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BMJ. 2007 October 27; 335(7625): 843.
PMCID: PMC2043435

Medical workforce gap in developing countries is set to worsen

Fiona Godlee, editor

The number of healthcare workers in sub-Saharan Africa will have to triple each year for 10 years if every person with HIV or AIDS is to get antiretroviral treatment, said researchers this week.

Their study, published in AIDS Patient Care and STDs (2007;21:799-812), was one of seven—including one in this week's BMJ (2007;335:862-5 doi: 10.1136/bmj.39345.467813.80)—selected for presentation at the launch at the US National Institutes of Health of the multi-journal global theme issue on poverty and human development.

The BMJ was among 235 journals from 37 countries that took part in the global theme issue, coordinated by the Council of Science Editors. They published more than 750 articles between them, representing 110 countries (see for a webcast and a link to a full list of citations on the council's website).

More than five million people who need antiretroviral treatment don't receive it, said one of the authors of the AIDS Patient Care and STDs study, Salal Humair, of Lahore University, Pakistan. Limited human resources to treat HIV and AIDS is one of the main constraints to achieving universal coverage, he said. He and his coauthors, Till Bärnighausen, of the University of KwaZulu-Natal, South Africa, and David Bloom, of the Harvard School of Public Health, estimate that antiretroviral treatment programmes in low and middle income countries currently lack 5000 to 10 000 doctors, 10 000 to 36 000 nurses, and 7000 to 21 000 pharmacists. However, the need for healthcare workers to administer treatment will increase as more and more people with HIV or AIDS survive. Even if no doctors emigrate, the authors estimate that sub-Saharan Africa alone will need 3000 extra doctors each year to treat people with HIV or AIDS.

Another study presented at the launch (American Journal of Public Health doi: 10.2105/AJPH.2006.095844) shows that the effect of medical emigration gets worse as developing countries get richer. Onyebuchi Arah and Uzor Ogbu, of the University of Amsterdam, and Chukwude Okeke, of the University of Nigeria Teaching Hospital, Enugu, found that, of the 141 countries that lost doctors to the four major migration destinations (United States, Canada, Australia, and the United Kingdom) between 2000 and 2004, those countries with more doctors per head of population and with better health and wealth status lost relatively more doctors. These countries are failing to benefit from their investment in medical human resources, said Dr Arah.

The World Health Organization's World Health Report 2006 says that the shortage of health workers is crippling nearly 60 countries around the world and that graduates from developing countries make up 25% of the healthcare workforce in destination countries.


Competing interest: FG's travel and accommodation to attend and chair the launch meeting were paid for by the Fogarty International Center of the US National Institutes of Health.

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