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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 67.
PMCID: PMC1914482

Donor countries should ensure donated funds reach health workers

Half of all money donated to poor countries should be spent on public services to enable recipient countries to pay healthcare workers, the United Kingdom's international development minister Gareth Thomas has said.

His comments came at the first meeting of the all party parliamentary group on AIDS, tuberculosis, and malaria and soon after the launch of a report from the African Medical and Research Foundation that sets out recommendations for the UK and other donor and African countries to tackle the serious shortage of health workers.

The report cites estimates of a worldwide shortage of 4.2 million health workers. This is most severe in sub-Saharan Africa, where HIV, malaria, and tuberculosis are most prevalent. The shortage has been made worse because of migration and decades of underinvestment in health systems and healthcare workers, the report says.

“Health workers in developing countries are often very badly paid, they often don't have the medicines or the equipment that they need to do the job they have been trained for and you can imagine the scale of the demands placed on them because there are fewer and fewer of them,” Mr Thomas said. “Between a third and a half of doctors leave Uganda, Zambia, and Ghana in search of a better life.”

He also acknowledged the part the UK had played in the shortage and emphasised the need for health authorities to abide by the NHS code of conduct for recruiting professionals from poor countries.

“We as a donor community need to provide more aid. We also need to give that aid in a better way. We need to help developing countries put comprehensive health plans together,” Mr Thomas added.

But Daraus Bukenya, the foundation's director for community partnering for health, cautioned that UK and other donor governments need to work in association with African governments to tackle the problem. Although the governments of the UK and other donor countries should lead on delivering funding, the development of services must be led and owned by African governments.

A key recommendation of the report is that African governments should commit 15% of national budgets to health, as agreed in Abuja, in Nigeria, in 2001.

But according to Dr Bukenya only half of the African governments have reached that target. He also said that rural areas were the worst hit by shortages among healthcare workers because facilities tended to be concentrated in urban areas, and the skills of healthcare professionals do not always match actual health needs.

To tackle this, the report recommends increasing the number of workers with basic clinical and community health competencies—for example, enrolled nurses and clinical officers at community level. It also suggests more investment in the use of community health workers through the provision of training, supervision, incentives, and links to formal healthcare professionals.


The report, People first: African solutions to the health worker crisis, is available at

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