The Global Workforce Crisis and Millennium Development Goals
Migration and the shortage of health personnel have placed human resources for health care on the agenda as never before. In 2004, the Joint Learning Initiative (JLI) reported an estimated shortage of 4 million health workers globally. This figure is based on the density of 2.5 health workers (physician, nurse, midwife) per 1000 population that is required to achieve 80% coverage of measles immunization and skilled attendants at birth (JLI, 2004). It was supported in 2006 in the World Health Report, which identified 57 countries as falling below this threshold, 36 of them in sub-Saharan Africa (WHO, 2006). The crisis also saw the launch of the Global Health Workforce Alliance, a partnership with national governments, finance institutions, health workers, international agencies, professional associations, academic institutions and civil society, dedicated to identifying and facilitating solutions to the human resource crisis (GHWA, 2006). It champions universal access to health care and the message that a skilled, motivated, and supported health force is the cornerstone of a robust health system.
Attention to “health human resources” is part of the Millennium Development Goals (MDGs), launched in 2000. With a target date of 2015, the eight MDGs address poverty, education, women, child mortality, maternal health, HIV and malaria, the environment, and a global social compact (UN, 2005). Achieving the MDGs ultimately affects the health and well-being of the world’s 6.8 billion people. Governments and others (e.g., the G8, made up of the heads of state of Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the U.S.) who meet annually to deal with major national and international economic and political issues recognized that these ambitious goals could not be met unless two key issues were addressed: Africa and the global health human resource crisis, particularly the nursing shortage.
Today nearly all nations face a nursing shortage brought about by increasing demand and diminishing supply, an aging nursing workforce, a shortage of other professional and ancillary staff, increasing acuity of illness, a poor image of nursing, and continuing health sector reform. For Africa, HIV/AIDS further complicates the shortage. Shortages vary by field of nursing, geography, level of care, sector, and organization; but one commonality exists: there are two shortages—a real shortage and a pseudo-shortage.
Pseudo-shortages exist in both developed and developing countries and occur when there are enough nurses in the country but when posts are not funded and/or nurses are not willing to work under the conditions available. For example, South Africa is said to have 31,000 vacant public sector nursing posts and 35,000 unemployed nurses. The lack of a positive practice environment (low salaries, poor benefit packages, lack of supplies and equipment, inadequate nurse/patient ratios, unsatisfactory patient and staff safety, lack of access to professional development and promotions, lack of family-friendly policies, and lack of decision-making input) remains the most critical element everywhere and particularly in Africa.
Africa is in dire straits. As former Prime Minister Tony Blair noted, “Africa is the only continent which, without change, will not meet any of the Millennium Development Goals” (Blair, 2005). While mortality rates are improving, in 2008 the mortality rate among children under 5 years of age in sub-Saharan Africa was 144/1000 live births compared with 6/1000 in industrialized countries (UNICEF, 2009). This means that an Ethiopian child was 30 times more likely to die by age 5 than a child in Western Europe (UNICEF, 2010). In 2008, malaria killed approximately 850,000 people, 90% of which were in Africa, mostly among children under 5 years of age (UN, 2010). In 2008, over 30 million African children were not attending primary school (UN, 2010), and 14 million were AIDS orphans (UNAIDS, 2009b).
During this past decade, successive meetings of the G8 have focused on aid to Africa. In 2005, they agreed to increase annual aid to Africa by $25 billion per year and overall aid by an estimated $50 billion by 2010. They have since reaffirmed these commitments as well as specific commitments for health and the health workforce, especially in Africa (DFID, 2009; Guebert, 2009). It will be important that nurses and other stakeholders monitor and lobby national governments to keep these commitments. Ultimately, we need to decrease poverty and increase health for all nations.