1. Health Workers and the Millennium Development Goals (MDGs). .
Health Workers and the Millennium Development Goals (MDGs)
Dr. Mirta Roses Periago Director
The UN and You: Making a Difference Together. GWU. Washington, D.C., October 2006.

2. MILLENNIUN DEVELOPMENT GOALS (MDGs)
THE HIGHEST LEVEL OF POLITICAL CONSENSUS ON THE MEASURES TO COMBAT POVERTY 1 2
HEALTH’S IMPORTANCE GIVES IT A KEY ROLE IN DEVELOPMENT
Why are the MDGs important?
Commitment to Action
QUANTIFIABLE AND AMBITIOUS GOALS AND INDICATORS TO MEASURE ADVANCEMENT AND DEMAND PROGRESS 3
BY DIFFERENTIATING BETWEEN THE AVAILABLE AND THE NECESSARY IT IS POSSIBLE TO CALCULATE ACHIEVEMENT COSTS 4
A GLOBAL PARTNERSHIP FOR DEVELOPMENT THAT EMPHASIZES THAT GLOBAL SECURITY AND PROSPERITY ARE RELIANT ON A MORE EQUITABLE WORLD. 5

3. MILLENNIUM DEVELOPMENT GOALS (MDGs)
1. Halve extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce under-five mortality rate by two thirds
5. Reduce maternal mortality by three quarters
6. Reverse the spread of diseases, especially HIV/AIDS and malaria
7. Ensure environmental sustainability
8. Create a global partnership for development
Skilled Health Personnel is critical to achieve these goals

4. Overview of progress towards the Goals
The region is on track to meet the targets for:
Reducing hunger
Reducing under nutrition among children
Reducing infant mortality
Access to drinking water
Gender equity in education
The region has not made enough progress towards the
targets concerning:
Extreme poverty (adverse pattern: countries with
higher poverty rates have advanced less)
Maternal mortality
Universal primary education
Access to sanitation
Environmental sustainability
The Shortage of Health Workers
The Millennium Development Goals: A Latin American and Caribbean Perspective
United Nations/ECLAC

5. Mortality rate for children under five years of age in 2003 and 2004
Latin America and the Caribbean (20 countries): Mortality of children under 5 in 2003 and progress since 1990
Source: World Population Prospects, The 2004 revision, calculations by ECLAC
Progress since 1990
Source: PAHO Core Health Data System
Mortality rate for children under five years of age in 2003 and 2004
Progress since 1990
ON THE RIGHT TRACK
Expected progress: 52%
In the period the region made significant strides in improving the health of its population, particularly children’s health as is demonstrated by the substantial reduction seen in all the child mortality indicators and the resultant increase in life expectancy at birth. In Latin America and The Caribbean, infant mortality has fallen faster than any where else in the world, and in 2003 it was lower in Latin America and the Caribbean than in any other developing region.
Percentages
Percentages progress
Source: PAHO Core Health Data System
Fuente: World Population Prospects. The 2004 revision

6. Maternal mortality ratio, 2003/2004
Latin America and the Caribbean (7 countries with data available): Maternal mortality ratio in and progress since 1990
Maternal mortality ratio, 2003/2004
Progress since 1990
Maternal mortality, and morbidity associated with its determinants, is a major public health problem that highlights some of the most severe inequities in living conditions and reflects the health status of women of reproductive age, their access to health services and the quality of the care they receive, including access to contraception.
Ratio per 100,000 live births
Percentage progress
Source: PAHO Core Health Data System

7. Relationship between mortality and health workers density

8. Mortality in selected groups of countries in LAC by density levels of Human Resources for Health
Source: PAHO/WHO Basic Indicators 2006
Source: PAHO/WHO Basic Indicators 2006

9. Percentages of Skilled Care at Delivery
Percentages of Births Attended by Trained Personnel Selected Countries of the Americas, c 2000
Percentages of Skilled Care at Delivery
LAC average:87.9%

10. Health Workers and the MDGs
The shortage of health workers in many places is among the most significant constraints to achieving the millennium development goals Health Workers shortage has replaced finance issues as the most serious obstacle to implementing national treatment plans Achieving the MDGs will depend on finding effective human resources approaches that can implement rapidly.
Source: WHO World Health Report 2006

