By Kate Tulenko. The world currently has a shortage of some 4 million health workers. This shortage is amplified by a complete mismatch between where health workers are stationed and where they are most needed. The healthier and wealthier a community is, the more health workers it has. The poorer and sicker a community, the fewer health workers it has. The situation is worsening as every year hundreds of thousands of health workers move from poor, rural, and underserved communities to wealthier, metropolitan communities with a surfeit of health workers. This occurs both within countries (a nurse moving from a rural area to the capital city) and between countries (a doctor moving from a developing country to a wealthy country).
Governments and their development partners have struggled to address this problem. Many have tried mandating new graduates to provide a few years of service in underserved areas. These programs have met with variable success depending on the governments’ commitment and ability to enforce the plan. Since the publication of the World Health Organization’s well-thought out and evidence-based guidelines on increasing access to health workers in rural areas, some health systems are implementing mid- and long-term solutions such as recruiting and training health workers in underserved communities.
But governments are under intense pressure to solve the problem now. Some have tried rural retention schemes but many of these have been too expensive to maintain long term or scale up to the entire country. For example, Zambia has a rural retention program for physicians, but the program is funded by an external donor (not sustainable) and the salaries are significantly out of proportion with the salaries of other health workers as well as per capita income in the country. These programs also tend to be more expensive than necessary because ministries of health tend to design them without involving the workers in the rural areas that they want to retain or even workers in metropolitan areas that they want to post to underserved areas. The plans have no foundation in evidence. (more…)