C. Health Systems: Basic Infrastructure and Capacity Building

There is little doubt that the single most important way to ensure population health is to build enduring health systems in all countries. States and local communities must possess well-functioning public health and health care systems with sound infrastructures and skilled human resources. If the vast preponderance of international assistance went into helping poor States develop and maintain health systems, it would give them the tools to safeguard their own populations. What poor countries need is not foreign aid workers parachuting in to rescue them. Nor do they need foreign run state-of-the-art facilities. Rather, they need to gain the capacity to provide basic health services themselves.

Health systems include public health agencies with the ability to identify, prevent, and ameliorate health risks in the population—disease surveillance, laboratories, data systems, and a competent workforce. They also include primary health, bringing basic medical services as close as possible to where people live and work—maternal and child health, family planning, and medical treatment. Primary care promotes individual and community self-reliance and participation in the planning, organization, operation and control of health services, making fullest use of local and national resources.

Human resources are critically important for well functioning health systems. But the availability of skilled health workers is dangerously low in developing countries. In a cruel twist of fate, countries with the highest burden of disease also garner the lowest proportion of the global health workforce. Southeast Asia, which shoulders the largest share of the global disease burden, has only 12% of the world’s health workforce. Africa has only 3% of health workers worldwide. In contrast, North America and Europe command a far larger share of health and medical professionals than their need would indicate.

Poor countries often do not have the public health, medical, pharmacy, and nursing schools necessary to train sufficient numbers of HCWs. But, even when developing countries do train HCWs, many leave for more lucrative positions in richer countries. For example, in Ghana and Liberia, 30% and 60%, respectively, of the country’s physicians are working in the U.S. or U.K. Physicians in middle income countries such as India and Pakistan are similarly moving to the West in droves. The migration of HCWs is caused by a “push” from depressed working conditions and opportunities in poor countries and a “pull” from more attractive conditions elsewhere. North America and Europe represent an overpowering lure for doctors and nurses, offering salaries and career opportunities that far surpass what could be offered in a poorer country. The problem is not simply due to diffuse global market forces. Rather, OECD countries are aggressively recruiting HCWs, even as they acknowledge the resulting dire situation in poor countries.

This “brain drain” is leaving poor countries – as many as 57 by WHO calculations – unable to meet the MDGs because of a shortage of HCWs. Africa would need at least an additional one million health workers just to offer the services that could meet the MDGs.