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A Special Report from the President
The Workforce Challenge: Thinking and Acting Globally
By Molly Seals, ASHHRA President 

It’s so easy to think of healthcare as merely a local issue. We have trained people who reside in our local communities, and they care for local residents. But the truth is, healthcare is interconnected around the world.

This fact was driven home for me in March when I had the privilege of representing ASHHRA at a global healthcare workforce conference entitled “A Call to Action: Ensuring Global Human Resources for Health,” held in Geneva, Switzerland. My time there helped me understand the truly global issues underlying the demand for healthcare that exist in our organizations, our communities, our country, and around the world. 

The conference—organized by the World Health Organization—brought together people from many nations to look past local and national boundaries and address the growing shortage of healthcare workers. It was designed to create support for an international network, build awareness of global healthcare issues, and provide an opportunity to share information. I am thrilled that ASHHRA was named one of the key sponsors of the event and that we provided evidence-based advice for healthcare policymakers and practitioners. 

The challenge of viewing healthcare from a global perspective is enormous. What difference does it make what happens in Ohio and Iowa to health services in Uganda or Pakistan? And how on earth if something changes in Iowa can that change the outcomes in Pakistan? But I left the conference in Geneva with the very firm belief that this shift in viewpoint is one we all must make.

The global healthcare workforce shortage is a multi-faceted problem, but there is one component of the crisis that is directly related to human resources management—the recruitment of health workers from other countries.


The “Brain Drain”

In 2000, three of the “Millennium Development Goals” adopted by the international community related to global health:

• A 66 percent reduction in infant and under-age-five deaths
• A 75 percent reduction in maternal deaths
• The halt and reverse of major epidemics including HIV/AIDS, tuberculosis, and malaria. 

Despite all the attention and billions of dollars invested to prevent the spread of HIV and other diseases in the world’s poorest countries, these efforts have yielded little success. Why?

Research shows that a significant contributing factor is an inadequate number of qualified health workers in the right place at the right time. Health workers are exiting these countries to work in the world’s richest nations, leaving the regions in the greatest need without the resources to reverse the disturbing trends related to these three goals (much less deliver other forms of basic health). This phenomenon has been labeled the “brain drain.”

The United States and United Kingdom lead the way in importing health workers. The United States employs over 50 percent of all English speaking doctors in the world. In the United Kingdom, more than 12,000 health workers were recruited from overseas in 2004 alone. In 2001, 600 of 1,000 pharmacists who graduated in South Africa migrated to other countries. In fact, a recent advertisement in USA Today appealed to pharmacists from South Africa to come and work in North America. 

Despite having the resources to do so, both the United States and United Kingdom have failed to produce enough medical and nursing staff to meet their healthcare demands. In this country, there is a projected deficit of 200,000 doctors and 800,000 nurses by 2020. While we find those numbers frightening, consider Mozambique—it has a population of 20 million people and only about 500 doctors.

A Call to Action

At ASHHRA, in the past couple of years, we have beckoned our members to view their roles as HR professionals more broadly. We have asked them to understand the critical impact they can have in producing the kind of outcomes their healthcare systems and communities need and then to implement programs and policies that drive their organizations to greater success.

I now call upon HR professionals to step up to an even bigger challenge—to integrate what we’ve learned and move beyond understanding the impact we currently have to understanding the impact we should have on improving the global healthcare system’s outcomes. 

For example, the shortage of skilled health workers has reached crisis level in many developing countries. The ability of health services to deliver care depends on the knowledge, skills, and motivation of health workers. Abundant research clearly shows that staffing affects quality and safety in outcomes. It stands to reason that inadequate staffing in developing countries plays a significant role in their growing health crises. Without enough skilled staff in the right place at the right time, health systems cannot function effectively, and populations are left without the treatment and support they need. 

The healthcare workforce shortage is diminishing the effectiveness of our health delivery systems locally, nationally, and globally.  If we believe we need to influence our organizations in every way possible to provide the best possible care for our community and patients, then we need to use our influence in every way possible to ensure our organizations view the shortage in the right context—as a global problem. 

What can an HR professional do?

• Seek more information and build your understanding of the global healthcare workforce shortage—what’s causing it and what you can do to influence change and ensure you are not causing harm. 

• Raise your voice and advocate within your own system and networks for ethical recruitment practices, ones that consider the delicate balance between meeting your needs while depleting world resources versus investing the necessary resources to dollars to “grow your own.” 

• Look for successful models of intervention (e.g., grow-your-own models, redesigned delivery models, creative health service worker models). 

• Advocate within your system for reciprocity or remittance when recruiting internationally—trade knowledge, skills, and delivery models or provide funding to support health infrastructures in countries suffering from “brain drain.”

• Assure effective support systems are in place that respect the knowledge, skill, and cultural differences of migrating workers. 

• Anticipate your workforce needs and develop workers to meet the demand. 

• Engage your heart, head, and hands in being a part of the solution, and ensure all solutions are team-based, multi-disciplinary, collaborative, transparent, and ethical.


I believe that, as HR leaders, we have a responsibility to help our organizations wrestle with the moral dilemmas involved in solving the healthcare workforce shortage. At ASHHRA, we encourage members to demonstrate community citizenship. My experience in Geneva reinforced something we all should take to heart—we live in an increasingly global community.


The Global Situation

Here are some sobering statistics:

• There are an estimated 100 million+ people working in healthcare worldwide, yet there is still a global shortage of at least 4 million workers.
• HIV infections rose from 36.2 million in 2003 to 38.6 million in 2005. 
• Sub-Saharan Africa has 11 percent of the world’s population and 24 percent of the global burden of disease, yet it has only 3 percent of the world’s health workers. 
• The global distribution of health workers per 1,000 people:  

North America 10.9  
Europe 10.4
Western Pacific 8.5
South & Central America 2.8
Middle East & North Africa 2.7
Asia 2.3
Sub-Saharan Africa 0.9
(Source: Joint Learning Initiative, 2004)


To learn more about the global healthcare workforce shortage, turn to these online publications and Internet sites:

• The New World of Global Health: www.science.mag.org
• February 2006 Bulletin of WHO: www.who.int/bulletin/volumes/84/2/3n/
• International Centre on Nurse Migration: www.intlnursemigration.org
• International Hospital Federation: www.ihf-publications.org