HEALTH WORKFORCE -- CRISIS AND OPPORTUNITY Fitzhugh Mullan George Washington University XVIII International AIDS Conference Vienna, Austria July 20, 2010
Feb 22, 2016
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.