HEALTH WORKFORCE --CRISIS AND OPPORTUNITY

Fitzhugh MullanGeorge Washington University

XVIII International AIDS ConferenceVienna, Austria

July 20, 2010

Countries with a critical shortage of health service providers (doctors, nurses, and midwives)

Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.

Density of Health Workers

Unequal Distribution of Health Workers

417

340280

220 220

13 2

206164

69 60

530

0

100

200

300

400

500

600

Cuba

Russia

Franc

eU.S.

U.K

.

Poland

Brazil

China

South A

frica

India

Ghana

Moz

ambique

Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.

Physician Density per 100,000 Population

Southern Challenge

Inadequate Educational Budgets

Modest Educational Capacity

Minimal Advanced Training Opportunities

Limited Practice Conditions

Lack of Post Graduate Training Opportunities

Insufficient practice Opportunities

Poor Remuneration Security Concerns HIV/AIDS

Push Factors from the South

Training Opportunities

Practice Opportunities

Better Remuneration Better Technology Family Opportunities

Pull Factors to the North and West

Rebooting the System

Educational scale up…

Socially accountable education…

16

3

Sub-Saharan African Medical Schools

Twenty do not yet have graduates Private schools have started in the last 20 years

Educational Innovations Global Health Workforce Alliance

Sub-Saharan African Medical School Study

Medical and Nursing Educational Partnership Initiatives (PEPFAR, NIH, HRSA)

Transformative Medical and Nursing Education Initiative (WHO)

Health Worker Migration

The Leaky Bucket…

Country Physicians per 100,000 population

% IMGs in MD workforce(total IMGs)

% IMGs from lower income countries

U.S. 293 25.0 (208,733) 60.2

U.K. 231 28.3 (39,266) 75.2

Canada 220 23.1 (15,701) 43.4

Australia 271 26.5 (14,346) 40.0

Source: Mullan, F. (2005). The Metrics of the Physician Brain Drain. NEJM: 353:1810-1818.

Characteristics of Physician Workforces of US, UK, Canada, and Australia

Global Regions

Sending country MDs in recipient

Countries by sending region

Sending country MDs in sending

regionEmigration

Factor

Sub-Saharan Africa 13,272 82,100 13.9

Indian Sub-Continent 78,680 656,876 10.7

Caribbean 8,010 87,443 8.4

Middle East and North Africa 27,010 489,464 5.2

Central and South America 12,103 707,416 1.7

Europe and Central Asia 44,988 2,741,717 1.6

East Asia and Pacific 39,910 2,808,400 1.4

North America 14,519 1,076,398 1.3

Source: Mullan, F. (2005). The Metrics of the Physician Brain Drain. NEJM: 353:1810-1818.

Regional Emigration Factors in 8 Regions Around the World

Source Countries of Nurses Immigrating to Selected OECD Countries

In the South -- To Do

Task shifting Community health workers Non-physician clinicians Focus on socially accountable education and

retention Strategic approaches – “sandwich programs”

and partnering

In the North -- To Do

Maintain support for quality and quantity scale up of health professional education

Train for Self Sufficiency

African Proverb…

The best thing to do is to have planted a tree

twenty years ago…

The next best thing to do is to plant a tree today.