Africa Needs a Million More Health Care Workers, Report Says
By CELIA W. DUGGER
The New York Times
November 26, 2004

Africa needs to nearly triple the number of its health workers if it is to reverse plummeting life expectancies and combat pandemics of disease, a research group of more than 100 scholars and experts said in a report released today.
So far, the global health debate has focused on lowering prices for AIDS drugs and increasing financial aid from wealthy countries. But money and drugs will fail unless poor countries have enough people to tend the sick, according to the research group, the Joint Learning Initiative, financed by the Rockefeller Foundation and the Bill and Melinda Gates Foundation, among others.
"These are not sexy issues like a miracle drug, but they hark back to the core issues of health," said Dr. Lincoln Chen, an author of the report and the director of Global Equity Center at Harvard.
The academics, health officials and other specialists in the Joint Learning Initiative said rich countries must take steps to slow what the report calls "fatal flows" of nurses and doctors from poor African countries to Europe and North America. By the group's calculations, Africa needs a million more health workers.
Wealthy nations must educate enough of their own nationals, the group says, rather than rely on doctors and nurses whose training has been paid for by African countries that are losing the fight against disease. The African Union estimates that poor countries subsidize rich ones with $500 million a year through the migration of health workers.
The group of specialists also supports growing efforts to channel doctors and nurses from rich countries, as well as from nations that willingly export health workers - Cuba, Egypt, India and the Philippines - to volunteer in Africa. It mentioned that the Institute of Medicine in the United States has recommended an AIDS corps of American professionals to help care for and treat people with H.I.V./AIDS.
The Joint Learning Initiative also called for the creation of an education fund that would pay to educate tens of thousands of health workers who are not doctors and nurses but are trained to diagnose and treat major killers in Africa - pneumonia, AIDS, malaria and tuberculosis - as well as to perform basic life-saving surgeries like Caesarean sections.
Such workers, used for decades in many African countries, are not attractive to employers in Western nations that rely on credentialed professionals.
African countries had banded together at the international assembly of the World Health Organization this year to push rich countries to compensate them for the loss of migrating health workers, but the group said in its report that computing who should pay how much and to whom was impractical in the fluid and largely undocumented global market for health professionals.
Instead, it said rich countries should voluntarily contribute to an education fund.
"Political pressures and public embarrassment are likely to grow as manpower shortages in the midst of health crises become linked to rich country's poaching of medical workers from those same countries," the Joint Learning Initiative's report said.
The Joint Learning Initiative commissioned studies that documented the importance of health workers in lowering death rates for infants, children under 5 and women in childbirth, controlling for the effects of higher income and female literacy in each country.
Researchers found that mortality rates fell with the rise of health worker density, defined as the number of doctors, nurses and midwives per 1,000 people.