A genuine concern for ordinary folk—by ordinary folk—carries the communities served by the Institute of Primary Health Care in remote Davao areas (photos above and below), where, for as little as a P20 membership fee and P5 in monthly contributions, poor people can access funds for emergency health care in a cooperative like setup. But initiatives like these are still few and far between in the developing world, where a severe lack of health personnel is as much a problem as infrastructure and medical insurance. --Manuel Cayon

GENEVA, Switzerland—The exodus of doctors, nurses and other health workers from many developing countries to higher-paying jobs abroad has created a health work force crisis taking its toll on the poorest and most vulnerable populations.  That was the warning raised by senior health officials who met here recently for the Geneva Health Forum 2008. The meeting heard reports saying that many developing countries in Asia and Africa face health-worker shortages. If present trends continue, this worsening shortage will push health systems to the brink of collapse, the forum warned.

Health workers in Asia—doctors, nurses and caregivers—who are seeking better-paying jobs and career advancement abroad, continue to migrate as the region’s population ages, the burden of chronic diseases rise and new health threats emerge, said Mubashar Sheikh, director of the Global Alliance on Health Workforce.

“This is a global problem. The demand for health workers has increased in the developed countries because these rich countries are not producing enough work force locally,” Mubashar said. “Urgent measures are needed to scale up education and training in poor countries like Africa and Asia.”

Citing the 2006 World Health Report, Mubashar said that 57 countries, most of them in Africa and Asia, face a severe health work force shortage of 4.3 million health workers, including 2.4 million physicians, nurses and midwives. Translated into access to care, the shortage means that over a billion people have no access to health-care professionals.

“Health workers are the cornerstone and drivers of health systems. The loss of its work force can bring the whole health system on the brink of collapse without prompt action,” he said.

In a number of middle-income countries with good medical education systems, such as Fiji, Jamaica, Mauritius and the Philippines, a significant proportion of students, especially in nursing school, enter their education with the intention of migrating, usually in search of a good income.

Mubashar said some countries—notably the Philippines—are seeking to capitalize on the demand for imported health workers by deliberately producing graduates for international export.

The United Kingdom and the United States have been major destinations for doctors and nurses. While government statistics show that 15,000 Filipinos leave each year to work abroad, an estimated 35,000 nursing positions in the Philippines remained unfilled.

“The health-care system in the country has gone critical. Nurses and doctors are leaving for a variety of reasons like political instability, low pay, corruption and poor working conditions. But we cannot stop them from leaving because it’s their right also,” said Filipino health researcher Don Eliseo Prisno, who attended the forum.

Prisno said that besides overall health-worker shortages, the work force problem is compounded by minimal expertise in epidemiology and laboratory analysis, which is necessary to meet emerging infectious diseases.

Still, he conceded, “The movement of health workers abroad has also positive features. Each year, migration generates millions of dollars in remittances and has, therefore, been associated somehow with a decline in poverty.”

The health-related Millennium Development Goals  aim to reduce child mortality, improve maternal health, combat HIV/AIDS and other diseases, such as tuberculosis and malaria, and ensure access to essential medicines. The health-worker shortage has been a major impediment to making progress on meeting these goals, Prisno said.

Ndioro Ndiaye, deputy director general of the International Organization for Migration, said it is high time programs and policies are put in place to reverse the devastating effects of the “brain drain” in developing countries.

Ndiaye said experts, for example, in the African continent, are increasingly engaged in strategies and programs to reverse the brain drain or retain skilled professionals at home. They include restrictive policies aimed at delaying emigration, such as adding extra years to medical students’ training. Various tax proposals have also been put forward as governments realize that the large number of citizens living outside their borders are a potential economic resource.

She said another strategy is the adoption of international agreements by industrial and developing nations under which wealthy countries pledge not to recruit skilled people from developing states.

“Time is running short. The problem on migration and shortage of health workers is becoming bigger and more alarming. We can overcome this crisis if we get our acts together and address the issue,” said Mubashar.

What else can be done? As a means of curbing the brain drain, Mubashar said governments need to scale up education and training of health workers; pay them reasonable salaries; enforce more conducive policies and environment, as well as better financial and nonfinancial incentives; and seek creative solutions to retain them.

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