many secondary school graduates complete their education without the requisite academic skill sets needed to enter nursing, midwifery, medical and pharmacy schools.
Well-intentioned reform approaches have focused on reducing the absolute number of health workers with little or no regard for the mix of skills needed to meet client demand or burden of disease. As a result, those workers who remain are over-worked, poorly motivated and under paid, and eventually leave, thereby further accelerating the worker retention problem.
In Africa, poorer African countries are now providing labor for the more affluent African countries, whose own workers have migrated to countries with better working conditions. The African “brain drain” situation is acute. For example, Ghana has one of the better nurse training systems, in 1999, 328 nurses left the country, which is equivalent to the country’s annual output of registered nurses. [from author]
This presentation was part of a USAID Mini-University session in October 2007. It gives an outline of healthcare worker issues and shortages, including worker density by region, and a breakdown of the reasons for the HRH crisis in Africa. The presentation also presents solutions to address the problem.
View this resource.
The HRH Global Resource Center has other resources on this topic including:
- Data on the Migration of Health-Care Workers: Sources, Uses and Challenges
- Health Workforce Challenges: Lessons from Country Experiences
- Retention of Health Care Workers in Low-Resource Settings: Challenges and Responses
Past Resource Spotlights
- Guideline for Incorporating New Cadres of Health Workers to Increase Accessibility and Adherence to Antiretroviral Therapy
- Human Resources for Health Planning and Policies for Sierra Leone
- HRH Fact Sheets