Global Health Policy
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July 05, 2007
Africans Need Doctors, But They Need Health Even More
Posted by Michael Clemens at 02:26 PM
Mozambique's Minister of Health Dr. Paulo Ivo Garrido is worried about the shortage of doctors in his country. He recently declared that "The main problem in the Ministry of Health is the shortage of [medical] staff. We need specialized doctors, not just general practitioners." He has a plan to encourage the migration of 8,000 doctors from other African countries into Mozambique over the next decade. Minister Garrido's colleagues in health ministries across his continent will not be happy with this plan, since nearly all are fighting the emigration of doctors from their countries. They will likely complain that Mozambique is aggravating the "main problem" in their own ministries.
But let's take a step back. I spent a couple of days at the Ministry of Health in Mozambique last year, and I met many smart and dedicated people working there in frustrating conditions. I believe Minister Garrido’s claim that a shortage of highly-trained staff could be a large problem for the ministry. But is this the "main problem" for health in Mozambique?
If we want to know what additional specialist physicians would do in Mozambique, the best guide is not what we wish they would do, but what those currently on the ground are doing. They are working hard and doing good, but they are not reaching the vast majority of the population. In the latest available figures (p. 67), 77% of specialist physicians in Mozambique lived and worked in the capital city of Maputo - more than 1,000 miles from the impoverished northern reaches of the country. There is no reason at all to believe that the marginal specialist physician added to the country would tend primarily to reach the least-served populations.
What's going on out in those villages in remote Niassa and Tete? The "main problem" for them is not lack of access to specialist physicians, it's that they lack access to any kind of modern preventive or primary care medicine, whatsoever. The Mozambique Demographic and Health Survey from 2003 shows that only 48% of births in the country are assisted by any kind of doctor, nurse, or midwife, and just 51% of children under age 5 who had an acute respiratory infection in the two weeks prior to the survey were taken to a modern health professional. Even allowing for changes over time in who uses the health system, this still suggests that around 40% of Mozambique’s 20 million people aren’t being reached at all by even the most minimal prevention or care.
What would be your and your children's most pressing health concerns if you had never once seen a doctor or nurse? The World Health Organization says that, tragically, around 60% of child death in Mozambique is due to diarrhea, malaria, and respiratory infections unrelated to HIV. The prevention, diagnosis, and treatment of these conditions are relatively easy matters that simply do not require specialist physicians, or any kind of physician for that matter. And that's just on the care side, setting aside prevention entirely: Much of this awful toll is linked to the fact that only a quarter of Mozambique's rural population has a safe source of drinking water and only a fifth has a way to keep their own excrement from contaminating the local water source.
By what sophisticated analysis was it determined that the "main problem" in Mozambique is a lack of specialist physicians? I don't suggest for a moment that Mozambique doesn't need, doesn't deserve, or shouldn't acquire more physicians. The country needs, deserves, and should acquire more doctors. But Mozambicans also deserve not to have to watch their loved ones die, and it is not at all obvious that the number one priority in that fight is the acquisition of more highly-trained physicians. The same question arises, to differing degrees, in various countries across Africa.
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Comments
I AGREE WITH YOU. I THINK PUBLIC HEALTH EDUCATION, HYGIENE AND PROVISION OF CLEAN WATER WILL GO A LONG WAY. WORLD HEALTH NEED TO FOCUS ON THESE ISSUES FIRST BEFORE APPROACHING ISSUES OF SPECIALISTS. I THINK THE PROBLEM WITH MOST MINISTRY OF HEALTH IS THAT THEY VIEW SITUATION FROM A PHYSICIAN POINT OF VIEW NOT FROM A PUBLIC HEALTH OFFICIAL VIEW. I THINK IF THEY UTILIZE SOME FUNDS TO REALLY TRAIN PERSONNEL AS AN EXTENSION OF NURSING PROGRAM OR COMMUNITY HEALTH IT WILL HELP PROMOTE PREVENTION RATHER THAN CURE IN SOME OF THESE RURAL AREAS OF AFRICA.
I HAVE SEEN THAT MANY PEOPLE HAVE CONCERNS FOR UNDEVELOPED NATIONS ESPECIALLY CHILDREN, BUT IT MIGHT BE BETTER FOR YOU TO REALLY FIND OUT WHAT THE NEEDS ARE RATHER THAN GOING IN AFTER SPENDING LARGE FUNDS ON WHAT YOU THINK THEY NEED. IT COULD BE A SIMPLE THING IN THE LONG RUN.THANK YOU FOR YOUR TIME.
Posted by: JOSEPHINE at July 14, 2007 02:44 PM
An interesting discussion began July 16 on community based health care with experts, Mushtaque Chowdhury of BRAC in Bangladesh and Frank Nyonator of the Ministry of Health in Ghana. Please go to the web site of the Health Systems Action Network (www.hsanet.org) to read comments and questions and to post responses.
Posted by: Rena Eichler at July 17, 2007 03:12 PM