Health workers are essential for health care. Without health workers there are no health systems, yet there is a critical global shortage of them, and it is the poorest countries that are most affected.
Take Africa for example; countries there have some of the worst health indicators in the world and people there die of preventable diseases more often than anywhere else. Yet while African people have 24% of the global disease burden, they only have 3% of the health workers to tackle the problem.
At the last estimate the world is 4.2 million health workers short of an adequate workforce. As well as this overall shortage, which needs to be addressed through training, retention and investment, there is the pressing issue of a global health worker imbalance caused by migration.
Of course health worker migration is a complex issue, caused by several interrelating factors. But there is one cause that those living in developed countries need to be aware of
Much of the health worker brain drain is caused by wealthy countries actively recruiting internationally trained health workers to fill the gaps in their own health service provisions. In 2006, it was estimated that 25% of all doctors and 5% of all nurses trained in sub-Saharan Africa had migrated and were working in the wealthy OECD member countries, meaning that rich countries are befitting from the already meager finance that the poorest countries in the world are able to put in to training health personnel.
This is no small financial loss for low-income countries. It is estimated to be in the billions, and it is thought that some countries may lose more funds through the health worker brain drain than they receive in aid for health. In other words, this is aid in reverse. This financial loss translates into the loss of lives, and the reinforcement of global inequality.
The UK is currently one of the largest destination countries for migrant health workers. While the UK did introduce a Code of Practice on the international recruitment of health workers in 2001, its impact has been questioned. The UK’s approach has been to actively recruit internationally trained health workers when it suits its current situation, and place strict restrictions on recruitment when it doesn’t. The latest figures show that 26.63% of doctors working in the UK gained their primary medical qualification outside of the European Economic Area, often trained at those countries’ public expense. This means poorer countries are paying to train the UK’s health workers while their own health systems suffer because of severe shortages.
Of course the right to migrate and the right to work are important rights that play a part in this issue, and the answer is not simple. But there are measures that will improve the situation . Wealthy countries should not have to depend on poor countries to supply their health workforce; they should train and retain more health workers nationally and manage their health workforces more effectively.
The World Health Organization has a Code of Practice on the International Recruitment of Health Personnel, but it is voluntary so lacks the teeth to make a real difference.
Simply stopping the reliance on internationally trained health workers does not go far enough considering that this practice has been happening for years. In recognition of this we should compensate the governments of low-income countries whose health workers are keeping the NHS afloat to the detriment of their own populations.
The urgency of this matter is compounded by the fact that Europe’s aging population and the current domestic shortages of health workers means the continent is on the edge of a huge deficit of health workers. Unless wealthy countries take action to address their own workforce shortages and adhere to ethical recruitment practices, the demand will draw more health workers from developing countries. Without compensation for this loss the progress the world has made in improving global health will be put at risk.
To find out more about the health worker crisis read this report from Health Poverty Action.