Facing the heatlh worker crises in developing countries: a call for global solidarity

There is no doubt that health workers are the cornerstone of functioning health systems. Chronic under-funding of health systems in developing countries has led to the current health worker crisis, which threatens the achievement of the Millennium Development Goals. In recognition of this, WHO has devoted The warm health repart 2006 to health workers. (1) WHO calls for national leadership supported by global solidarity to face this crisis. The report notes that wage ceilings should not constrain workforce expansion and recommends that a status of exception be accorded to public spending; it exhorts donors to ensure immediate and long-term financing--with emphasis on support for the health workforce coordinated and aligned with emergency national strategies--and rich countries to enhance the adoption of ethical recruitment codes to manage migration. According to the report, the global deficit is nearly 4.3 million health workers: a critical shortage is faced by 57 countries, 36 of which are in sub-Saharan Africa. Paradoxically, these shortages coexist with underutilized talent. The cost of training health workers to eliminate the shortfall by 2015 is calculated as US$ 136 million per year for an average country. The additional cost of paying health workers once the shortage is met is estimated at US$ 311 million per country. Resource-poor governments are reluctant to take on such commitments without clear support from the international community. The report therefore urges donors to undertake immediate financial investment and sustain it over the next 10 years. While the report recognizes that inadequate salaries play a pivotal role in the fatal outflow of health workers, it does not analyse the major causes for such failure so its recommendations do not take account of them. Throughout the 1980s and 1990s, the World Bank and the International Monetary Fund (IMF) introduced structural adjustment policies (SAPs) to induce economic stability. These policies led to cuts in public expenditure that diminished governments' ability to expand and maintain infrastructure, to provide necessary supplies and equipment, and to train and sustain competitive salaries for the workforce. (2) To exacerbate matters, the World Bank portrays health workers as lazy, inept and prone to absenteeism. (3) The World Bank and other donors have actively pursued market-based restructuring of the public sector in poor countries, often imposing these reforms as conditions for their loans. Sanders et al. (4) state that public health services have been dangerously compromised through rationalization of staff. Failing to learn from the failures of SAPs, and despite most poor countries having achieved broad macroeconomic stability, the IMF continues to insist on punitive and ill-conceived restrictions on public spending. …