Portal de Periódicos da CAPES

Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?

2008; Elsevier BV; Volume: 371; Issue: 9613 Linguagem: Inglês

10.1016/s0140-6736(08)60308-6

1474-547X

Edward J. Mills, William A. Schabas, Jimmy Volmink, Roderick B. Walker, Nathan Ford, Elly Katabira, Aranka Anema, Michel Joffres, Pedro Cahn, Julio Montaner,

Global Health and Surgery

Shortages of health-care staff are endemic in sub-Saharan Africa (table). 1 World Health Statistics 2007WHOSIS (WHO Statistical Information System). http://www.who.int/whosis/whostat2007/en/index.html Google Scholar Overall, there is one physician for every 8000 people in the region. In the worst affected countries, such as Malawi, the physician-to-population ratio is just 0·02 for every 1000 (one per 50 000). There are also huge disparities between rural and urban areas: rural parts of South Africa have 14 times fewer doctors than the national average. 2 Bedelu M Ford N Hildebrant K Reuter H Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care. J Infect Dis. 2007; 196: S464-S468 Crossref PubMed Scopus (215) Google Scholar These numbers are very different to those in developed countries: the UK, for example, has over 100 times more physicians per population than Malawi. 3 World Health OrganizationHuman resources for health 2007. http://www.who.int.whosis/indicators/2007HumanResourcesForHealth/en/ Google Scholar Furthermore, almost one in ten doctors working in the UK are from Africa. The insufficiency of health staff to provide even basic services is one of the most pressing impediments to health-care delivery in resource-poor settings. The consequences are clearly shown by the inverse relation that exists between health-care worker density and mortality. 4 Braitstein P Brinkhof MW Dabis F et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet. 2006; 367: 817-824 Summary Full Text Full Text PDF PubMed Scopus (967) Google Scholar , 5 Barnighausen T Bloom DE Humair S Human resources for treating HIV/AIDS: needs, capacities, and gaps. AIDS Patient Care STDS. 2007; 21: 799-812 Crossref PubMed Scopus (99) Google Scholar , 6 Anand S Barnighausen T Human resources and health outcomes: cross-country econometric study. Lancet. 2004; 364: 1603-1609 Summary Full Text Full Text PDF PubMed Scopus (430) Google Scholar TableRatios of health workers to number of population 1 World Health Statistics 2007WHOSIS (WHO Statistical Information System). http://www.who.int/whosis/whostat2007/en/index.html Google Scholar Physicians Nurses Pharmacists Number Per 1000 population Year Number Per 1000 population Year Number Per 1000 population Year Non-African countries Australia 47 875 2·47 2001 176 188 9·10 2001 13 956 0·72 2001 Canada 66 583 2·14 2003 309 576 9·95 2003 20 765 0·67 2003 UK 133 641 2·30 1997 704 332 12·12 1997 29 726 0·51 1997 USA 730 801 2·56 2000 2 669 603 9·37 2000 249 642 0·88 2000 Saudi Arabia 34 261 1·67 2004 74 414 2·97 2004 5485 0·22 2004 United Arab Emirates 5825 2·02 2001 12 045 4·18 2001 1086 0·38 2001 African countries Angola 1165 0·08 2004 18 485 1·31 2004 919 0·07 2004 Benin 311 0·04 2004 4965 