Global Shortage of Health Care Workers Finally Receiving Attention, NEJM Perspective Says

Donors and international agencies finally are addressing the shortage of health care workers in many parts of the world, Pooja Kumar, a resident at the Harvard Affiliated Emergency Medical Residency, writes in a New England Journal of Medicine perspective piece. "Although this shortage is not new," recent efforts to fight HIV/AIDS, tuberculosis, malaria and other diseases have "brought it into sharper focus," Kumar writes. Kumar adds that donors are "increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, pumping money into projects will not have the desired effects." According to Kumar, Africa has been most affected by the health worker shortage. The World Health Organization's World Health Report 2006 found that the continent has 24% of the global burden of disease but only 3% of the health care work force and 1% of the world's monetary resources to manage it, Kumar writes.

According to Kumar, health care worker shortages occur because of a "combination of underproduction, internal maldistribution" and "brain drain." Some countries -- including Ghana, Swaziland, Uganda and Zambia -- have "begun attacking the problem by implementing innovative programs that may serve as models for other countries," Kumar writes. Kumar adds that some efforts aimed at addressing issues contributing to shortages focus on improving overall health care systems. Others focus on improving wages and offer additional incentives -- such as including lunch allowances in workers' benefit packages -- Kumar writes. Some countries are recruiting trainees from rural areas to address "internal inequities," while others are providing special benefits for physicians who agree to serve understaffed areas, according to Kumar. In addition, some countries have "targeted task-shifting and the assembly of new cadres of workers" to curb worker underproduction, Kumar adds.

Although "additional health workers will be necessary for any solution, simply churning out more members of the work force will not be enough," Kumar writes. Kumar adds that workers "will need to be adequately trained and equipped to make a difference to their patients" and that the increasing "numbers of trainees may also overload the existing training programs in critical countries." Innovative programs implemented throughout Africa are "testing approaches to ameliorating the shortage," Kumar writes, adding, "Once effective pilot programs have been identified, scaling up will be the next hurdle" (Kumar, NEJM, 6/21).

The perspective is available online.