World needs 3.5 million more health workers to deliver essential services, charity says

BMJ 2011; 343 doi: (Published 21 September 2011) Cite this as: BMJ 2011;343:d6005
  1. Sophie Arie
  1. 1London

In the week in which this year’s session of the United Nations General Assembly begins, the charity Save the Children has called for a major push to secure funding to fill the global shortfall of 3.5 million health workers.

In a new report the children’s charity says that efforts to improve health worldwide in recent years have overlooked the need to boost the health workforce.

“The focus has been on inputs into the health system—drugs, vaccines, bed nets—all of which are critical,” says Save the Children’s chief executive, Jasmine Whitbread, in the report. “But without a parallel focus on recruiting, training, and retaining health workers needed these interventions will not deliver.”

The charity says that at present there is a global shortfall in funding of health workers. If donor countries donated 0.7% of their gross domestic product to aid (as pledged), and 15% of that to health, then the United Nations’ millennium development goal of reducing infant mortality by two thirds by 2015 could be met.

At present one billion people worldwide will never see a health worker, says the World Health Organization. Children aged under 5 years suffer the most from the lack of care. A critical shortage of doctors, nurses, midwives, and community health workers in the world’s 49 poorest countries means that millions of children die unnecessarily, the report says. A quarter of the global disease burden is in Africa, but the continent has just 3% of the world’s doctors, nurses, and midwives.

For everyone to receive basic healthcare at least 23 doctors, nurses, and midwives are needed for every 10 000 people. But Ghana has only half that number and Sierra Leone a 10th. Somalia, where almost a fifth of children die before the age of 5, has only 1.5 doctors, nurses, and midwives per 10 000 people. In contrast, Norway has 188 doctors, nurses, and midwives per 10 000, and only one child in 250 will die before turning 5.

It has been estimated that an additional 2.5 million health workers are needed in 49 low income countries, together with around one million community health workers. Save the Children’s calculations show that filling the 350 000 shortfall in midwives and having a health worker with midwifery skills present at every birth would save the lives of 1.3 million newborn babies each year.

Training of health workers in the poorest countries is also urgently needed. At present 173 000 health workers are trained each year in Europe and only 5100 in Africa. And salaries need to be boosted so that health workers don’t leave the poorest countries, the report concludes. Only 19 countries surveyed by WHO receive support from donors for health workers’ pay, because donors are reluctant to commit to long term, recurrent costs. In nearly a fifth of countries surveyed by Unicef nurses barely earn enough to keep them out of poverty. Some 81% of Liberian nurses and 75% of Mozambican doctors work abroad. Health workers who remain in the poorest countries are often concentrated in urban areas and used ineffectively.

African governments often fail to allocate enough (15%) of their national budget to health. Even when they do, many have such small overall budgets that the investment is still way too little. Liberia’s 17% share of spending on health works out at just $9 (£6; €7) per person. In contrast the United Kingdom spends $2500 per person per year on health.

Fragmented aid programmes often create an additional burden on national services. The Organisation for Economic Co-operation and Development found in a 2011 report that there were 185 separate donor health projects under way in Mozambique, each with separate planning, implementation, and reporting requirements.


Cite this as: BMJ 2011;343:d6005


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