The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

Approximate number of Washington, DC residents: 600,000

Population size of Ethiopia: 80.7 million

Ratio of doctors in Washington, DC to doctors in Ethiopia: 2:1

Number of countries the World Health Organization identified as having severe shortages of health workers: 57

Number of times quarterback Jay Cutler spoke the phrase “you know” during a televised interview within five minutes: 57

Vehicles recalled by Toyota in October 2009 for faulty floor mats: 4.3 million

Number of missing health workers in 57 severe shortage nations: 4.3 million

Of the 57 shortage nations, percentage of which are in Africa with severe health worker shortages: 69

Ratio of physicians to total Liberian population (2007): 1:21,000

Ratio of physicians to total U.S. population (2009): 1:386

Percent increase in number of health workers required to address African nation shortages: 140

Temperature in Celsius degrees for the boiling point of aspirin: 140

Additional health workers (doctors, nurses, midwives) required to alleviate severe health workers shortage in South East Asia region: 1.2 million

Minimum number of new health workers the US government has committed to train and help retain in the 2008 PEPFAR legislation: 140,000

Number of applications currently available for Apple’s new iPad: 140,000

Number of health workers in Africa the Japanese government has promised to train by 2013: 100,000

Amount of funding G8 nations have jointly agreed to commit to addressing the health worker shortage: $0

In meetings held with members of Congress in Washington, DC last week, PHR doctors briefed co-Chairs from the House Commission on Human Rights, Congressional Women’s Caucus and Congressional Caucus on Sudan on the urgent health, food and security needs in Camp Farchana. The camp was the site of PHR’s 2008 investigation into the impact of sexual violence on survivors of the Darfur conflict (see the report here), which found high levels of malnourishment, lack of healthcare, insufficient sanitation and lack of protection for women and girls in the face of daily risk of attack.

The food security issues and the health needs are closely linked — and an integrated strategy between UN agencies and aid organizations on the ground is desperately needed — on both sides of the Sudan/Chad border. Although the World Food Program (WFP) target caloric intake of 2,100 kilocalories is formally being provided to the refugees by WFP rations, the type and quantities of food apparently are seriously inadequate.

WFP rations consist of only five items (sorghum, oil, salt, sugar, corn-soy blend) and the sorghum rations are distributed in an un-ground form, which means that the refugees themselves have to pay the cost of grinding the grain.

The lack of milk, meat or vegetables has consequences for the health needs of refugees, particularly vulnerable groups like children and pregnant women. Even where fortunate refugees receive the target caloric intake, they don’t receive sufficient nutrients because of the limited diet.

We must commit to reducing child malnutrition by providing milk and meat to pregnant women and children. PHR has been working to encouraging UN agencies to coordinate sufficiently so that refugees themselves can be involved in the solution to this issue.

Currently, women are forced to sell their meager sorghum rations for milk or meat, travelling to a local market where they receive a vastly reduced price for their sorghum due to market saturation. However, if UN peacekeepers would provide protection for women and girls outside the camps, they could collect the necessary hay and water and raise livestock around the camp. This would give them a supply of milk and meat to add to their diet, and also provide them with the opportunity to provide for their family’s livelihood.

In his briefing yesterday, Abdur Rab also mentioned that international donors need to increase their support for fragile health services in Sudan, with special attention to secondary and tertiary care centres. Next week PHR will be doing more work on the issue of Sexual and Gender-based Violence (SGV) programming, and the need to provide emergency assistance for injuries, documentation of injuries, access to HIV/AIDS prophylactic treatment, pregnancy testing, psychological and social support — none of which are currently being provided to women and girls in Darfur.