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JOHANNESBURG, May 25 2007 (IPS) - A shortage of health care workers is paralysing the health system in Lesotho, Malawi, Mozambique and South Africa, and threatens the lives of millions, particularly in rural areas, warns Medecins Sans Frontieres, a global nongovernmental organisation specialising in medical services.
A new report by the organisation, launched in South Africa’s commercial hub of Johannesburg yesterday (24 May), shows that only South Africa has met the World Health Organisation (WHO) target for an adequate supply of health care workers: 74.3 doctors, 393 nurses and 468 health providers per 100,000 people.
The minimum WHO requirement is 20 doctors, 100 nurses and 228 health providers per 100,000 people. Even if South Africa meets the WHO target, it still suffers from a lack of staff to manage and deliver essential services like anti-retroviral drugs (ARVs) to prolong the lives of people living with HIV/AIDS.
The study, ‘‘Health Worker Shortage Limits Access to HIV/AIDS Treatment in Southern Africa”, found that Lesotho, Mozambique and Malawi are in desperate situations. ‘‘In Lesotho there are just 89 doctors, and 80 percent of these are foreigners,” Pheelo Lethola, field doctor for MSF in the tiny mountain kingdom of Lesotho, told journalists in Johannesburg.
The shortage also affects nurses. ‘‘There are only 1,123 nurses for a population of about 1.8 million. Only six of the 171 health centres in the country have the minimum required staffing,” Lethola said.
Malawi is also feeling the pinch. ‘‘Malawi has only 10 percent of the medical doctors and only 40 percent of the nurses recommended by the WHO. About half of the 165 medical doctors working in Malawi are in central hospitals, leaving severe shortages in rural areas. The vacancy rate for nurses in rural areas is 60 percent,” Veronica Chikafa, a Malawian nurse, told journalists.
Mozambique is facing the same predicament, MSF says, as there are only 2.6 doctors, 20 nurses and 34 health providers per 100,000 people.
‘‘About half of the 608 medical doctors active in Mozambique work in the capital city Maputo, leaving the health centres in rural areas devoid of medical doctors,” David Nhantumbo, medical technician for MSF in Mozambique, told the gathering.
Other African sub-regions face the same problem. Commemorating World Health Day last year, the WHO singled out sub-Saharan Africa as facing the greatest challenges.
‘‘While it has 11 percent of the world’s population and 24 percent of the global burden of disease, it has only 3 percent of the world’s health workers,” it said.
‘‘On average, one in four doctors and one in 20 nurses trained in Africa is working in the OECD (the Organisation for Economic and Co-operation Development) countries. Some countries have been hit harder than others. For example, 29 percent of Ghana’s physicians are working abroad, as are 34 percent of Zimbabwean nurses,” the WHO said.
WHO said 57 countries, most of them in Africa and Asia, face a severe health workforce crisis. ‘‘At least 2.4 million health service providers and 1.9 million management support workers, or a total of 4.25 million health workers, are needed to fill the gap. Without prompt action, the shortage will worsen,” it said.
In Southern Africa, most of the health care workers migrate to Canada, New Zealand, the United Kingdom and the United States where they earn more than they do at home.
For example, the doctors and nurses from Lesotho are leaving for South Africa and the United Kingdom for better pay and better working conditions, Pheelo said. ‘‘It is the responsibility of government to increase salaries and improve working conditions. For each day that no action is taken, more people are dying,” she said.
To stop the poaching of health professionals from poor countries, the South African government announced plans last year to reduce the recruitment of foreign doctors. But the plan was criticised by campaigners such as Mignonne Breier, a chief research specialist at the statutory research body the Human Sciences Research Council (HSRC).
‘‘Policy plans to reduce the number of foreign doctors are particularly difficult to understand when one considers South Africa has less than 7 doctors per 10,000 people whereas the UK has around 21, the United States around 24 and many European countries more than 30,” Breier wrote on the HSRC website.
‘‘Our own doctors emigrate in significant numbers (estimated at 150 per year) and, of those who stay, more than 60 percent work in the private sector where they serve less than 20 percent of the population,” she said.
‘‘There is the assumption that South Africa can make up the shortfall by rapidly increasing its output from medical schools. The aim is to double the number of graduates from 1,200 to 2,400 per year by 2014,” she said.
MSF South Africa believes that the brain drain could be reversed. Steps should be taken such as creating career prospects for nurses through promotion and training.
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