Africa Hard Hit by Health Worker Gap

Every week, Charity Kiconco drives hundreds of miles down some of the world's worst roads on a motorbike, bringing drugs and counseling to hundreds of AIDS patients.

What the 26-year-old Kiconco lacks in medical training, she makes up for in commitment.

"It's a hard job. It's exhausting both physically and mentally," she said. "But then you see the difference you make to someone's life and it's worth it somehow."

Deploying workers like Kiconco trained in key tasks but without the range of qualifications of a nurse or doctor is one way of addressing a global health care shortage that is hitting African and other developing nations hardest.

Experts gathered in Uganda this week to discuss the problem also considered asking rich countries _ which often benefit from the migration of health care workers _ to compensate poorer nations for the staff they recruit and to pay to train health workers in the developing world.

The long-term goal, though, was galvanizing the funding and political will to radically expand the education and training of health workers in the developed and developing world.

The World Health Organization estimates that more than 4 million more health workers are needed worldwide to improve health systems and achieve international health and development goals. The gap is felt keenly in Africa, which carries 25 percent of the global disease burden yet has only 3 percent of the world's health workers and 1 percent of its economic resources.

"What's the use in having medicines if we don't have health workers to take it to the patients and ensure it's taken correctly?" asked Miriam Were, the head of the African Medical and Research Foundation.

Were previously worked as a teacher in Kenya but switched to medicine when she saw how many of her students missed classes due to preventable illnesses like diarrhea and malaria.

More typically, though, the movement is not from teaching to medicine, but out of Africa. For overworked and underpaid workers in developing countries, migration is often an appealing option.

The Global Health Workforce Alliance _ organizers of this week's conference in Uganda _ says a physician in sub-Saharan Africa or Asia might earn only $100 per month, but could earn $14,000 monthly in some developed countries. One in four doctors trained in sub-Saharan Africa works in a developing country.

"There are more Ethiopian doctors on the east coast of America than there are in Ethiopia," Were said.

According to figures published in the British medical journal The Lancet, the U.S. has 9.37 nurses per 1,000 people and Uganda has just 0.55. But even the United States is facing a shortage, according to organizers of the Uganda conference, needing 800,000 nurses and 200,000 doctors.

"Better working conditions at home would be a massive factor in mitigating migration but these countries don't have money," said Dr. Francis Omaswa, executive director of the Global Health Workforce Alliance. Rich countries should invest in training, he said, "so that we have a big enough pool of health workers to share between all of us."

Interim measures such as the training and use of community volunteers are being tried in many sub-Saharan and Asian countries.

Working in Uganda for a national charity called The AIDS Support Organization, Kiconco drives to drug distribution centers in rural areas and works with volunteers to mobilize patients to pick up their medication _ rather than having to make home deliveries.

Volunteers, themselves HIV-positive, have been trained in basic counseling and are provided with bikes. Competitive salaries, loan programs and training programs as well as a relaxed and informal working environment keep morale high.

"You would need to at least double my salary before I would think about leaving because this place has such a good working environment," said Emmanuel Odeke, a doctor with the organization.