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The past century has seen the most spectacular medical breakthroughs in human history, but these advances are of little value without qualified health workers putting them into practice.

Unfortunately, a steady exodus of doctors, nurses and other health workers from developing countries to higher-paying jobs abroad has created a health workforce crisis. The resulting shortage of health workers in the developing world comes at a time when traditional diseases, such as malaria and tuberculosis, are combining with modern lifestyle-related diseases, such as diabetes and heart disease, to place an unprecedented strain on health-care systems. Add to this burden a wave of newly emerging threats such as avian influenza, and the day may not be too far off when the quality of healthcare will be jeopardized in many countries.

This critical shortage of doctors, nurses, midwives and other health workers takes its greatest toll on the poorest and most vulnerable populations. In the World Health Organization's (WHO) Southeast Asia and Western Pacific Regions, for instance, more than 5,000 children under the age of 28 days die every day. Many of those infants would survive if skilled attendants were on hand during childbirth. Yet, only 43 percent of births in India and 60 percent of births in the Philippines take place with the assistance of a health worker.

Many health workers from poorer countries are being pulled away by the lure of bigger pay cheques and better working conditions in wealthier nations. In fact, about one-quarter of all licensed physicians in Australia, Canada, the United Kingdom and the United States are from the developing world, with India, the Philippines and Pakistan providing most of them. In effect, developing countries are providing a reverse subsidy, in which the costs of the global mobility of health workers are being shouldered by poorer source countries, while the benefits are concentrated in wealthier recipient countries. The result: Asia has about three health workers for every 1,000 people, less than one-10th of the ratio in North America.

The effects of unfettered migration can be devastating. The Philippines loses more than 15,000 nurses annually, more than any other country. Many of them are among the country's best-educated and most-experienced nurses, leaving a critical shortage of qualified specialty nurses. Some doctors in the Philippines are training for higher-paying nursing jobs in the United States.

The shortage of doctors, nurses and health workers in the developing world is made worse by imbalances within many countries, where there might be a sufficient number of doctors and nurses in cities but too few in the countryside.

Health workers are not just the cornerstone of health systems. By improving the quality of life of others, they enable them to be fuller members of society. In countries with inadequate number of health workers, national productivity suffers and the fabric of society is weakened. But policy-makers often overlook the needs of these unsung heroes. Decades of budget cuts and under-investment have created the crisis we now face.

What can be done? First, we need to pay health workers reasonable salaries. While it is true that the kinds of pay increases that can be offered in developing countries won't close the gap with salaries elsewhere, paying decent wages and paying them on time will go a long way towards convincing doctors, nurses and other health workers that their contribution to society is recognized.

Second, we need better non-financial incentives. In fact, we need a comprehensive package of reforms to address working conditions, transport, housing, opportunities for career advancement, and the education of family members.

Third, governments need to seek creative solutions. In Mongolia, where the average health worker earns only US$40 a month, scholarships are being offered to medical students willing to return and work in rural areas for at least three years. Thailand has found that training staff with a locally focused curriculum encourages retention in rural areas and a drop in migration.

Finally, there needs to be better international co-operation. Wealthier nations must increase investment in the education and training of health professionals to meet their own domestic needs. They also need to target some of their development aid to programs that will help expand the health workforce in poorer countries. And they need to work with ministries of health, training institutions and other relevant national authorities to avoid claims of "poaching" and other unethical recruiting practices. A code of ethics is being developed by WHO and its partners to ensure transparency and fairness in the international recruitment of health workers.

Surveys of migrating workers show that the vast majority would prefer to work in their home countries as long as the conditions are right, which generally means improved wages and working conditions.

The WHO is using World Health Day 2006 (which falls today) to announce a new Alliance for Human Resources. It's an effort to ensure that we do all we can to retain the doctors, nurses and other health workers the developing world needs to ensure good health for all.

The author is the World Health Organization's Regional Director for the Western Pacific.

(China Daily April 7, 2006)