The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.
The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:
EDUCATION RECOMMENDATIONS Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
REGULATORY RECOMMENDATIONS Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
FINANCIAL INCENTIVES RECOMMENDATIONS The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.
The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.
As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.
Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,” is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce. Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the “brain drain” that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.
14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.
The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.
The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.
You are not the only one encouraging your Congressperson to co-sponsor the Global HEALTH Act. Representative Barbara Lee sent a letter to all her Congressional colleagues last week, urging them to support the bill. Check out her letter below. It outlines the four ways that the Global HEALTH Act will assist with the development and implementation of Obama’s landmark Global Health Initiative. The Act will provide strategy, consistency and a greater emphasis on health workforce and health systems — all key to making foreign health policy that supports the right to health.
Her letter includes a list of organizations from across the globe that support the Global HEALTH Act — including PHR. Organizations are continually being added to this list, and we encourage you all to contact your Congressperson and urge them to co-sponsor this bill, which will revolutionize foreign health aid and save lives.
