Estimates of health care professional shortages in sub-Saharan Africa by 2015

Health Affairs

Volumn 28, Issue 5, 2009, Pages

  Scheffler, Richard M ^a,b   Mahoney, Chris Brown ^c   Fulton, Brent D ^c   Dal Poz, Mario R ^d   Preker, Alexander S ^e  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b PAHO/WHO Collaborating Center on Health Workforce Economics Research   (United States)

^c Global Center   (United States)

^d WORLD HEALTH ORGANIZATION   (Switzerland)

^e WORLD BANK   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AFRICA; ARTICLE; CLINICAL TRIAL; FORECASTING; HEALTH CARE COST; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HUMAN; MIDWIFE; MULTICENTER STUDY; NURSE; PERSONNEL SHORTAGE; PHYSICIAN;

AFRICA SOUTH OF THE SAHARA; FORECASTING; HEALTH MANPOWER; HEALTH POLICY; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; SALARIES AND FRINGE BENEFITS;

EID: 70349201001     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.5.w849     Document Type: Article

References (75)

1. World Health Organization, United Nations Children's Fund, and United Nations Population Fund, Maternal Mortality in 2000, Estimates Developed by WHO, UNICEF, and UNFPA, 13 December 2004, http://www.who.int/reproductivehealth/ publications/monitoring/9241562706/en/index.html (accessed 20 July 2009);
2. UN, "Goal 6: Combat HIV/AIDS, Malaria, and Other Diseases," in The Millennium Development Goals, 2007, http://www.un.org/millenniumgoals/pdf/ mdg2007.pdf#page=11 (accessed 28 August 2008).
3. WHO, Working Together for Health: The World Health Report 2006 (Geneva: WHO, 2006). Hereafter, a needs-based shortage (or surplus) will be called simply a shortage (or surplus).
4. L. Chen et al., "Human Resources for Health: Overcoming the Crisis," Lancet 364, no.9449 (2004): 1984-1990. (Pubitemid 39574602)
5. N. Crisp and B. Gawanas, Scaling Up, Saving Lives: Task Force for Scaling Up Education and Training for Health Workers, 2008, http://www.who.int/ workforcealliance/documents/Global-Health/Final%20REPORT.pdf (accessed 24 July 2009).
6. High-Level Forumon the Health MDGs, "Addressing Africa's Health Workforce Crisis: An Avenue for Action," December 2004, http://www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf (accessed 27 July 2009).
7. Addressing Africa's Health Workforce Crisis: An Avenue for Action," 2004, Ibid.;
8. Crisp and Gawanas, Scaling Up;
9. K. Wyss, "An Approach to Classifying Human Resources Constraints to Attaining Health-Related Millennium Development Goals," Human Resources for Health 2, no.11 (2004): 11.
10. A. Preker et al., "Scaling Up Health Professional Education: Opportunities and Challenges for Africa," Paper prepared for the Task Force for Scaling Up Education and Training for Health Workers, Global Health Workforce Alliance, World Bank, Washington, D.C., 2008.
11. O. Munjanja, S. Kibuka, and D. Dovlo, The Nursing Workforce in Sub-Saharan Africa (Geneva: International Council of Nurses, 2005);
12. S.A. Fritzen, "Strategic Management of the Health Workforce in Developing Countries:What Have We Learned?" Human Resources for Health 5 (2007): 4.
13. D. Dovlo, "Using Mid-Level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa: A Desk Review," Human Resources for Health 2, no.1 (2004): 7;
14. S.A. Brown and D.E. Grimes, "A Meta-Analysis of Nurse Practitioners and Nurse Midwives in Primary Care," Nursing Research 44, no. 6 (1995): 332-339;
15. J. Buchan and M.R. Dal Poz, "Skill Mix in the Health Care Workforce: Reviewing the Evidence," Bulletin of the World Health Organization 80, no. 7 (2002): 575-580;
16. G. Richardson et al., "Skill Mix Changes: Substitution or Service Development?" Health Policy 45, no. 2 (1998): 119-132;
17. A. Richards et al., "Skill Mix between Nurses and Doctors Working in Primary Care-Delegation or Allocation: A Review of the Literature," International Journal of Nursing Studies 37, no. 3 (2000): 185-197.
18. Dovlo, "Using Mid-Level Cadres";
19. Preker et al., "Scaling Up."
20. Buchan and Dal Poz, "Skill Mix in the Health Care Workforce."
21. A. Soucat, G. Fields, and E. Gasakure, "Not Enough Doctors and Nurses in Poor Countries: Adjusting Supply Policies to the Labor Market" (Working Paper, World Bank, Africa Region, 2008).
