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Doctor Shortage Hurts Global Health Goals

November 26, 2004

LONDON — Efforts to combat diseases such as malaria, AIDS, tuberculosis and polio in the developing world are being thwarted by a critical shortage of 4 million health care workers, a new report has found.

Money is beginning to flow for health programs in poor countries and drugs, vaccines and technologies are now more available than ever. But it is of little use without the health workers to deliver the care, according to the report outlined in this week’s The Lancet medical journal.

“What we do, or what we fail to do, will shape the course of global health for the entire 21st Century,” said lead investigator Dr. Lincoln Chen of Harvard University.

Researchers documented for the first time the dangerous scarcity of doctors, nurses, midwives and community health workers in the developing world.

“On the front line of human survival, we see overburdened and overstressed health workers, too few in number, without the support they so badly need, losing the fight,” the report concluded.

Many of the weakest health systems are also the most besieged by HIV. In some countries, the disease is killing doctors and nurses faster than they can be replaced.

The ones that are left are often working in dire conditions, where supplies, drugs and facilities are depleted, the report found. It’s no surprise, then, that scores are fleeing to richer countries for a better life and more rewarding work.

The report found that there are more Malawian doctors in Manchester, England than in Malawi, and that only 50 of the 600 doctors trained in Zambia since that country’s independence stayed.

Experts estimate that countries need at least one health worker for every 400 people, but about 75 countries, with 2.5 billion people, fall below that minimum threshold, the report found.

In Uganda, for example, there is only one nurse or midwife for every about 11,000 people, while Liberia and Haiti have one per 10,000.

Shortages are most severe in sub-Saharan Africa, where HIV medications sometimes exist, but hardly anyone is available to distribute them. About 1 million new health workers – triple the current number – are needed immediately in sub-Saharan Africa to boost collapsing health systems, the scientists found.

Overall, 4 million new health workers are needed to meet the minimum health goals set by the United Nations at the turn of the millennium, the report says.

“It is people, not just vaccines and drugs, who prevent disease and administer cures,” the report said.

The report is the result of two years of analysis by the Joint Learning Initiative – a consortium of more than 100 health leaders worldwide sponsored by the World Bank, World Health Organization and private charities.

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Joint Learning Institute




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