Update on the MDGs: Where Are the Health Workers?
The UN’s Millennium Development Goals Report 2011 provides a fascinating snapshot of how far we’ve come in improving health outcomes—and how much further we need to go. Unfortunately, the report ignores the health workforce crisis in many of the countries struggling to meet their 2015 health goals. The MDGs cannot be achieved when large numbers of people lack access to a health worker, yet the persistent, severe shortage of health workers is paid scant attention in the recently released UN report.
A fundamental barrier to improving health is the health worker crisis. The report’s section on Goal 5 (Improve Maternal Health), for example, points out that far too many women are without access to a skilled birth attendant during delivery. While many regions have made progress, “coverage remains low in sub-Saharan Africa and Southern Asia, where the majority of maternal deaths occur.” 
Besides this unique mention of health workers’ role in saving lives, it’s hard to find any other significant reference to health workers in the UN report. And now is long past the time to draw attention to the consequences of the health worker shortage and to advocate for resources and the political will to address the crisis.
Five years ago the WHO identified 57 “crisis” countries with fewer than 2.3 doctors, nurses, and midwives per thousand people. Today all 57 countries are still below this threshold, and a 2010 WHO report states that these countries’ health worker shortages translate to an estimated one billion people with no access to essential health services.
As countries take steps to increase their health workforce, time isn’t on their side. Growing populations will require even more workers to provide minimum services. And it’s not just a question of increasing the number of health workers, but making sure they are equitably distributed, trained, and supported. Many health workers prefer to stay in urban areas, leaving the large rural populations with very limited access to primary health care.
The 2011 UN MDG report reflects the continued low visibility of this issue and represents a missed opportunity to put the health worker crisis front and center. The cost of inaction is too great. “We must make sure that promises made become promises kept,” writes UN Secretary-General Ban Ki-Moon. “The consequences of doing otherwise are profound: death, illness and despair, needless suffering, lost opportunities for millions upon millions of people.” Keeping this promise means keeping our commitment to mitigating the global health workforce crisis, not just in words but in action.
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