Scaling Up Health Worker Production: The Bottlenecks and Best Buys Approach

February 2013

Kate Tulenko, Rebecca Bailey, and Richard Seifman, IntraHealth International

Health professional students in MaliOver one billion people worldwide lack access to essential health services (World Bank 2000). The only route to reaching better health outcomes is through health workers; there are no shortcuts or quick fixes. However, the World Health Organization (2006) estimates that there is a global shortage of approximately 4.3 million doctors, nurses, midwives, and support workers, and not enough health workers are being educated and trained to fill this gap—especially in Africa where the health needs are greatest.

Health professional schools include medical, dental, pharmacy, nursing, midwifery, and public health schools, as well as vocational training institutes for allied health professions. Worldwide, there are approximately 2,420 medical schools, 467 schools or departments of public health, and an indeterminate number of nursing institutions training about one million new health workers every year (Frenk et al. 2010). With additional gaps in training for dentists, pharmacists, and public health and allied health professionals, there are simply not enough schools to produce the numbers of health workers needed. Sub-Saharan African countries must nearly triple their current numbers by adding approximately one million workers, yet 26 of those countries have only one medical school or none at all (Mullan and Frehywot 2010).

Whether public or private, many health professional schools lack critical human and financial resources and do not perform as efficiently as they could, reducing the potential for increasing the quantity and quality of their graduates.

Some indicators of improved school performance and efficiency, which require varying levels of new investment and resources, include increased student enrollment; reduced student dropout rates; increased number and proportion of students from rural or underserved areas; increased proportion of students who take up positions in rural or underserved areas after graduation; increased number and proportion of students who pass the leaving/final exams and the local licensing or certification exams; and decreased unit cost of producing a graduate.

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