The Global Shortage of Health Workers

New briefing – health workers and the MDGs

Health Poverty Action is part of a network of organisations calling for the UK Government to put health workers at the heart of the Millennium Development Goals (MDGs).

Download the briefing: pdf Health workers and the MDGs (757.48 kB)

There is a shortage of 4.25 million health workers around the world. Developing countries bear the brunt of this, unable to retain public health workers in the face of global competition for staff.

57 countries have critical shortages of health workers – and 36 of them in sub-Saharan Africa. This region has 25% of the global burden of disease but only 3% of the world’s health workers.

Developing countries can’t afford to train enough new health staff, and they can’t retain existing staff either. Low salaries, poor working conditions, and few opportunities for promotion or development mean many staff move to the private sector or non-governmental organisations who can pay more, or to wealthy countries. Conflict and instability only increase outward migration.

The statistics are startling:

  • 51% of health workers originally born in Kenya now work abroad
  • The wealthiest countries have on average 280 doctors per 100,000 people
  • The least developed countries have just 50
  • Countries such as Ethiopia, Kenya, Rwanda, Sierra Leone and Somalia have less than 10 doctors per 100,000 people.

Most developing country governments can’t afford to pay staff more, or expand training schemes. Even where they can afford to, they may face caps on government spending from international donors like the International Monetary Fund, which insists that keeping inflation low is more important than increasing public spending.

The lure of the West

Although some wealthy countries have codes of practice for recruitment of overseas health workers, these tend not to apply to private sector recruitment.

As a result, Ghana, for example, has lost $52.5 million of its training investment in health professionals to the UK, saving the UK $97.5 million in its own training costs between 1998 and 2002.

Looking ahead, the US expects to need nearly a million nurses over the next 15 years – a shortfall which is likely to be largely met by overseas recruitment.

One response was to set up the Global Health Workforce Alliance in 2006. It brings together governments, donors and agencies, and aims to train and support people to develop and implement health workforce plans for their countries. However, the Alliance does not seek an outright ban on active recruitment of staff by rich countries, which some critics say is still an important and feasible option.

Health Poverty Action says:

  • Without enough money, committed for the long term, to spend on the training and retention of health workers, many countries cannot begin to address their health crises in a sustainable way. Wealthy countries must address the broader factors behind the shortages, by delivering on their aid pledges.
  • Wealthy countries must financially compensate developing countries whose health workers are working in their health systems. They should also train more health workers to address their own shortages.
  • Partnerships should be agreed between wealthy and developing countries to provide incentives for potential migrant workers to stay at home, and for existing migrants to return to their home countries.
  • Responsible recruitment policies, where recruitment continues, need to be agreed with the governments of the countries whose staff are seeking to work abroad.
  • Developing country governments must give much greater priority to health spending within their budgets.

What is Health Poverty Action doing to help?


Last modified: 11/01/2011