African Press Organization (APO)/ – Nearly a third of students in medicine and nursing in the developing countries do not have the intention to work in their own country after obtaining their diplomas, while less than a fifth of them have the intention to work in the rural areas where they are most needed, according to a new study.
The shortages of health care workers have been a major factor in the current epidemic of Ebola virus in West Africa. The disease has quickly spread first in the rural areas of three countries (Guinea, Sierra Leone and Liberia), where the number of health workers is very low.
The study, which is published in the Bulletin of the World Health Organization, provides new evidence to support the recommendations of the World Health Organization (WHO) relating to the recruitment and retention of health workers in the rural areas, including the admission of targeted students in medicine and nursing care of rural origin.
“Considerable investments have been made in recent years to develop the training of health personnel in low-income countries and middle-income countries”, said the main author of the study, Dr. David Silvestri of the Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, in the United States of America.
“Unfortunately, we have not paid sufficient attention to the recruitment of students most likely to work in the rural areas where the health needs are the most important. Accordingly, a significant proportion of these increased investments can be used to train people who aspire to only migrate after their training.”
From 2011 to 2012, Dr. Silvestri and his colleagues have interviewed 3199 students of first year and final year of medicine and nursing care enrolled in the 16 largest schools of medicine and nursing care managed by the government in 8 countries: Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, Tanzania and Zambia.
This study is important because it is a multinational study (where the data have been collected and analyzed in several different countries) who suggested, for the first time, that there would be a similar trend in the future career goals of students in medicine and nursing in the different countries and in several regions.
When they were interviewed on the place where they had the intention to work in the 5 years following their graduation, 28% of students surveyed were looking for a job abroad, whereas only 18% of students planned to choose a career in the rural areas.
“We found that students who had grown up in the rural areas were most likely the ones wanting to pursue a career in rural areas, and that they were the least likely to want to go abroad”, said Silvestri. “Our data suggest that the intentions of career of students can be identified before their registration, which means that the country could admit selectively the persons who would be most likely to work in areas where the needs are great.”
The seriousness of the shortage of health personnel in developing countries is a major obstacle to progress in world health, and has been identified for the first time by the World Health Report 2006: working together for health. The countries of sub-saharan Africa have on average 2 doctors and 11 nurses or midwives for 10,000 persons, against 30 doctors and 84 nurses or midwives in high-income countries, according to the World Bank.
To find a solution to the shortage and poor distribution of health workers in developing countries, WHO has created the Global Alliance for health personnel in 2006, a partnership dedicated to these issues. In 2010, the alliance has published the Global Code of Practice for the recruitment of health personnel at WHO, as well as recommendations for the recruitment and retention of health personnel in rural areas, titled Improving access to health personnel in rural and remote areas by improving retention.
Understanding the motivation of pupils to work in the rural areas and strengthening the rural orientation of health workers are two tasks that are part of a collaborative work standing between the WHO, the World Bank and the International Labor Organization.
The study is timely given that the Code of Practice of WHO global must be examined for the first time by the Executive Council in January 2015, and that its findings have political implications for the countries that are trying to put in place the universal coverage of health care, according to James Campbell, Director of the department of personal health at WHO headquarters and the Executive Director of the Global Health Workforce Alliance.
The retention of health personnel is essential in case of emergency – as we can observe in the current epidemic of Ebola virus in west Africa. We need to rethink some of the policies aimed at attracting the cream of the cream to train and prepare these students to work where they are most needed”, said Mr. Campbell.
“Without a reassessment of the teaching, of the deployment and the equitable distribution of health care workers, many health systems could be forced to provide little or more care for the rural populations”, concluded Mr. Campbell.
Photo Credit: Acoustimac
