This is the first in a two-part blog series from Tarascon Publishing Author, Matthew Dasco, MD, MSc.
The world’s burden of disease and human resources for health are not well aligned. While sub-Saharan Africa has 24% of the world’s disease burden, it only has 3% of the world’s healthcare workers. On the other end, the Americas region has 10% of the world’s disease burden but 37% of its health workers.
The Joint Learning Initiative (JLI) has calculated that the minimum number of health care workers (doctors, nurses, and midwives) in a population to achieve and 80% coverage rate of skilled birth attendance and measles vaccination is 2.5 per 1000 – countries with fewer than this number run a very high risk of not achieving the health-related millennium development goals (JLI, 2004). 57 countries in the world have been designated by the World Health Organization (WHO) as in this state of “crisis” with regards to human resources for health, which translates to a global shortage of roughly 2.4 million health workers (WHO, 2006).
(Chart from Kerry, 2011)
My first contact with the disparity between disease burden and human resources for health occurred while I was attending on the internal medicine wards at Princess Marina Hospital (PMH) in Gaborone, Botswana. PMH is the largest of two public sector tertiary care referral hospitals in the country. In our department, there were six general medicine teams, an oncology service, and a nephrology service – each was assigned an internal medicine specialist. The department consisted of two Cubans (a pulmonologist and a nephrologist), a Chinese generalist, an Indian generalist, a German oncologist, an Egyptian cardiologist, and a smattering of Americans working through university partnerships. I found it odd that there were only two Batswana internal medicine specialists working there – they were among a very small number that had received specialty training abroad and returned to their home country to practice.