Poor nations denied health workers by West's cash lure

Western countries were warned yesterday to halt the poaching of foreign doctors and nurses from the world's poorest nations to shore up their health services.

The haemorrhage of health workers from poor countries to rich is a key factor behind a global health workforce crisis which is costing millions of lives, the World Health Organisation said.

At least 1.3 billion people have no access even to the most basic healthcare, often because there are no health workers, and the burden is greatest in countries hardest hit by poverty and disease.

WHO yesterday named 57 countries which are short of 2.4 million doctors, nurses and midwives in its annual World Health Report.

Essential life-saving measures such as childhood vaccination, pregnancy and maternity care and treatment for HIV, malaria and tuberculosis are threatened by the shortage.

"Not enough health workers are being trained or recruited where they are most needed and increasing numbers are joining a brain drain of qualified professionals who are migrating to better paid jobs in richer countries," said Timothy Evans, WHO assistant director-general.

In New Zealand, Canada, Britain and the United States, a quarter or more of all physicians have been imported from other countries. On average one in four doctors and one nurse in 20 trained in Africa is working in OECD countries.

Last year, a report by Save the Children and the charity Medact estimated that Britain had saved £65 million ($186 million) in training costs for doctors and £38 million for nurses it had taken from Ghana alone since 1999.

Estimates show that the US, which already has more than half of the world's nurses, will need a further 800,000 by 2012 and cannot fill the gap from those trained at home. It is expected to buy in nurses from abroad.

The 2006 World Health Report calls for urgent investment in training, recruitment of extra health workers in countries where they are most needed and incentives for them to stay.

It says health budgets will have to increase by at least US$10 ($16) a person per year in the 57 countries with the most severe shortages to educate and pay the salaries of the extra four million health workers.

But the report stops short of recommending measures to prevent health workers migrating, such as financial bonds to cover the cost of training or restrictions on exit visas.

Manuel Dayrit, WHO director of Human Resources for Health, said: "We know these don't work. And WHO supports the right to people to migrate and follow their aspirations."

More must be done to encourage them to stay, rather than preventing them from leaving, he said. In many countries, they were poorly paid and their conditions were "objectionable".

Britain introduced an employment code for NHS trusts six years ago which bans international recruitment from countries with the worst shortages.

But hospitals in the NHS and private sectors have found ways around it. As word has got around that a medical qualification can be a passport to a better life, applications to nursing and medical schools have soared.

The report says half of all new donor funds for health should be dedicated to health systems of which half should be allocated to training and retaining the health workforce.

- INDEPENDENT