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We must stop stealing doctors from the poor

By Peter Deutschmann - posted Thursday, 17 July 2008

The shortage of Australian-trained doctors and nurses is well documented. More than 10 per cent of our medical workforce is made up of foreign-trained doctors, mostly from Asia. At a time when the Government has committed to further strengthen health services for Aborigines, many of whom live in remote corners of the Northern Territory, this raises significant ethical issues. Where will these health professionals come from? Can we continue, with a clear conscience, to recruit trained doctors, nurses and midwives from the countries that need them more than we do?

At last week's G8 meeting in Japan, leaders of the most powerful nations of the world were joined by leaders from poorer African and Asian countries, including the Prime Minister of India. These countries have all been affected by migration of doctors and nurses who have helped prop up the Western world's health systems.

As well as meeting Australia's shortfall, India continues to supply much of the foreign-trained medical workforce recruited by Britain and the United States, where 30 per cent and 20 per cent respectively of that workforce is recruited from Asia and Africa.


The World Health Organisation estimates that the global shortfall of health workers is a staggering 4.3 million. It is no wonder that without enough doctors and nurses the poorest countries remain the sickest. This crisis is most apparent in the countries of sub-Saharan Africa and South Asia. Our continued failure to find local solutions to the health workforce needs of Australia sadly contributes to sustained poverty and illness in Africa and Asia, where the situation is far worse than that experienced in our rural and remote settings.

Recognising that the poorest countries are home to 4 per cent of the global health workforce but experience 25 per cent of the global burden of disease, WHO two years ago called on all nations to marshal resources to deal with this shortfall. India, for example, has recently responded and is setting up new public health institutes that will increase the meagre annual output of 400 public health graduates a year to 10,000 a year within the next 10 years.

Having benefited for so long from Asian expertise, Australia should now return the favour and provide much-needed assistance to support this effort and others like it.

As poorer nations begin to take action to plan and develop their own future workforces, there is much Australia can do to support this commitment. This is vital if this global emergency is to be solved within the next decade.

With increased funding being directed at diseases such as AIDS, malaria and TB, health experts now realise that a greater proportion of the available funds must be directed into training and retaining the health-care workforce where it is most needed.

There is reason for optimism. Buried beneath the major headline declarations and commitments by the G8 nations - such as those to combat climate change and provide emergency food aid - was a recommitment to the promises made at the Gleneagles G8 meeting of 2005 to double aid to Africa. The G8 pledged $60 billion over the next five years to fight infectious disease and strengthen health systems.


Of equal importance, the G8 will now begin to tackle a major constraint to the achievement of improved health in the poorest countries of Africa and Asia, namely the chronic health workforce shortage.

At the same time WHO has been asked to develop a code of practice regarding the ethical recruitment of health workers from developing nations by countries such as Australia.

Resolving the health workforce crisis is the key to accelerating progress to reach the health and development goals set by the United Nations. G8 host nation Japan has led the way by pledging to fund the training of 100,000 health workers in Africa over the next five years.

AusAID, the government agency responsible for the Australian aid program, is to be commended for recently increasing the number of scholarships available to graduates from poorer Asian countries to study in Australian institutions. But, in light of the call from WHO and the commitment of the G8, Australia can do far more. We will serve the people of Asia well if our effort is matched by a commitment to help build up strong training institutions in the countries from which our scholarship students come. We would do well to support the type of initiative recently undertaken in India.

Building on the decisions of the G8 nations, we should resolve to commit long-term finance for the development of the health workforce in countries of our region through greater support to the institutions that train doctors, nurses and midwives within the countries of Asia. In this way Australia can be part of the solution, rather than being part of the problem.

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First published in The Age on July 11, 2008.

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About the Author

Peter Deutschmann is associate director of the University of Melbourne's Nossal Institute for Global Health.

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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