9 April 2006
Almost exactly 58 years ago, the World Health Organisation declared that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being". Yet in much of sub-Saharan Africa, life expectancy at birth is less than it was 30 years ago: in Sierra Leone it is now 36 years. How shameful that nearly six decades after the world's governments recognised a fundamental right to health, in some regions 600,000 women die each year at childbirth and 30,000 children under five die of preventable diseases or sheer hunger each day. One reason for this tragic loss of life is that human resources are insufficient.
Last month I visited Ghana, a stable democracy, a growing economy with improving educational standards, and disease rates less appalling than many of its neighbours. Ghana is getting many things right, yet it faces a range of challenges, particularly concerning health.
There can be no real improvements in health without sufficient staff to make them happen. Recent success stories, such as the astounding 60 per cent drop in the number of children who die each year of measles in sub-Saharan Africa, owe as much to staff and training as to affordable vaccines.
Ghana is renowned for producing well-trained medical staff, which helps explain why it is losing them faster than any other country in the region. It has only a third of the nurses and doctors it needs. The opportunity for any worker to migrate is an important and precious freedom. But the migration of health professionals is proving deadly for too many of Ghana's citizens. In 2002,72 new doctors graduated from Ghana's two medical schools, but 68 have since emigrated. In most years about one in four newly trained midwives and nurses goes abroad. The aging populations of Britain, Germany, the US and other richer countries are the beneficiaries.
Countries like Ghana need help to develop health systems that professionals want to build careers in. But these changes will take longer than Africa can afford to wait. The right to health for millions of people cannot continue to be denied. We need a constructive debate on what can be done today. One approach involves the training and use of para-professional health workers to fill gaps. These mid-level providers, less likely to migrate, have potential to deliver healthcare to those most in need, and least able to claim it.
But investments made by African countries in educating and training their health personnel are benefiting health systems in richer nations. We have a responsibility for helping to create a virtuous cycle of co-development, which can improve health in the global North and South.
Fortunately, that mind-shift is beginning to happen. Codes of practice for recruitment, and plans for exchange of talent and training, are being put in place by countries like the UK and South Africa in recent agreements on the movement of health workers. But more needs to be done. Africa has exported some of its most precious human resources. We must find ways to give something back, through increased training, technical help, equipment, and management expertise, such as the UK's scheme to train nurses in Malawi to balance those who have left. We can encourage the aspirations of African health workers who have migrated to give back to their country. Diasporas are a vitalising force that is often overlooked.
Health systems maintain the life of a country, and the people who work in them are its life blood. For too long the structural adjustment policies of the IMF and the World Bank, and the development approaches of donor countries have neglected the human resources that make health systems into public services. In the week of World Health Day, we should commit to doing more to support the hard-working people of Ghana, and their colleagues around the world who are struggling to make the right to health a reality.