While much of the attention on fighting AIDS and other diseases in poor
countries has focused on access to affordable drugs, concern is now shifting to
the question of who exactly, will deliver them. Unfortunately, there is a
severe shortage of doctors, nurses and other health-care workers in these
countries. According to a report published in this week’s Lancet by the Joint
Learning Initiative (JLI), an international consortium of academic centres and
development agencies, sub-Saharan Africa has only one-tenth the number Of nurses
and doctors per head of population that Europe does, though its health-care
problems are far mom pressing. (47) The reasons for this are tw07fold, and
well known—not enough health-care workers are trained in the fast place, and too
many of those who are trained then leave for better-paid jobs in the rich world.
What the report does is to put some numbers on these problems.
A mere 5,000 doctors, it finds, graduate in Africa each year (a third of
the number that graduate in America). Only 50 of 600 doctors mined in Zambia in
recent years are still in the country. There are more Malawian doctors in
Manchester than Malawi. (48) And many rich countries exacerbate the problem
by recruiting from poor ones to help deal with their own
shortages. To overcome all this. the JLI reckons that the
world needs 4m more health-care workers, of whom lm are required in sub-Saharan
Africa alone. The question is. who will pay for them The report floats some
ideas. (49) It recommends that roughly $400m, or 4% of the overseas aid
currently spent on health, -be earmarked to help build up the health-care
workforce in poor countries. (50) But it also suggests that better use be
made of existing resources, for example by employing local volunteers rather
than highly trained doctors for many. routine matters. As Lincoln Chen of
Harvard University, one of the report’s authors, points out, a few countries,
such as Brazil. Thailand and Iran. have taken steps in the right direction.
Others need to follow their lead.