22. N. Dreesch et al., "An Approach to Estimating Human Resource Requirements to Achieve the Millennium Development Goals," Health Policy and Planning 20, no.5 (2005): 267-276.
23. R.M. Scheffler et al., "Forecasting the Global Shortage of Physicians: An Economic- and Needs-Based Approach," Bulletin of the World Health Organization 86, no.7 (2008): 516-523;
24. Crisp and Gawanas, Scaling Up.
25. WHO, "About the Global Health Atlas," http://apps.who.int/ globalatlas (accessed 20 July 2009).
26. The methodology used to impute missing wage data and the resulting wages for each country are shown in technical appendix Exhibit A-1, online at http://content.healthaffairs.org/cgi/content/full/hlthaff.28.5.w849/DC2.
27. UN Population Division, "World Population Prospects: The 2004 Revision" (New York: United Nations, 2005).
28. WHO, Working Together for Health.
29. For a background on the WHO's analysis, see N. Speybroeck et al., "Reassessing the Relationship Between Human Resources for Health, Intervention Coverage and Health Outcomes: Evidence and Information for Policy," 2006, http://www.who.int/entity/hrh/documents/reassessing- relationship.pdf (accessed 5 February 2009).
30. Chen et al., "Human Resources for Health";
31. S. Anand and T. Barnighausen, "Human Resources and Health Outcomes: Cross-Country Econometric Study," Lancet 364, no.9445 (2004): 1603-1609;
32. S. Anand and T. Barnighausen, "Health Workers and Vaccination Coverage in Developing Countries: An Econometric Analysis," Lancet 369, no. 9569 (2007): 1277-1285.
33. As in Scheffler et al., "Forecasting the Global Shortage of Physicians," we used more precise numbers per 1,000 population: 0.5487 doctors and 1.7313 nurses and midwives.
34. To be consistent with WHO, Working Together for Health, we used the term"doctor" instead of "physician" throughout this study.
35. Scheffler et al., "Forecasting the Global Shortage of Physicians";
36. WHO, Global Atlas of the Health Workforce, http://apps.who.int/ globalatlas/default.asp (accessed 20 July 2009).
37. The doctor supply data in Scheffler et al. "Forecasting the Global Shortage of Physicians," were based on the World Bank's Health, Nutrition, and Population database, which obtains its health care professional estimates from the WHO.
38. Scheffler et al., "Forecasting the Global Shortage of Physicians." Nine countries were missing midwife data. For these countries, we estimated the number of midwives by assuming that there were 1.2 midwives per doctor, which was the median midwife-to-doctor ratio from the reported data in Africa.
39. R.M. Scheffler, Is There a Doctor in the House? Market Signals and Tomorrow's Supply of Doctors (Palo Alto, Calif.: Stanford University Press, 2008);
40. R.M. Scheffler, N.J. Waitzman, and J.M. Hillman, "The Productivity of Physician Assistants and Nurse Practitioners and Health Work Force Policy in the Era of Managed Health Care," Journal of Allied Health 25, no.3 (1996): 207-217;
41. J.C. Record et al., "New Health Professions after a Decade and a Half: Delegation, Productivity, and Costs in Primary Care," Journal of Health Politics, Policy and Law 5, no. 3 (1980): 470-497.
42. Numbers do not add to total because of rounding. Also, our doctor supply estimate is different than that of Scheffler et al., "Forecasting the Global Shortage of Physicians," because the latter is based on a net shortage - that is, surpluses in countries offset shortages in other countries, and our study did not include Nigeria and Swaziland as shortage countries because their estimated number of nurses and midwives offset their doctor shortage (measured in doctor-equivalent units).
43. Between 2001 and 2006, these countries experienced an average increase in gross national income (GNI) per capita of 7 percent per year. If one assumes that the rate of growth is the same between 2007 and 2015 and that the income elasticity of health care spending is approximately 0.8 in low-income countries, then this would result in the annualwage bill to eliminate the shortage increasing to $4.0 billion, assuming that the real wage increase did not result in a productivity increase. Given the current global financial crisis, economic growth between now and 2015 is difficult to predict; therefore, we chose to not increase wages in real terms between 2007 and 2015.
