FIGHT, NOT FLIGHT: THE NEED FOR HEALTH WORKERS IN DEVELOPING COUNTRIES

Research has shown strong correlation between health workers and population health. The workers of a health care system drive performance. Density of human resources for health is a significant factor in accounting for variation in mortality rates of infants, children under age five, and especially maternal mortality1. However, there is a shortage of adequate health workers in most developing countries. High absence rates among health care workers in poor regions are perpetuating the poor quality of health service delivery in developing countries2.

 In the case of some West African countries, trained physicians are migrating to rich countries in order to obtain better pay, working conditions, and research opportunities3. Though emigrating offers many benefits to these individuals, it is leaves little chance for the health care systems of their home countries to improve. Emigration adds to the shortage of physicians and leaves the need for health services left unmet, particularly in the case of Ghana and Nigeria. Possibly the bigger issue, however, is the detrimental effect such emigration has upon the possibility for systemic development in health care. Such systemic change requires leadership, and it will prove difficult for health care systems to expand or organize with so many physicians leaving the country.

 While it is understandable that migration is desirable in order to achieve high personal and career standards, it is difficult for me to completely understand the continued encouragement of emigration by medical faculty, given the perpetual negative effects upon the home country’s health care system. It is true that there are sometimes contributions made by alumni who have emigrated to their alma maters, but in the end this so-called brain circulation is really a brain drain for the home country. Incentives must be increased in order to encourage medical school graduate to stay in their respective countries of trainings. However, unless efforts are directed towards strengthening the other components of health care systems, it is unlikely—and unfortunate—that this culture of migration will change in the near future. Weak institutions for supplying public goods, such as health care, are a crucial barrier to good health service, as well as economic growth2.  Human resources as a health care institution must be strengthened, as retaining quality workers is essential to an effective health care system.

1Anand, S, Baernighausen, T. (2004) “Human resources and health outcomes: a cross-country econometric study” Lancet 364: 1603-09.

 2Chaudhury, N, Hammer, J, Kremer, M, Muralidharan, K, Rogers, FH. (2006) “Missing in Action: Teacher and Health Worker Absence in Developing Countries.” Journal of Economic Perspectives 20(1): 91-116.

 3Hagopian, A, Ofosu, A, Fatusi, A, Biritwum, R, Essel, A, Hart, LG, Watts, C. (2005) “The flight of physicians from West Africa: Views of African physicians and implications for policy.” Social Science & Medicine 61 (8). 1750-1760.

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