The health workforce bottleneck: one major threat on implementing

health reforms in LAC

Andre MediciInter American Development Bank

Why has health workforce been a threat on implementing health reforms in LAC?

• Quantitative imbalanced

• Qualitative unskilled and unprepared

• Ethically unset and politically incorrect

• Economically unequal and underpaid

• Institutionally undervalued

• Professionally shortened

Percapita Income and nurses per doctor: The Americas 1999

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All Spanish Speakers Countries and Brazil

Quantitative imbalanced

Some examples…

• Argentina: physicians per capita 10 times higher in Buenos Aires compared to Tierra del Fuego;

• Paraguay: nurse per capita ratio in Asunción is about 5 times higher than for the rest of the country;

• Uruguay: Montevideo has 45% of the population but 80% of the country’s physicians;

• Brazil: medical doctors make up 66% of health professionals;

• Dominican Republic: eight doctors for every nurse

Challenges to multilateral institutions. Helping countries on…

• Creating information and evaluation systems to measure imbalances in workforce;

• Setting up HHR needs and promoting better health personnel distribution;

• Working with communities: professionalizing massive health workforce at local levels;

• Planning HHR integrated with the Health Planning Process;• Paying fairly health personnel; valorizing HHR institutionally;

using adequate incentives and offering long term perspectives ;

• Setting up medical and health schools to new ethical and social standards;

• Empowering communities to face the threat of health unions.

HHR in IDB

• Key point in the Health Strategy 2005;• Improving health skills by vocational training (PROFAE

and PSF-BR);• Promoting short term training in public health and

primary care in specific areas linked with the MDGs (PDLs);

• Promoting changes in the curricula of medical schools to revert the curative trend and include public health and health management;

• Increasing health knowledge on small communities and promoting health workforce training at local level