National Nurses United

14 REGISTERED NURSE The Joint Learning Initiative on Human Resources for Health and Development, an enterprise involving more than 100 global health leaders, list three major factors as exacerbating the problem faced by healthcare workers in the most understaffed areas of the developing world: HIV—which increases their workloads, exposes them to infection, and lowers their morale. Labor migration that is accelerating from countries that can least afford the brain drain. Two decades of health sector "reform" that has lead to chronic underinvestment in human resources. The problem of the migration of nurses and other healthcare providers has become an issue not only in the countries negatively affected but in the nations receiving the immigrants. Increasingly, governments and the healthcare industry in major industrial countries are turning to immigration as a way to solve—or avoid solving— shortages that have resulted largely from the "reforms." Vicky Lovell of the Institute for Women's Policy Research said, "It is immoral of the United States to ignore the impact of it [immigration of healthcare workers] on the countries where these nurses come from." Writing in the American Journal of Nursing, Diana Mason argues that the issue is a "primary moral" one of "draining these countries of their much-needed nursing resources and further undermining their healthcare infrastructure and the health of their people (and thus the health of their economies)." World public health specialists acknowledge the problem, but a major stumbling block, they say, is providing sufficient motivation for healthcare providers to remain within their countries. It's a problem faced by scores of other countries, particularly in Asia, Africa, and Latin America. South Africa, for instance, says it has spent $1 billion educating health workers who emigrated - the equivalent of a third of all development aid it received from foreign agencies between 1994 and 2000. Meanwhile, public health experts say the countries of sub-Saharan W W W. C A L N U R S E S . O R G APRIL 2007 MARCO UGARTE/AP With a population of more than 8 million, Nurse students Chad has around 3,600 health workers, of take classes at which 50 percent are unskilled, and another the nursing school 35 percent are nurses and midwives. And yet of the National one recent survey revealed that more than 10 Cardiology Institute percent of the Chadian-trained nurses were in Mexico City. working outside the country—mostly in France, some in the United States. Chadian healthcare figures are replicated throughout sub-Saharan Africa, which has 25 percent of the world's disease burden, and only 1.3 percent of the world's healthcare workers. Nor is the problem confined to Africa. Worldwide there is a shortage of trained healthcare personnel in the places most desperately in need. According to the United Nation's International Migration and Millennium Development Goal, "Poor countries, many of them with the fewest healthcare workers but the highest infectious disease burdens, are 'subsidizing' the healthcare systems of wealthier countries." Billions of dollars have been invested in efforts to prevent the spread of HIV and other diseases in the world's poorest countries. Yet at the same time, qualified health workers are leaving those same areas to work in the world's richest countries. The situation is particularly acute in Africa. More Malawian doctors are said to be practicing in Manchester, England than in the whole of Malawi. And only 50 of the 600 doctors trained since independence are still practicing in Zambia. In Central African Republic, Liberia, and Uganda, there are fewer than 10 nurses per 100,000 people, compared with more than 2,000 per 100,000 in countries such as Finland and Norway. Experts say there is a global shortage of at least 4 million healthcare workers. Health system weaknesses mean that death rates are rising and life expectancy is falling in the poorest countries, despite the global health advances of recent years. Healthcare workers hold the key to tackling these challenges. But urgent action is needed to improve the supply, capacity, and distribution of the global health workforce.

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