Assuming our global responsibility: improving working conditions for health care workers globally

HEALTH CARE SYSTEMS WORLDWIDE CONTINUE to be plagued by difficulties in recruiting and retaining health workers, resulting in a short­ age of health human resources that is now considered a global crisis.1,2 However, although the gap between the need for health care workers and the supply is experi­ enced globally, it widens disproportionately, so that the regions with the greatest need have the fewest workers: sub­Saharan Africa and southeast Asia together have 53% of the global disease burden but only 15% of the world’s health care workforce.3 Moreover, the shortage experienced by countries that can least afford it is ex­ acerbated by health worker migration to high­income countries. South Africa, for example, has fewer than 7 doctors per 10 000 people, but reported in 2002 that 14% of the physicians who had trained there had emig­ rated to the US or to Canada.4 And the problem is not going away:5 in the UK, US, Canada and Australia, 23% to 28% of all physicians are international graduates.6 Efforts to reduce migration usually focus on redu­ cing recruitment by high­income countries, and these ef­ forts are gaining a higher profile.7,8 Improving the working conditions in source countries has not received the same attention, however, even though this would help counter the factors that push health professionals to seek better conditions elsewhere. It would also make work healthier for those who remain, and thereby re­ duce work absenteeism, as well as occupational con­ cerns such as injuries, violence and stress, and exposure to biological, chemical and physical hazards. Although concerns about healthy work conditions exist to varying degrees around the world, they are greatest in nations with few resources, and particularly in Africa,9 where work conditions are the most challen­ ging. It is well documented that health workers in low­ and middle­income countries experience fear and frus­ tration when caring for patients with tuberculosis and blood­borne diseases, and that they do so often in diffi­ cult work environments10 and under the ever­present stigma associated with exposure.11 It is now also well es­ tablished that health workers are indeed at higher risk of acquiring numerous infectious diseases.12,13