11. Constraints Inadequate numbers and skills of health workers
Uneven distribution of workers at different levels of service delivery, from national program officers to health facility personnel
Inappropriate or inadequate training, with curricula that are not needs-based
Poor access to information and knowledge resources
Source: WHO World Health Report 2006

12. Human Resource for Health by WHO Regions 1995-2004

13. Percentage of the Population assisted by doctors & nurses, 37 & 36 countries of Latin America and the Caribbean c. 2001
Nurses
Doctors
More than 50 nurses
2000 patients per doctor
20-49 nurses per
Fewer than 5 physicians per
per 10,000: 2%
10,000: 0.4%
10,000: 0.1%
Less than 5 nurses
per 10,000: 17%
5-14 physicians per 10,000:
More than 30 physicians per
10,000: 9.6%
27.6%
More than 2000 patients
per nurse
Nurses
15-29 physicians per 10,000:
62.6%
5-19 nurses per
Between 526 & 2000 patients per nurse
10,000: 81%
Between 667 & 345 patients per doctor
A Call to Action TOWARD A DECADE OF Human Resources for Helath in the Americas ( )
VII Regional Meeting of HR Observatories in Toronto,
4-7 Oct 2005

14. The Toronto Call to Action
Five Challenges:
Develop HHR plans and policies
that respond to health needs of population
Place the right people in the right places
Regulate migration (internal and external)
of health workers
Generate labor relationships that promote safe and healthy work environments and foster institutional commitment
Develop links between health services and academia
I would now like to present the main elements that make up the theoretical framework on which our project is based. There are 5 elements; which are:
The five challenges that were identified in the Toronto Call to Action
The values on which these challenges are based
The 10-year plans that have been developed by the countries
The concept of leadership which we are using for our analysis
The country context
Although the challenges and problems to solve in the area of human resources for health are many, the countries agreed to group them into five critical challenges and to focus their efforts over the next decade on them.
The challenges are:
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15. In the Region of the Americas
In 2000, over 163 million people in the Americas resided in areas where the human resources density was below the minimum target of 25 per 10,000
In the 15 countries where the health human resources density ratio is below 25, it would take approximately 128,000 additional doctors and nurses to reach that level

16. In the Region of the Americas
With respect to the 6 countries with the lowest densities, it would require almost 23,000 doctors and nurses to raise the ratio to the mid-point between the current 8,3 and the target of 25
Physician supply in urban areas is 8 to 10 times higher than it is in rural areas
Nurses outnumber doctors 3 to 1 in North America, but doctors outnumber nurses 3 to 1 in many Latin American countries

17. In the Region of the Americas
Roughly three quarters of the countries and territories of the Americas have experienced a net loss with respect to migration of their health human resources
Haiti, with the lowest physician to population ratio in the Americas, has a physician migration rate almost 12 times higher than Cuba, with one of the highest ratios in the world
The gap between countries with high and low densities of health workers continues to grow

18. Exit Routes from the Health Workforce
Source: WHO World Health Report 2006

19. Migration Not just brain drain…
Migration takes place within countries (rural to urban) Within regions (From poorer to better off countries)
However…
When large of numbers of doctors and nurses leave the countries that finance their education, they lose a return on their investment and end-up providing wealthy countries with a “perverse subsidy”
When a country has a fragile health system, the loss of its health workforce can bring the whole system close to collapse and the consequences can be measured in lives lost.
Each year migration generates billions of dollars in remittances and has therefore been associated with a decline in poverty in low income countries.
If the health workers return, they bring significant skills and expertise to their home countries
In this context the calculus of international migration shifts from “brain drain” to “fatal flows”

20. “The Call to Action aims to mobilize institutional actors, both national and international, of the health sector and other relevant sectors and civil society, to collectively strengthen the human resources for health through policies and interventions, in order to achieve the Millennium Development Goals and according to the national health priorities to provide access to quality health services for all the peoples of the Americas by the year 2015”

21. Human Resources for Health: a global public health issue