In plain economic terms, the world has a supply and demand problem when it comes to healthcare workers.
Demand for health care is increasing as people live longer and suffer from diseases such as diabetes and cancer. However, the supply of medical workers is not keeping up.
A study based on 2020 data published in the journal BMJ Global Health found that by 2030, the world will have 1,000 fewer people than would be needed to reach the United Nations Sustainable Development Goal of universal health coverage. It is estimated that the country will face a shortage of 10,000 medical workers.
Jim Campbell, director of human resources for health at the World Health Organization, said the COVID-19 pandemic has exacerbated workforce shortages, with many staff leaving, falling ill or dying. Stated.
Data on labor shortages also reveal significant inequalities. According to a BMJ study, as of 2020, high-income countries had 6.5 times more healthcare workers per capita than low-income countries. The biggest shortfall is believed to be in the WHO's Africa region.
Campbell said two mechanisms are causing the global health worker shortage.
First, high-income countries have a shortage of trained doctors, nurses, and other health workers, so governments fill the gap by recruiting from abroad. For example, a paper in the Public Health Journal found that more than half of doctors registered with the British General Medical Council since 2018/19 were trained outside the UK.
In poorer countries, the situation is almost reversed, with more people getting qualifications than jobs. “In some lower-middle-income countries, high interest rates mean a debt burden.” [annual payments to service government borrowing] “This means that even though more graduates are coming through the scheme, there is no new funding to create jobs,” Campbell says.
“There is a global labor shortage due to a mismatch in demand… and supply from the education system.”
A lack of job opportunities at home has led many health workers to go abroad. A WHO report found that 42% of health workers in the organization's African region intend to emigrate in the future, mainly to the UK, the US, Canada, Ireland and Australia. But the region also has some of the highest levels of disease.
According to Dr Matshidiso Moeti, WHO Regional Director for Africa, this migration of health workers has sharply increased during the pandemic. Zimbabwe, Nigeria and Ghana are among the countries that have seen large-scale migration of health workers.
“The economic costs for African countries are enormous,” she says. For each doctor who emigrates, the country stands to lose about $1.85 million in profits from investments in doctor training, Moeti said. The region is currently “facing significant impacts from unmanaged global health workforce mobility,” she says.
Although the WHO advises countries to talk to each other and publishes best practice guidelines to ensure migration is mutually beneficial, self-interest often takes precedence.
A person receives a corneal transplant at an eye hospital in Nairobi © Patrick Meinhardt/AFP via Getty Images
“Ministers of Health are responsible for the health of the population and if there aren't enough workers… they're going to try to step it up,” Campbell said. “We totally understand that, but there's an ethical and moral responsibility. You can't take from people who have fewer resources than you.”
One solution to alleviating these workforce pressures is “task shifting,” or delegating some tasks to less highly qualified professionals. This has been effective in cases such as HIV testing in rural areas.
But ultimately, “the shortage is too great, the supply gap is too great,” Campbell warns. “If you have health care workers who are burned out, they're not going to be able to optimize their performance.”
Rob Yates, director of Chatham House's global health program, says the solution is to increase public health spending. “We need more public funding to meet the needs of an aging society. We have no choice but to accept this. We have no other choice.”
While this may be difficult in times of tight public finances, Chatham House research found that moments of genuine crisis can trigger expansion. In parts of Asia, the SARS outbreak led to large-scale spending. Thailand successfully grew its health system during her rebuilding from the 1997 financial crisis. A similar phenomenon was seen in post-genocide Rwanda. And Britain's National Health Service was a product of post-World War II austerity.
Recently, the new coronavirus infection has become such a crisis in some regions. Kenya, South Africa, Cyprus, and Egypt have since announced plans to expand health insurance coverage.
Moeti points out that since 2018, there has already been a 70 per cent increase in the number of healthcare workers being trained in Africa. However, job creation for these graduates remains a major challenge. WHO estimates that hiring all trained health workers in the WHO Africa Region will require a 43 percent increase in spending on health worker employment by governments, the private sector, and donors.
The private sector can play a role, especially while government budgets remain very tight: at least 40% of the additional training delivered in the WHO African Region between 2018 and 2022 was provided by the private sector.
Similarly, development spending can help. In Benin, one-time development spending boosted health care delivery. But “multilateral development spending is woefully inadequate,” Yates said. Like anything else, this is not a silver bullet.
