"Stacking nurse numbers for a healthier society"

April 7, 2006 -- Today Business Day (South Africa) posted a fairly long article by Chantelle Benjamin headlined "Stacking nurse numbers for a healthier society." The piece is based primarily on a new World Health Organization report showing how important the number of health workers is to patient mortality, and how inequitably such workers are distributed around the world. The regions with the biggest health problems, especially Africa, have the fewest health workers. The piece does not really discuss nurses specifically, despite the good headline. But it does provide a striking picture of the crushing burden a lack of nurses and other health workers places on poor nations, as well as measures that could improve the situation.

The piece explains that the WHO's annual health report has "revealed" an "inverse relationship between the number of healthcare workers a country has and the number of deaths there." The report notes that the shortages impair "life-saving interventions" such as childhood immunizations and treatment for diseases like AIDS and malaria. The report estimates that 1.3 billion people lack basic health care. The article notes that the study includes "health service providers, such as nurses and doctors, and health management and support workers, who make up a third of the vacancies and who the WHO says are essential in a properly functioning healthcare system." The WHO is reportedly trying to help nations fill more than 4 million vacant health-related posts worldwide; it deems 57 nations to have serious shortages, and 36 are in sub-Saharan Africa. The piece also underlines the "huge divide between the haves and the have-nots":

The Americas, with 10% of the global burden of disease, has 37% of the world's healthcare workers and spends 50% of the world's health financing, whereas Africa has 24% of the world's diseases but only 3% of the world's healthcare workers and just 1% of expenditure. Not only are healthcare workers in Africa dealing with more diseases, requiring more expertise, but they have heavier work loads, poorer working conditions and they earn less than their American counterparts.

The piece links these poor conditions and a "limited investment in healthcare worker education" to a decline in the number of health workers being trained. It quotes WHO assistant director-general for evidence and information for policy Tim Evans as noting that the number of health workers is stagnating or declining in places where they are most needed. He cites both the lack of health care workers being trained and the "brain drain" of workers to higher paying jobs in more developed nations, which need more workers to care for aging populations. Evans notes that South Africa, which is one of the greatest exporters and receivers of health workers, has played a leading role in trying to stem emigration.

What is to be done? Shockingly, the WHO says fixing the problem will take money, specifically more direct investment from governments and development entities in the training and support of the health workers in the nations with severe shortages. The WHO recommends that nations focus on improving working conditions, salaries, and management skills. Evans also recommends bilateral agreements between rich and poor nations to ensure "responsible recruitment policies" that prevent developing nations from losing more skilled staff. The piece does not explore what such agreements might say, or whether a multilateral health worker recruitment agreement might make sense.

At first glance, articles like this might seem to suggest that the nursing shortage is just part of a larger trend in health care, and so the lack of public understanding of nursing on which the Center focuses is not a significant factor in the shortage. Nursing is of course greatly affected by the larger problems the report reflects, notably an apparent reluctance to allocate the resources needed to finance the level of health care and public health infrastructure society is now physically able to provide. But the abysmal level of understanding of nursing poses special problems, which is why nursing shortages are especially severe and appear in places without significant shortages of physicians and other health professionals. We are not aware that the professions of physicians and health management workers are well over 90% female, a devastating limit on nursing recruitment and power that flows in large part from public misunderstanding. The piece might have noted that health care workers are a highly diverse group.

We commend Ms. Benjamin and Business Day for this important piece on the critical global health problems that stem from issues in the health care workforce itself.

See the article by Chantelle Benjamin: "Stacking nurse numbers for a healthier society" from the April 7, 2006 edition of Business Day.