Many countries around the world don’t have the number of health care professionals they require to run a robust health system. While there is an overall health worker shortage, part of the problem is brain drain where nurses and doctors train abroad and often don’t return, experts said during this week’s 80th United Nations General Assembly.
“We are operating from a really strong deficit, and the question is: How do we address this sustainably, equitably, and with dignity?” Anne Makena, director of partnerships at the University of Global Health Equity, or UGHE, in Rwanda, asked the room in New York.
Currently, 15% of health care workers globally are working outside their home countries, while Africa, in particular, faces a significant workforce shortage with 24% of the global disease burden but only 3% of the health care workforce.
At an UNGA80 side event, organized and hosted by the Saudi Commission for Health Specialties, or SCFHS, in partnership with Devex, four global health experts came together to discuss how international cooperation can strengthen health workforce education, retention, and mobility, especially in regions facing acute shortages.
“The world is facing the greatest health workforce challenge of our time while cross-border recruitment and migration are accelerating, opening new possibilities but also intensifying the strain on fragile systems,” said Fahad Alrowaitea, executive director of corporate communications at SCFHS. “The commission wanted to bring people together to discuss how to shape the future of global health and cocreate solutions that ensure health systems everywhere can rise to the growing demand for care.”
These were the takeaways from the event:
Speakers described recruitment practices that avoid brain drain by pairing recruitment with training replacements. For example, Ireland recruits general practitioners from lower-income countries for postgraduate surgical training, after which they must return home.
“Ireland gets the benefit of their labor during that time. … It’s a win-win situation because they’re not taking specialists, they’re actually creating specialists,” explained Dr. Kate Tulenko, founder and board chair of global health services company Corvus Health, adding that this is a blueprint that other countries could copy. In Germany, there is also a model of bilateral agreements with governments to recruit health workers while also expanding the pool of health workers.
Many health workers opt to train overseas because they don’t have access to affordable education at home, panelists said. Innovative funding mechanisms, including loans for training institutions and student support, could expand capacity. This is why UGHE, Makena said, is located in a medically underserved area in Rwanda and offers tuition-free programs. But universities also need loans, added Tulenko, so they can expand.
Felicitas Riedl, European Investment Bank’s director for innovation and competitiveness at the projects directorate, said the EIB provides financing for student loans and supports public and private sector development in health care education.
Riedl also highlighted how technology can be used to scale health care education while avoiding physically displacing people. Artificial intelligence, for example, is a “game-changer” that enables practical training to be done locally and theoretical content to be provided centrally, she said.
Digital platforms such as Appleseed Education, for example, can help to digitize curricula and administrative functions in low- and middle-income countries.
For technology to be scaled in this way, however, regulators should approve the use of digital learning, Tulenko said, and harmonize standards.
Accurate payroll and workforce data, alongside talking to health workers about what they need, can also improve local retention. “Health workers count, and we need to count them, and we need to have the global picture,” said Rachel Hoy Deussom, global strategist for health systems and workforce at the World Bank and steering committee member for the Frontline Health Workers Coalition.
Tulenko recounted her work in the Dominican Republic, identifying six million fake workers as an example. “It’s a massive level of payroll fraud with people getting paid twice, people who are retired who are still being paid, fake people. By having the correct data … they were able to free up about $9 million per year that they then used to hire real health workers and pay all the health workers more,” she shared.
With aligned values, clear metrics, and inclusive planning, international collaboration can expand and sustain the global health workforce, the panelists said.