PAHO/WHO urges improved allocation and retention of health professionals in areas of greatest need

Recife, Brazil, 11 November 2013 (PAHO/WHO) — About 70% of countries in the Americas have sufficient—and in some cases, more than enough—doctors, nurses and midwives to provide basic healthcare services for their populations. But many face challenges in the distribution, training and migration of health personnel, according to data from the Pan American Health Organization/World Health Organization (PAHO/WHO).

The conclusions are in a 2013 report assessing progress toward a set of regional goals for human resources in health, which focuses on five key challenges in this area: planning, distribution, migration, labor relations and relations between training and educational institutions and countries' health services.

"One of the challenges for achieving universal health coverage is ensuring that everyone—especially people in vulnerable communities and remote areas—has access to well-trained, culturally sensitive and competent health staff," said Dr. Carissa Etienne, PAHO Director and WHO Regional Director for the Americas. "The best strategy for achieving this is to strengthen multidisciplinary professional teams at the primary healthcare level."

Twenty-five countries of the Americas report having over 25 health workers per 10,000 inhabitants—the minimum recommended by PAHO/WHO—while three countries are on track to reach that level by 2015 (Belize, El Salvador and the Dominican Republic). Eight are below that minimum. Among countries over the minimum, 11 have between 25 and 35 health staff per 10,000 inhabitants, 12 have between 35 and 100, and two have more than 100 per 10,000.

The countries of the Americas that have the greatest density of human resources in health are Barbados, Canada, Cuba, the United States and Venezuela, while those with the lowest density are Bolivia, Guatemala, Guyana, Haiti and Honduras.

Globally there is a shortage of some 7.2 million health workers, and that number is expected to reach 12.9 million in 2035, according to a new WHO report, A Universal Truth: No health without a work force, launched at the Third Global Forum on Human Resources for Health, which is being held on Nov. 10-13 in Recife, Brazil. The forum was organized by the Global Health Workforce Alliance and PAHO/WHO with support from the Government of Brazil. More than 1,000 delegates from around the world are participating, including ministers of health.

The concentration of health professionals in urban areas at the expense of sparsely populated and difficult-to-access areas is another problem facing countries in the Americas. In Peru, for example, 47.7% of health personnel were concentrated in the cities of Lima and Callao in 2009. In Lima, there were 15 doctors per 10,000 inhabitants, while in the city of Ayacucho, in the Andes mountains, there were only five doctors per 10,000 inhabitants, according to the PAHO/WHO report Health in the Americas 2012.

"Countries have made progress, but more efforts are needed to put the right health personnel in the right places to ensure distribution that is equitable and that meets people's health needs," said Charles Godue, coordinator of PAHO/WHO's Human Resources for Health program.

Migration of health personnel also has a major impact on health care, particularly in the Caribbean, some Central American countries, and increasingly in South America. More nurses from the Caribbean work abroad than in the countries where they received their training, and thanks to out-migration, some 42% of Caribbean nursing posts remain vacant.

Measures designed to increase the retention of health workers and to improve working conditions in public health services are important help to reduce shortages and improve distribution of the health workforce.

Another key challenge, particularly for the future, is to align training and education of health personnel with changing health needs, emphasizing models based on universal health coverage, equity and quality, and with increased interaction between training and educational institutions and health services.

PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.

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