Valuing health workers

VSO has provided doctors, midwives and other health workers to developing countries for over three decades. The health sector shows dramatically some of the inequalities in the global distribution of resources:

• Sub-Saharan Africa has only one per cent of world health expenditure.

• In Malawi there is only one doctor for every 100,000 people.

• Fify-seven countries show a chronic shortage of health workers and therefore very poor delivery of health services.

• One third of the global health force works in North America.

• Only four in every hundred health workers are in sub-Saharan Africa, which has a quarter of the global burden of disease, and less than one per cent of the world's financial resources.

• In the poorest countries in the world, patients are expected to pay for health treatment – people die because they cannot pay for healthcare.

The role of health workers

The role of health workers is pivotal for achieving and sustaining progress. This is firstly a matter of reducing the deficit in numbers, with an estimated 2.4 million doctors and nurses required by 2015. Secondly, it is a matter of training and motivation to ensure that the system is staffed with competent professionals. Thirdly, there are critical issues regarding health worker management and support where VSO has massive experience. These include the need for effective systems for deployment, promotion, terms and conditions and  working environments that enable rather than hinder their ability to deliver quality and inclusive services. Yet in many developing countries, dysfunctional health management and support systems have led to:

• low motivation and morale of health workers

• high levels of attrition, or health workers working two jobs at once

• regional and gender imbalances in health worker deployment

• inadequate terms and conditions

• poor living and working conditions for health workers (which contribute to negative impacts levels of morale and attrition rates)

• poor quality of health services received by the disadvantaged, and thus high levels of infant and maternal mortality and unnecessary ill health.

Faced with these dramatic injustices, VSO has seen that civil society needs to increase their advocacy with their governments, while international non-governmental organisations (NGOs) need to increase advocacy with powerful global institutions. For this to be achieved, we need to increase the evidence base for our advocacy, talking directly with health workers at every level in a countries health system. VSO has a five-year programme of research and global advocacy on human resources for health. Engaging on international advocacy strengthens the work being carried out in the field and gives voice to health workers who were previously voiceless.

‘Valuing health workers’

From years of experience supporting health and HIV programmes in the South, VSO believes that, for health systems to improve, there must be more health workers, recruited and retained. These workers need to be of good quality, in the right places, well trained and with access to the basic necessities of equipment and drugs. They also need to be well supported – placed in the right location, treated fairly, and well managed.

In the course of its five-year programme, VSO will carry out research and share the findings with important stakeholders such as the World Health Organisation. VSO aims to make a significant contribution to improvements in the quality of health worker recruitment, training and management, by identifying the issues that affect health worker motivation and morale.

Health worker migration

At present, Africa has just three per cent of global health workers but bears 24 per cent of the global burden of disease. In the last two decades, these shortages have been exacerbated by thousands of health workers leaving to find employment in developed countries, including the UK.

VSO have recently published Brain Gain – a report highlighting how improved circular migration, the legal and recurring movement of people, could help international aid efforts to tackle this ‘brain drain’ of health workers leaving Africa.

Brain Gain contains a number of policy recommendations that could reduce the devastating effects that the migration of health-workers is currently having on sub-Saharan Africa. VSO argues that by supporting the professional development of migrant health workers and increasing opportunities for health workers to return home and help their countries of origin, health worker migration could become a powerful force for strengthening the African health workforce. You can find out more by downloading the report from this page.