Medical Schools in Fragile States: Implications for Delivery of Care

OBJECTIVE: To report on medical schools in fragile states, countries with severe development challenges, and the impact on the workforce for health care delivery. DATA SOURCES: 2007 and 2012 World Bank Harmonized List of Fragile Situations; 1998-2012 WHO Global Health Observatory; 2014 World Directory of Medical Schools. DATA EXTRACTION: Fragile classification established from 2007 and 2012 World Bank status. Population, gross national income, health expenditure, and life expectancy were 2007 figures. Physician density was most recently available from WHO Global Health Observatory (1998-2012), with number of medical schools from 2014 World Directory of Medical Schools. STUDY DESIGN: Regression analyses assessed impact of fragile state status in 2012 on the number of medical schools in 2014. PRINCIPAL FINDINGS: Fragile states were 1.76 (95 percent CI 1.07-2.45) to 2.37 (95 percent CI 1.44-3.30) times more likely to have fewer than two medical schools than nonfragile states. CONCLUSIONS: Fragile states lack the infrastructure to train sufficient numbers of medical professionals to meet their population health needs.