Speaker after speaker at a World Health Organization-World Bank meeting that concluded today in Addis Ababa, Ethiopia drew attention to an emerging crisis of health manpower in Africa. The situation threatens to defeat the efforts of African governments, private health care providers, NGOs, and donors for health improvement. Training programs unsuited to changing health conditions, inadequate cooperation among the many parties concerned, and the losses of staff to opportunities outside Africa risk making Africa's health care facilities barely able to function for lack of qualified, motivated doctors, nurses and other health workers. This situation is made even worse by the AIDS epidemic, which reduces further the availability of trained health workers by staff deaths and increases the demand for care. These were the principal findings at a Consultative meeting on improving collaboration amongst health professionals, government and other stakeholders on health workers issues. The meeting opened on 29 January, with statements by the World Health Organization Regional Director for Africa, Dr Ebrahim Samba and His Excellency, Dr. Demmisse Tadesse, Vice Minister of Health of Ethiopia.

The Chairperson of the meeting, Honourable Dr. Marie Coll-Seck, Minister of Health of Senegal, told participants of her personal commitment to ensure that health labor force issues are high on the agenda of her Government. Dr. Samba explained that, while reliable data are extremely hard to obtain, preliminary information available to WHO suggests that there are tens of thousands of African doctors and nurses outside Africa, and more leaving every day, making it increasingly difficult to furnish patient care in African countries. He appealed to African Ministers of Health to take the initiative to address the issue with other members of their Governments, with professional associations of doctors, nurses and other health workers, with private sector health care providers, and with donor countries and institutions. Dr. Ok Pannenborg, Director of the World Bank's work on health in Africa, placed the problem of African doctors and nurses in the global context of an increasingly flexible labor market, which facilitates migration of high level African manpower to other countries. He noted that Uganda was making progress in addressing the problem, and stressed that each country had to find its own solutions. 

Meeting participants underscored that doctors, nurses and other health workers who provide patient care are the most important health system input. The consultative meeting found that health sector reform strategies have failed thus far to adequately address this critical health system component. The importance of forming new partnerships between Ministries of Education and Ministries of Health for the education of Africa's future doctors and nurses was stressed by numerous speakers. Action taken in this area by Senegal was highlighted. Appropriate policies and plans to address health workforce problems, such as in Botswana, exist in few African countries. Dramatic events such as the recruitment by a European country of an entire graduating nursing class in one African country exacerbate the problem of staff losses, and add a new sense of urgency. Indeed, without urgent action there is a risk that the moneys soon to be committed in Africa by the new Global Fund to combat AIDS, tuberculosis and malaria will not even have a serious possibility of achieving their goals. Participants at the WHO-World Bank consultation recognized that new funding initiatives such as debt relief through the HIPC (heavily indebted poor countries) program and the global HIV/TB/malaria fund, combined with heightened awareness of the issue amongst Africa's development partners, provide new opportunities to address the health manpower issues in all their various dimensions.

WHO, the World Bank, and other partners (including USAID and the Rockefeller Foundation) have agreed to establish a joint secretariat to support actions by African countries to address the health manpower crisis in Africa. Participants undertook to widen the dialogue on the issues at home, and identified individual, country-specific measures that they could take, including review of training curricula and establishing country-specific benchmarks for fairness in health reform. Decisions on specific actions and the execution of country-specific work programs will take place, with support from the joint secretariat, in the months ahead.

The joint consultative meeting was organized by WHO/AFRO and the World Bank, and co-sponsored by WHO/AFRO, the World Bank and UNESCO, with financial support from the Government of Norway. Participants came from 17 African countries - Algeria, Angola, Cameroon, Chad, Cote d'Ivoire, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Niger, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zimbabwe. Senior officials attended from ministries of health, higher education, labor, planning and finance - giving participants a unique opportunity for consultation across institutional barriers that are frequently difficult to bridge. Health educators were also prominent at the meeting, including deans of medical and nursing schools, and representatives of a wide range of professional and other non-government institutions.

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