A community health worker is seen here registering patients at a rural health fair outside Thomonde, Haiti. Community health workers are critical at serving "last mile" healthcare needs and are typically deeply embedded in communities.
It is widely acknowledged that the developing world is in the midst of a healthcare personnel crisis. Even the citizens of middle-income countries that have begun to reap the rewards of increasing standards of living and the emergence of disposable incomes are finding that local health systems lack the healthcare personnel to provide adequate care. The World Health Organization estimates that 57 countries lack the health care personnel needed to reach health-related Millennium Development Goals. Even small increases in the ratio of healthcare workers to the general population correlate with substantial declines in maternal, infant, and child mortality.
Unfortunately, progress is not being made fast enough, and the primary problem is lack of infrastructure. The consulting firm McKinsey & Co. has modeled current workforce education capabilities and estimates that $33 billion and 300 new medical schools would be needed in sub-Saharan Africa alone to meet the continent’s workforce needs. Radical changes to the existing system of healthcare workforce education are needed if health systems are to meet the demands of a world in need of accessible and quality healthcare.
The current paradigm of health workforce education across much of the world involves a massive financial and social investment into the education of highly-skilled, upper-tier medical professionals that typically requires 5-10 years of higher education. However, in a number of developing countries, substantial healthcare services have been provided with less highly trained mid-level providers.
Having trained pharmacists available at dispensaries ensures that patients receiving proper counseling on the use of medications.
Changing the workforce shortage starts with changing the paradigm. New models of healthcare workforce education need to be tried that move away from the high-cost, state-run institutions currently being used. One alternative would be to begin offering private, market-based programs that provide a more flexible path to licensure as mid-level providers. These programs could use a modified version of distance education — already popular in the developing world — and take advantage to the expanding technical capabilities of mobile networks in these communities.
The biggest obstacle to experimenting with new workforce education strategies is the regulatory environment. Many governments in the developing world still find it difficult to license mid-level providers given their unusual place in the medical hierarchy and these governments’ lack of experience with such providers. Additionally, these novel education schemes would need to be accredited as well.
Given these regulatory hurdles, a “bottom-up” approach of market creation is unlikely to work for new education models. Hence, the workforce shortage issue is ultimately a policy problem. If one is able to leverage government policymakers, these new models of medical workforce training represent a great opportunity for addressing the biggest, least recognized problem affecting global health today.
Interested in learning more? See this proposal I previously prepared on how such market-based education solutions could be implemented given the risky regulatory environment.
Ira Leeds
Blue Oceans for Health 