Numbers of health workers being trained insufficient, states new report

International health and education experts recommend urgent implementation of new strategies to address acute shortages of health workers

In many countries, the number of people currently being trained to become health workers falls far below the levels needed to ensure health and development goals are met, states a new report released today under the auspices of the Global Health Workforce Alliance.

The report 'Scaling up, Saving Lives', issued by an international group of experts in health and education at a side event during the 61st World Health Assembly, stresses the need for urgent action to address the acute shortages of health workers. In Ethiopia, for example, some 200 doctors are trained a year for a population of some 75 million while the UK trains more than 6000 doctors for a population of about 60 million. In 2006, the World Health Organization estimated a global shortage of 4.3 million health workers.

"We are dealing with an urgent and critical shortage. Without implementing changes thousands of people in the poorest countries in the world will continue to suffer," said Lord Nigel Crisp, co-Chair of the Task Force for Scaling up Education and training for Health Workers, the international group tasked with producing the report as part of the work of the Global Health Workforce Alliance. "It is clear that fresh approaches, aligned to local needs, are required. More needs to be done to turn existing knowledge into action at country and international level," he said.

Responding to the 2006 World Health Assembly Resolution (59.23) which called on all member states to contribute to a rapid scale up of the production of health workers, the Global Health Workforce Alliance tasked the group, made up of governmental representatives, international development partners and agencies, professional associations and the private sector, to review and report on the experience of countries and research from around the world, and draw up practical proposals for how to massively scale up the education and training of health workers.

Drawing on examples from 10 country case studies--Bangladesh, Brazil, Ethiopia, Ghana, India, Kenya, Malawi, Pakistan, Tanzania and Venezuela-- the report details a set of recommendations to ensure a sufficient increase in health workers to achieve MDG targets.

Learning by example

Evidence presented from country case studies shows that there are several factors critical to successful scale up of the health workforce. Sustained political commitment from the highest levels; rigorous workforce planning that ideally includes long-term 10 year plans of action; an enabling environment including sound management systems and a labour market with capacity to employ new workers are all cited as essential for sustained health workforce education development.

The Task Force’s analysis demonstrates that scaling up can be affordable, and countries implementing successful models are reaping improvements in the health status of their populations. For example:

  • In Brazil in the late 1980s the Ministry of Health adopted the 'Family Health Programme' strategy of training family health teams to provide care for the country’s entire population. Each team, which looks after 2,000 to 3,500 families, is composed of one physician, one nurse and up to six health aides, such as auxiliary nurses, community health workers and other technical support workers.
  • The Ministry of Health of Ethiopia initiated the Health Extension Programme in 200, which focuses on community-level provision. This aims to train 30,000 new Health Extension Workers to work at local health posts and to provide a package of essential interventions to meet needs at this level. Additionally five thousand additional health officers will be trained by 2009 and the aim is to increase the annual medical student intake from 250 to 1,000.
  • The government of Pakistan created the Lady Health Worker cadre in 1994, aiming to provide essential primary healthcare services in the community. The programme set out to select, train and deploy 100,000 female community health workers, known as ‘Lady Health Workers’, throughout the country by 2005. Evaluation found that the population served by Lady Health Workers had substantially better health indicators than the control population.

Increased training, increased costs

Addressing financing, the report underlines that if the current shortage is to be resolved, increased and long-term sustainable investment at both domestic and international levels is urgently needed; and this has to be combined with all stakeholders coordinating their efforts to support country-owned health plans. The report estimates that it will cost an additional $2.6 billion a year to educate and train 1.5 million additional health workers, over a 10-year period, just in Africa. Subsequent employment of trained staff will incur additional costs.

"With the shortage of over four million, increased education and training of health workers is fundamental to resolving the crisis. Generating the necessary political will and commitment among key stakeholders and providing the necessary financing must therefore be a priority. All involved in resolving this crisis must commit to working together to ensure the funding available is implemented effectively and efficiently," said Commissioner Bience Gawanas, co-chair of the Task Force.

The Task Force concludes that if it's recommendations are followed, the impact of an increased health workforce, particularly one which focuses on community and mid-level workers, would already be seen by the MDG milestone of 2015; and the adoption of ten year plans with significant financial commitment could see considerable results by 2020.

"With concerted action at the national, regional and global level, the global shortage of health workers could be a thing of the past. This report shows us how effective and comprehensive interventions can reverse the current reality. But we have no time to lose. We must all work together and act immediately," said Dr Mubashar Sheikh, Executive Director of the Global Health Workforce Alliance.

WHO/A. Chaouachi
Official launch of the Task Force on Education and Training on 13 March 2007.

Notes to editors:

  • The Global Health Workforce Alliance (GHWA) was set up in May 2006, with a secretariat provided by WHO. It is a partnership of a wide variety of stakeholders (UN agencies, NGOs, academia, professional associations, donors and IGOs) with the common goal of working together to find solutions to the health workforce crisis.
  • Task Force members:
    • Lord Nigel Crisp (co-Chair)
    • Commissioner Bience Gawanas (co-Chair)
    • The Honourable Stephen Mallinga (Minister of Health, Uganda)
    • The Honourable Marjorie Ngaunje (former Minister of Health, Malawi)
    • Professor Miriam Were (African Medical & Research Foundation)
    • Peter Loescher and subsequently Dr Stefan Oschmann, with Dr Jeff Sturchio (Merck & Co)
    • Professor Srinath Reddy (Public Health Foundation of India)
    • Dr Cristian Baeza and subsequently Dr Julian Schweitzer, with Dr Alex Preker (World Bank)
    • Judith Oulton (International Council of Nurses)
    • Dr Anders Nordström (formerly World Health Organization)
    • Kathy Cahill (Bill & Melinda Gates Foundation)
    • Dr Francisco Campos (Ministry of Health, Brazil)
    • Sarita Bhatla and subsequently Louise Holt (Canadian International Development Agency)
    • Ann Keeling and subsequently Dr Ernest Massiah, with Peggy Vidot Commonwealth Secretariat)
    • Dr Michèle Barzach (Adviser on Health Strategy, France), with Dr Gustavo Gonzalez-Canali (Ministry of Foreign Affairs, France)
    • Dr Francis Omaswa, Executive Director, Global Health Workforce Alliance (ex-officio)