44. Exhibit A-2 in the technical appendix (as in Note 16) shows the savings by country, assuming that the nurse-plus-midwife-to-doctor ratio increased by 50 percent and that one nurse or midwife equaled 0.8 doctors. The overall savings were 3.5 percent, but the savings varied by country, the highest being 16.1 percent.
45. World Health Organization, Working Together for Health.
46. Working Together for Health.Ibid.
47. World Bank, OECD, and WHO, Task Team on Health as a Tracer Sector, Effective Aid: Better Health, Report prepared for the Accra High Level Forumon Aid Effectiveness, 2-4 September 2008, http://www.who.int/hdp/publications/ effectiveaid-betterhealth-en.pdf (accessed 24 July 2009). Based on TT-HATS estimates of official development assistance (ODA) for health for twenty-nine sub-Saharan African countries,we estimated that ODA for health for the thirty-one countries with estimated shortages averaged $2.0 billion per year from 2002 to 2006. Our estimate applied the same per capita ODA for health estimates in the twenty-nine sub-Saharan African countries to our thirty-one countries with estimated shortages. Although the $2.0 billion only includes ODA for health, total aid for health is still well below the $19 billion needed.
48. Crisp and Gawanas, Scaling Up.
49. Scheffler et al., "Forecasting the Global Shortage of Physicians."
50. Dreesch et al., "An Approach to Estimating Human Resource Requirements";
51. International Council of Nurses, Nursing Care Continuum Framework and Competencies (Geneva: ICN, 2008).
52. Dreesch et al., "An Approach to Estimating Human Resource Requirements";
53. Buchan and Dal Poz, "Skill Mix in the Health Care Workforce."
54. Preker et al., "Scaling Up";
55. F. Mullan and S. Frehywot, "Non-Physician Clinicians in Forty-seven Sub-Saharan African Countries," Lancet 370, no.9605 (2007): 2158-2163;
56. Dovlo, "Using Mid-Level Cadres."
57. Crisp and Gawanas, Scaling Up;
58. Dovlo, "Using Mid-Level Cadres."
59. Task Force on Global Action for Health System Strengthening, G8 Hokkaido Toyko Summit Follow-Up: Global Action for Health System Strengthening: Policy Recommendations to the G8, http://www.jcie.org/researchpdfs/takemi/full.pdf (accessed 15 February 2009).
60. B.K. Baker et al., "Systems Support for Task-Shifting to Community Health Workers," http://www.healthworkforce.info/advocacy/Task-Shifting.pdf (accessed 4 September 2008).
61. Dovlo, "Using Mid-Level Cadres."
62. Chen et al., "Human Resources for Health."
63. M.B. Rosenthal et al., "Early Experience with Pay-for-Performance: From Concept to Practice," Journal of the American Medical Association 294, no.14 (2005): 1788-1793.
64. M.B. Rosenthal et al., "Climbing Up the Pay-for-Performance Learning Curve: Where Are the Early Adopters Now?" Health Affairs 26, no.6 (2007): 1674-1682.
65. C. Hongoro and B. McPake, "How to Bridge the Gap in Human Resources for Health," Lancet 364, no.9443 (2004): 1451-1456. (Pubitemid 39370722)
66. Chen et al., "Human Resources for Health";
67. Dovlo, "Using Mid-Level Cadres.quot;
68. Fifty-ninth World Health Assembly, "Rapid Scaling Up of Health Workforce Production," 2006, http://www.who.int/gb/ebwha/pdf-files/WHA59/ A59-R23-en.pdf (accessed 31 March 2009).
69. Preker et al., "Scaling Up."
70. Crisp and Gawanas, Scaling Up.
71. "G8 Hokkaido Toyko Summit Leaders Declaration," 2008, http://www.mofa.go.jp/policy/economy/summit/2008/doc/doc080714-en.html (accessed 20 July 2009);
72. WHO, "The Kampala Declaration and Agenda for Global Action: Health Workers for All and All for Health Workers," 2006, http://www.who.int/ workforcealliance/Kampala%20Declaration%20and%20Agenda%20web%20file.%20FINAL. pdf (accessed 20 July 2009).
73. WHO, Working Together for Health;
74. P. Verboom, T.T. Edgar, and D. Evans, "The Costs of Eliminating Critical Shortages in Human Resources for Health" (Working paper), http://www.who.int/choice/publications/d-human-resources.pdf (accessed 20 July 2009);
75. Preker et al., "Scaling Up."