High Income Countries

high income countries

British nurse Charlie McCulloch (centre) with Liberian nurses Rommina Yah and Watta Mamie Borbor. Charlie is one of a growing network of Health Worker Campaigners who are supported by Save the Children to advocate on behalf of health workers around the world. Credit: Cliff Hide/Save the Children.

Maintaining a sufficient number and mix of health workers is an issue for many high income countries, such as Australia, England (UK), France, Japan, Norway, Spain and the USA. For example, due to an ageing health workforce, the growth in demand and difficulty of recruiting faculty and students, the USA is predicting a shortage of 500,000 nurses and 44,000 family physicians in 2025. Australia projects a shortfall of 109,000 nurses by 2025 and the EU Commission has estimated that shortages across all member states will be around 2 million by 2020.

Australia England (UK) France Japan Norway Spain USA
Neonatal mortality rate  (per 1,000 live births) (2011) 3 3 2 1 2 3 4
Under-five mortality rate (per 1,000 live births) (2011) 5 5 4 3 3 4 8
Maternal mortality ratio (per 100,000 live births) (2010) 7 12 8 5 7 6 21
Number of doctors, nurses and midwives per 10,000 people (2010) 134.4 n/a 126.8 62.8 154.1 92.4 122.4
Births attended by skilled personnel (2009-2011) 99.1% n/a% 97.5% 99.8% 99% n/a% 99.4%
Total expenditure on health as a percentage of gross domestic product (2011) 9% 9.3% 11.6% 9.3% 9.1% 9.4% 17.9%
General government expenditure on health as a percentage of total expenditure on health (2011) 68.5% 82.7% 76.7% 80% 85.6% 73.6% 45.9%

A number of richer countries remain dependent on foreign workers to avoid health worker shortages. For example, in England up to 35% of registered physicians are foreign-trained. Health worker migration can worsen the shortage of qualified personnel in both low and middle income countries. To discourage the active recruitment of health personnel from developing countries facing critical shortages of health workers, the WHO Global Code of Practice on the International Recruitment of Health Personnel was adopted by the World Health Assembly in 2010. Ongoing efforts are required to ensure that all countries regularly report on their adherence to this Code.

Accessibility, acceptability and quality of care are also challenges for high income countries. They face similar challenges in recruiting and retaining health workers in more remote and rural areas. Even when well-established quality assurance mechanisms exist, examples of poor quality care are reported. Well-known problems such as high rates of nosocomial (hospital-acquired) infections, resulting mainly from poor handwashing habits of workers, still persist.

All countries need to take steps to build and maintain a health workforce that can translate the vision of UHC into improved health care for all people. High income countries also have a responsibility to support low and middle income countries, particularly those with the highest burdens of maternal, newborn and child mortality, to predict future workforce needs and develop and implement plans to meet these requirements. Many commitments to improve women’s and children’s health , eradicate infectious diseases and address the growing burden of non-communicable diseases all depend on strong health workforces.

High income countries must maintain their commitments to overseas development assistance (ODA) and redouble efforts to translate pledges on health and health workforces into action. In 2008, the G8 committed to “work towards increasing health workforce coverage towards the WHO threshold of 2.3 health workers per 1,000 people, initially in partnership with the African countries where we are currently engaged and that are experiencing a critical shortage of health workers.” Five years on, the G8 have conceded that progress towards this commitment has been “below expectations”.

Donor governments must ensure that ODA supports countries to reduce inequalities, strengthens health systems over the long term and follows principles of aid effectiveness.