0·72 2004 11 0·00 2004 Botswana 715 0·40 2004 4753 2·65 2004 333 0·19 2004 Burkina Faso 708 0·05 2004 4268 0·32 2004 343 0·03 2004 Burundi 200 0·03 2004 1337 0·19 2004 76 0·01 2004 Cameroon 3124 0·19 2004 25 997 1·60 2004 700 0·04 2004 Cape Verde 231 0·49 2004 410 0·87 2004 43 0·09 2004 Central African Republic 331 0·08 2004 908 0·23 2004 17 0·00 2004 Chad 345 0·04 2004 2146 0·24 2004 37 0·00 2004 Comoros 115 0·15 2004 481 0·61 2004 41 0·05 2004 Côte d'Ivoire 2081 0·12 2004 7773 0·46 2004 1015 0·06 2004 Congo, Democratic Republic of the 5827 0·11 2004 28 789 0·52 2004 1200 0·02 2004 Congo, Republic of the 756 0·20 2004 3214 0·84 2004 99 0·03 2004 Equatorial Guinea 153 0·30 2004 218 0·43 2004 121 0·24 2004 Eritrea 215 0·05 2004 2365 0·55 2004 107 0·02 2004 Ethiopia 1936 0·03 2003 14 270 0·20 2003 1348 0·02 2003 Gabon 395 0·29 2004 6275 4·64 2004 63 0·05 2004 The Gambia 156 0·11 2003 1618 1·13 2003 48 0·03 2003 Ghana 3240 0·15 2004 15 797 0·74 2004 1388 0·06 2004 Guinea 987 0·11 2004 4061 0·47 2004 530 0·06 2004 Guinea-Bissau 188 0·12 2004 912 0·59 2004 40 0·03 2004 Kenya 4506 0·14 2002 37 113 1·18 2002 3094 0·10 2004 Lesotho 89 0·05 2003 1123 0·62 2003 62 0·03 2003 Liberia 103 0·03 2004 589 0·17 2004 35 0·01 2004 Madagascar 5201 0·29 2004 3585 0·20 2004 175 0·01 2004 Malawi 266 0·02 2004 7264 0·59 2004 - - - Mali 1053 0·08 2004 5986 0·45 2004 351 0·03 2004 Mauritania 313 0·11 2004 1658 0·56 2004 81 0·03 2004 Mauritius 1303 1·06 2004 4438 3·60 2004 1428 1·16 2004 Mozambique 514 0·03 2004 3947 0·21 2004 618 0·03 2004 Namibia 598 0·30 2004 6145 3·06 2004 288 0·14 2004 Niger 296 0·02 2004 2421 0·20 2004 20 0·00 2004 Nigeria 34 923 0·28 2003 127 580 1·03 2003 6344 0·05 2004 Rwanda 432 0·05 2004 3570 0·42 2004 278 0·03 2003 São Tomé and Príncipe 81 0·49 2004 256 1·55 2004 24 0·15 2004 Senegal 594 0·06 2004 2606 0·25 2004 85 0·01 2004 Seychelles 121 1·51 2004 634 7·93 2004 61 0·76 2004 Sierra Leone 162 0·03 2004 1211 0·23 2004 340 0·07 2004 South Africa 34 829 0·77 2004 184 459 4·08 2004 12 521 0·28 2004 Sudan 7552 0·22 2004 17 656 0·51 2004 3558 0·10 2004 Swaziland 171 0·16 2004 4590 4·24 2004 70 0·06 2004 Tanzania 822 0·02 2002 10 729 0·30 2002 365 0·01 2002 Togo 225 0·04 2004 1667 0·33 2004 134 0·03 2004 Uganda 2209 0·08 2004 14805 0·55 2004 668 0·03 2004 Zambia 1264 0·12 2004 16 990 1·56 2004 1039 0·10 2004 Zimbabwe 2086 0·16 2005 9357 0·72 2004 883 0·07 2004 Open table in a new tab Finding solutions to the human resources for health crisisEarlier this month, medical workers at Lira Hospital in northern Uganda went on strike to demand unpaid allowances promised by the government for working in this war-torn area. Seven patients died. There were reports of bodies decomposing in wards and women in the maternity ward assisting with each other's deliveries. This shocking situation serves as a stark reminder of the reality of the human resources for health crisis in sub-Saharan Africa. It also highlights the complexities of the crisis, where competing human rights, health-care needs, and international agendas clash, and in which the poor and most vulnerable suffer the most. Full-Text PDF