Health and Human Resources

(image credit: WHO)

I'm in Ethiopia for a final week of travel before I head back to the States for class. I had planned to head up to the northern part of the country to see some of Ethiopia's amazing historical sites, but a giant dust storm stopped out plane from landing and re-routed us back to Addis Ababa. In the hours I spent in line trying to negotiate a ticket refund, I got to talking with a fellow stranded passenger.

Turned out that passenger was in town presenting his research on the human resource crisis in global health. The World Health Organization and World Bank -- among some other partners -- are hosting an
international symposium on the topic here in town, and my co-passenger invited me to drop by since I had some extra time in Addis on my hands.

It was exciting to hear the presentations, both from government officials from several African countries and from international development agencies. But with this topic, as with many in global health, I left feeling almost as overwhelmed as I was motivated and excited.

Where do we begin, on a topic as vast and problematic as the shortage of trained health workers in Africa?

In my own work in Tanzania, I experienced the "HRH crisis," as NGOs like to call it, every day. The government health staff I met were usually overworked, underpaid, and shuffled around a circuit of
government health facilities as they are frequently assigned to new posts. It's no wonder so many African doctors and nurses leave their home countries to work in Europe, North America, or take more
lucrative positions with NGOs.

There simply aren't enough trained health professionals on this continent. According to a World Bank presentation I heard yesterday, Africa bears 24% of the global burden of disease. Yet it has only 3%
of the world's trained healthcare workers.

I admit the human resource problem wasn't high on my radar before I worked in Africa. Like most Americans, I thought of global health inequality as a question of commodities -- mosquito nets, HIV tests, penicillin. They're tangible, easy to visualize.

But as a representative from the Tanzanian Ministry of Health and Social Welfare said yesterday, "I want the human resources for health agenda as a top global agenda."

As it should be. How can somebody take his HIV medication if it isn't prescribed to him? How can a mother treat her infant's dehydration if someone doesn't recognize the symptoms?

The conference yesterday was filled with interesting ideas about how to answer those questions.

Joan Holloway, a representative of the U.S. Global AIDS Coordinator, assured the audience that PEPFAR -- that's the President's Emergency Plan For AIDS Relief, a multimillion dollar aid package to fight HIV
-- was increasingly dedicating funds towards training healthcare workers.

World Bank official Alex Preker argued that a boost in private sector programs, like private universities and training programs, could encourage health professionals to work in rural areas.

There was talk of eLearning, training village-level workers to diagnose common diseases, incentives to draw African doctors and nurses away from Europe and back to their countries of origin.

It's clear there isn't one easy solution. As a representative from the Liberian Ministry of Health and Social Welfare put it yesterday, any realistic approach to the African healthcare worker shortage will
address recruitment, retention, incentives, and management. That's a tall order -- four tall orders, actually.

What interesting strategies have readers come across? Is this problem gaining traction as an issue of importance to American donors and activists?