All posts by Steven J D'Ascanio

Partners in Health: a Sustainable Model for Decreasing Health Disparities

Sub-Saharan Africa is currently facing one of the highest global burdens of disease, while maintaining the world’s smallest percentage of healthcare workers. This statistic, illustrated by the graph released in the World Health Organization’s 2006 Report (Figure 2), highlights the endemic lack of health care workers across the Sub-Saharan landscape. The World Health Organization’s recommended ratio of 2.3 health professionals for every 1000 persons seems an impossibly far cry from the Sub-Saharan norm highlighted by Rwanda’s ration of 0.72 health professionals for every 1000 persons (Cancedda 2014). What has lead to this huge deficit of health workers in the developing world and what has been done to fix it? Current work has focused primarily on confronting the burden of disease that has swept through developing nations, but what about addressing the heart of the issue? Setting up a sustainable system to fight the problem in the future is just as if not more important than attacking current health issues. This disparity in health workers has been attributed in part to the “Brain Drain”, or the migration of graduates from higher education, specifically health workers, from developing nations to developed nations in order to seek better opportunities.

Paul Farmer and his organization Partners in Health have illustrated the great work that foreign aid groups can do in aiding nations during crises, however there is little these organizations can do in order to prevent crises. There must be a shift in global health thinking from responsive to preventative, and the best way to accomplish this is by making health care more readily available. The easiest way to create a sustainable system of preventative care is by increasing the number of native health workers. However, to increase local health workers, one must slow the “brain drain” that is pulling these workers away from their countries. Factors that cause this migration of workers have been organized into Push and Pull Factors. Push factors are characterized by strong reasons to leave a country of residence like; limited career opportunities and poor working conditions, whereas Pull factors are those that incentivize movement to another country like; recruitment and better wages (Kissick). This drive to leave Sub-Saharan Africa is best characterized in Figure 3, which shows the percentage of health workers intending to migrate for better opportunities. This statistic is higher than 50% in most nations, and the reason why is clear from Figure 4 which shows the average monthly wages for health workers in developing versus developed nations. Kissick points out that the United Nations Universal Declaration of Human Rights states “Everyone has the right to leave any country, including his own, and to return to his country.” Making the point that in order to stop this migration you cannot ban it, but rather incentivize staying so that health workers will not choose to migrate.

How can Developing Nations incentivize their health workers in order to make them want to stay? Higher wages are one idea, but because of the economic situation in many developing nations it is not a valid option. Creating a sense of national pride and the want to stay and help build up your nation is another idea, however one would think this already would have worked if it was ever going to. The responsibility for stopping this migration might not fall on the nations losing their workers at all, but rather on the nations that are recruiting them away. Whichever of these if any are the right answer is not yet known, but what is for certain is that this problem needs to be fixed, or else the health disparities already present around the world will just become more exaggerated.



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Discussion Questions:

  1. How would you incentivize health workers to keep them from migrating from developing nations?


  1. Create a policy that would still allow Health Workers to move internationally, but would keep developed nations from stealing these workers away from developing nations.



Cancedda, Corrado. “Enhancing Formal Educational and In-Service Training Programs in Rural Rwanda A Partnership Among the Public Sector, a Nongovernmental Organization, and Academia.” Academic medicine 89, no. 8 (August 2014): 1117-.


Fink, Sheri. “Pattern of Safety Lapses Where Group Worked to Battle Ebola Outbreak.” The New York Times (Apr 2015).


The “Brain Drain”: Migration of Healthcare Workers out of sub-Saharan Africa

Kasey Kissick


Figures Sources

Connell, J, P Zurn, B Stilwell, M Awases, and J Braichet. “Sub-Saharan Africa: beyond the health worker migration crisis?” Social Science & Medicine 64 (2007): 1876-91.


World Health Organization. “Working Together for Health: World Health Report 2006.” 2006.


Vujicic, M, P Zurn, K Diallo, O Adams, and MR Dal Poz. “The role of wages in the migration of health care professionals from developing countries.” Human Resources for Health 2 (2004).