Pulling the Plug on Brain Drain

Many of the people in the world’s poorest countries are without adequate medical care, be it lack of medications and/or lack of health workers. The narrative regarding access to medications is quite complex and largely due to Big Pharma, yet the reason why there are an ever-decreasing number of health workers is essentially due to brain drain. Without health workers, there is no one skilled to diagnose and appropriately prescribe the myriad of medications churned out by Big Pharma. While reading the article Human resources for health: overcoming the crisis by Chen et al., I was struck by a particularly strong and profound statement: “Health workers are the ultimate resource of health systems…it is people, not vaccines and drugs, who prevent disease and administer cures. Workers are active, not passive, agents of health change.” Extensive research and efforts have been extended in order to increase access to pharmaceuticals, but what about increasing the number of health workers?

A frightening statistic only underscores the fact that Sub-Saharan countries must triple their current health workforce numbers, adding approximately one million providers, if they intend to realize the MDGs for health by 2015.1, 2 You may ask, where will these health workers come from? The solution lies in the ability of these countries to develop and implement dynamic programs, through which they may retain the current workforce and recruit new health workers.

Many health workers ultimately leave the decrepit and corrupt work environments of rural clinics, which have limited resources and low salaries. In light of these squalid conditions, in comparison to their urban counterparts, these workers can hardly be blamed for leaving. Furthermore, the employment avenues of the developed world, are far more fiscally and professionally enticing. Nevertheless, it is in these nations of shortage where health workers are needed the most. It is therefore, of utmost importance for countries to dramatically enhance working conditions for their health workforces and deliver both monetary and nonmonetary incentives in order to engender the motivation of providers and retainment. Additionally, these countries must upgrade their education system by enhancing their training capacity, decreasing their dropout rate, and improving the quality of the education provided through pre-service trainings.2, 3 A novel way to do this, would be by establishing partnerships between educational institutions in developing and developed countries.4

Another innovative technique to increase the number of health workers would be through the development of a population of non-provider clinicians (NPC). These providers require less training compared to nurses and doctors, and therefore are less costly, but are still capable of using a basic diagnostic skill-set and medical treatment protocols. Implementing a set of NPCs would then enable countries to deploy a group of community health workers (CHWs), or local villagers with limited health education.5 Due to the fact that CHWs require even less training compared to their counterparts, they would need to be monitored by providers with a higher level of competency. With the shortage of nurses and doctors, NCPs could fill this gap.

Regardless as to how countries choose to increase the numbers of health workers, all the means by which to do so require financing. An essential step would be for local, regional, and global actors to develop a partnership to create a strategic plan by which to address the issues. Additionally, donor organizations need to see the workforce shortage as the crisis that it is, and begin providing funds to countries in order to respond to the issue, rather than targeting specific diseases. For without health workers to assess people and prescribe corrective treatment, these interventions will only fail in the long run. In sum, to put it bluntly, the dire situation caused by the severe lack of health workers in developing countries requires nothing short of an exceptional global response.

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1.L. Chen, T. Evans, S. Anand, J.I. Boufford, H. Brown, M. Chowdhury, M. Cueto, L. Dare, G. Dussault, G. Elzinga, E. Fee, D. Habte, P. Hanvoravongchai, M. Jacobs, C. Kuowski, S. Michael, A. Pablos-Mendez, N. Sewankambo, G. Solimano, B. Stilwell, A. de Waal, and S. Wibulpolprasert. (Nov 2004). Human resources for health: overcoming the crisis. Lancet, 364(9449): 1984-1990.

2.R.M. Scheffler, C.B. Mahoney, B.D. Fulton, M.R. Dal Poz, and A.S. Preker. (2009). Estimates of health care professional shortages in sub-Saharan Africa by 2015. Health Aff, 28(5): w849-862.

3. Y. Kinfu, M. R. Dal Poz, H. Mercer, and D.B. Evans. (2009) The health worker shortage in Africa: are enough physicians and nurse being trained?  Bulletin of the WHO, 87: 225-230.

4. Resolution WHA59.23. (2006). Rapid scaling up of health workforce production. In: Fifty-Ninth World Health Assembly, Geneva, 22-27 May 2006. Geneva: World Health Organization.

5. F. Mullan and S. Frehywot. (2007). Non-physician clinicians in 47 sub-Saharan African countries. Lancet, 370: 2158-63.

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